Clinical Rheumatology

, Volume 26, Issue 6, pp 872–878 | Cite as

Anxiety and depression in patients with rheumatoid arthritis

  • Ahmet Isik
  • Suleyman Serdar KocaEmail author
  • Abdullah Ozturk
  • Osman Mermi
Original Article


Rheumatoid arthritis (RA) mostly follows a painful, progressively disabling course, and individuals with RA experience more psychological distress than healthy individuals. The objective of the present study is to examine the prevalences of accompanying anxiety and depression in RA cases. The study included 82 RA cases and 41 age- and sex-matched healthy volunteers as the control group. Psychiatric examinations of all cases of the patient and control groups were performed according to DSM-IV criteria. Hamilton Anxiety Scale or Hamilton Depression Scale was applied to those who were found to have anxiety or depression. Total prevalence of anxiety, depression, and mixed anxiety-depressive disorder was found to be 70.8% (n=58) in the patient group and 7.3% (n=3) in the control group, and the difference was significant (p<0.001). Of the RA patients, 41.5% (n=34) was found to have depression, 13.4% (n=11) anxiety, and 15.9% (n=13) mixed anxiety-depressive disorder. The disease duration in patients with anxiety was shorter than the RA patient with depression (p<0.05). The disease duration was positively correlated with the degree of depression and negatively correlated with the degree of anxiety (r=0.341, p<0.05; r=−0.642, p<0.05, respectively). The results of our study suggest that prevalences of anxiety and mainly depression, increase in RA cases. When the clinical picture in RA cases becomes complicated with anxiety or depression, some problems at patients’ adaptation and response to treatment may be possible. RA cases should be monitored for accompanying anxiety or depression during follow-up.


Anxiety Depression Rheumatoid arthritis 



We thank Murad Atmaca M.D. of the Department of Psychiatry for his contributions.


