Treating Depression Could Control Early Inflammatory Polyarthritis

Patients with early inflammatory polyarthritis and rheumatoid arthritis experience more psychological problems, such as depression, than healthy populations. Studies have shown that depression affects 42 percent of patients with rheumatoid arthritis, which is two to three times greater than the general population. The biological processes that connect depression with early inflammatory polyarthritis and rheumatoid arthritis are not thoroughly understood. Doctors know that when rheumatoid arthritis is in remission, depressive symptoms tend to lift. Now, a new study published in the July 25 issue of Rheumatology, makes a case for diagnosing and controlling depressive symptoms in patients with early inflammatory polyarthritis in an effort to alter the course of disease outcomes. 

 Depressive symptoms in treated-to-target arthritis patients were the best available biomarker to predict follow-up simple disease activity index. Treat-to-target strategies should include means to detect and address persistent depression in treated inflammatory arthritis. Source:  RheumatologyThe study is based on an evaluation of 275 patients with early inflammatory polyarthritis (EPA) who were recruited at four months (on average) post diagnosis. At 42 months, researchers evaluated RA disease status using the Simple Disease Activity Index (SDAI). Depression was measured with the Center for Epidemiologic Studies Depression Scale (CES-D). [[{"type":"media","view_mode":"media_crop","fid":"40763","attributes":{"alt":"","class":"media-image media-image-left","id":"media_crop_2764811313245","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"4222","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"font-size: 13.0080003738403px; line-height: 1.538em; float: left;","title":" ","typeof":"foaf:Image"}}]]The findings:  Patients with 12-month high CES-D (519; suggestive of depression) had a lower proportion of disease (SDAI) remission (31.3% vs 84.3%; P<0.001) and reached remission less rapidly [hazard ratio = 0.25 (95% CI 0.12, 0.53); P<0.001]. Researchers found that patients who were depressed at 12 months after diagnosis, were strongly associated with a delay and failure to reach remission. In fact, having high depressive scores at 12 months decreased - from 84.3% to 31.3% - the proportion of patients who reached remission. “The finding that higher CES-D scores are associated with increased SDAI scores and decreased remission rates suggests the importance of detecting depression early, in order to be able to treat it properly,” wrote the authors of the study, which was led by Gilles Boire, of the Centre Hospitalier Universitaire de Sherbrooke in Que´ bec. “Depression aggravates the functional consequences of RA by increasing work disability and even mortality. Unfortunately, RA patients are rarely assessed for depression, despite its high prevalence.” Boire and colleagues recommend that patients with early inflammatory polyarthritis be evaluated for depression and treated accordingly in order to improve patient outcomes. “Clinicians should be aware that depression during the first year of disease is associated with prolonged time to remission and decreased rates of remission, even in the favorable context of early diagnosis and treat-to-target approaches using the best pharmacological treatments of arthritis currently available,” researchers wrote. RELATED COVERAGE ON RHEUMATOLOGY NETWORK 

• Psychosocial Risk Factors Lead to Cardiovascular Disease in RA 
• Fatigue, Common in RA, Traced to Factors Beyond Inflammation
• Depression and Autoimmunity: The Biological Connection 
• Arthritis, Anxiety, and Depression: Managing a Common Comorbidity

References:

Leblanc-Trudeau1 C, Dobkin P, Carrier N, Cossette P, deBrum-Fernandes A, et al. Depressive symptoms predict future simple disease activity index scores and simple disease activity index remission in a prospective cohort of patients with early inflammatory polyarthritis. Rheumatology. July 25, 2015. doi:10.1093/rheumatology/kev272