  1. 1.
    Barlow JH, Cullen LA, Rowe IF (1999) Comparison of knowledge and psychological well-being between patients with a short disease duration (<or=1 year) and patients with more established rheumatoid arthritis (>or=10 years duration). Patient Educ Couns 38(3):195–203PubMedCrossRefGoogle Scholar
  2. 2.
    Anderson KO, Bradley LA, Young LD, McDaniel LK, Wise CM (1985) Rheumatoid arthritis: review of psychological factors related to etiology, effects and treatment. Psychol Bull 98:357–358CrossRefGoogle Scholar
  3. 3.
    Eberhardt K, Larsson BM, Nived K (1993) Psychological reactions in patients with early rheumatoid arthritis. Patient Educ Couns 20:93–100PubMedCrossRefGoogle Scholar
  4. 4.
    Sharpe L, Sensky T, Allard S (2001) The course of depression in recent onset rheumatoid arthritis: the predictive role of disability, illness perceptions, pain and coping. J Psychosom Res 51(6):713–719PubMedCrossRefGoogle Scholar
  5. 5.
    Katz PP, Yelin EH (1993) Prevalence and correlates of depressive symptoms among persons with rheumatoid arthritis. J Rheumatol 20:790–796PubMedGoogle Scholar
  6. 6.
    VanDyke MM, Parker JC, Smarr KL, Hewett JE, Johnson GE, Slaughter JR, Walker SE (2004) Anxiety in rheumatoid arthritis. Arthritis Rheum 51(3):408–412PubMedCrossRefGoogle Scholar
  7. 7.
    Hawley DJ, Wolfe F (1988) Anxiety and depression in patients with rheumatoid arthritis: a prospective study of 400 patients. J Rheumatol 15:932–940PubMedGoogle Scholar
  8. 8.
    El-Miedany YM, El-Rasheed AH (2002) Is anxiety a more common disorder than depression in rheumatoid arthritis? Jt Bone Spine 69:300–306CrossRefGoogle Scholar
  9. 9.
    Parker JC, Smarr KL, Slaughter JR, Johnston SK, Priesmeyer ML, Hanson KD et al (2003) Management of depression in rheumatoid arthritis: a combined pharmacologic and cognitive-behavioral approach. Arthritis Rheum 49(6):766–777PubMedCrossRefGoogle Scholar
  10. 10.
    Wells KB, Stewart A, Hays RD, Burnam MA, Rogers W, Daniels M et al (1989) The functioning and well-being of depressed patients. Results from the medical outcomes study. JAMA 262(7):914–919PubMedCrossRefGoogle Scholar
  11. 11.
    Bradley LA, Young LD, Anderson KO, McDaniel LK, Turner RA, Agudelo CA (1984) Psychological approaches to the management of arthritis pain. Soc Sci Med 19:1353–1360PubMedCrossRefGoogle Scholar
  12. 12.
    Chandarana PC, Eals M, Steingart AB, Bellamy N, Allen S (1987) The detection of psychiatric morbidity and associated factors in patients with rheumatoid arthritis. Can J Psychiatry 32:356–361PubMedGoogle Scholar
  13. 13.
    Treharne GJ, Kitas GD, Lyons AC, Booth DA (2005) Well-being in rheumatoid arthritis: the effects of disease duration and psychosocial factors. J Health Psychol 10(3):457–474PubMedCrossRefGoogle Scholar
  14. 14.
    Wittchen HU, Kessler RC, Pfister H, Lieb M (2000) Why do people with anxiety disorders become depressed? A prospective-longitudinal community study. Acta Psychiatr Scand Suppl 406:14–23PubMedCrossRefGoogle Scholar
  15. 15.
    Alloy LB, Kelly KA, Mineka S, Clements CM (1990) Comorbidity of anxiety and depressive disorders: a helplessness–hopelessness perspective. In: Maser JD, Cloniger CR (eds) Comorbidity of mood and anxiety disorders. American Psychiatric, Washington, DC, pp 499–543Google Scholar
  16. 16.
    Young LD (1992) Psychological factors in rheumatoid arthritis. J Consult Clin Psychol 60:619–627PubMedCrossRefGoogle Scholar
  17. 17.
    Sharpe L, Sensky T, Timberlake N, Ryan B, Brewin CR, Allard S (2001) A blind, randomized, controlled trial of cognitive-behavioural intervention for patients with recent onset rheumatoid arthritis: preventing psychological and physical morbidity. Pain 89:275–283PubMedCrossRefGoogle Scholar
  18. 18.
    Parker JC, Smarr KL, Buckelew SP, Stucky-Ropp RC, Hewett JE, Johnson JC et al (1995) Effects of stress management on clinical outcomes in rheumatoid arthritis. Arthritis Rheum 38:1807–1818PubMedCrossRefGoogle Scholar
  19. 19.
    Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS et al (1988) The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 31:315–324PubMedCrossRefGoogle Scholar
  20. 20.
    America Psychiatric Association. DSM-IV: Diagnostic and Statistical manual of mental disorders, 4th edn. Washington, DC, 1994Google Scholar
  21. 21.
    Hamilton M (1959) The assessment of anxiety states by rating. Br J Med Psychol 32:50–55PubMedGoogle Scholar
  22. 22.
    Hamilton M (1960) A rating scale for depression. J Neurol Neurosurg Psychiatry 23:56–62PubMedCrossRefGoogle Scholar
  23. 23.
    Dickens C, Mcgowan L, Clark-Carter D, Creed F (2002) Depression in rheumatoid arthritis: a systematic review of the literature with meta-analysis. Psychosom Med 64:52–60PubMedGoogle Scholar
  24. 24.
    Zautra AJ, Smith BW (2001) Depression and reactivity to stress in older women with rheumatoid arthritis and osteoarthritis. Psychosom Med 63:687–696PubMedGoogle Scholar
  25. 25.
    Newman SP, Fitzpatrick R, Lamb R, Shipley M (1989) The origins of depressed mood in rheumatoid arthritis. J Rheumatol 16:740–744PubMedGoogle Scholar
  26. 26.
    Murphy S, Creed FH, Jayson MIV (1988) Psychiatric disorders and illness behaviour in rheumatoid arthritis. Br J Rheumatol 27:357–363PubMedCrossRefGoogle Scholar
  27. 27.
    Katz PP, Yelin EH (1995) The development of depressive symptoms among women with rheumatoid arthritis. Arthritis Rheum 38:49–56PubMedCrossRefGoogle Scholar
  28. 28.
    Pilowsky I (1993) Dimensions of illness behaviour as measured by the illness behaviour questionnaire. J Psychosom Res 37:53–62PubMedCrossRefGoogle Scholar
  29. 29.
    Brown GK, Nicassio PM, Wallston KA (1989) Pain coping strategies and depression in rheumatoid arthritis. J Consult Clin Psychol 57:652–657PubMedCrossRefGoogle Scholar
  30. 30.
    Hurwicz ML, Berkanovic E (1993) The stress process in rheumatoid arthritis. J Rheumatol 20:1836–1844PubMedGoogle Scholar
  31. 31.
    Evers AW, Kraaimaat FW, Geenen R, Jacobs JW, Bijlsma JW (2002) Longterm predictors of anxiety and depressed mood in early rheumatoid arthritis: a 3 and 5 year followup. J Rheumatol 29(11):2327–2336PubMedGoogle Scholar
  32. 32.
    Pincus T, Callahan LF (1993) Depression scales in rheumatoid arthritis: criterion contamination in interpretation of patient responses. Patient Educ Couns 20(2–3):133–143PubMedCrossRefGoogle Scholar
  33. 33.
    Maes M, Meltzer H, Bosmans E, Bergmans R, Vandoolaeghe E, Rajan R et al (1995) Increased plasma concentrations of interleukin-6, soluble interleukin-6 receptor, soluble interleukin-2 receptor and transferrin receptor in major depression. J Affect Disord 34:301–309PubMedCrossRefGoogle Scholar
  34. 34.
    Dunn AJ, Wang J, Ando T (1999) Effects of cytokines on cerebral neurotransmission. Comparison with the effects of stress. In: Dantzer R, Wollman EE, Yirmiya R (eds) Cytokines, stress and depression. Academic/Plenum, New York, pp 117–127Google Scholar
  35. 35.
    Bonaccorso S, Puzella A, Marino V, Pasquini M, Biondi M, Artini M et al (2001) Immunotherapy with interferon-alpha in patients affected by chronic hepatitis C induces an intercorrelated stimulation of the cytokine network and an increase in depressive and anxiety symptoms. Psychiatry Res 105(1–2):45–55PubMedCrossRefGoogle Scholar
  36. 36.
    de Vries E, Schipperijn AJ, Breedveld FC (1994) Antinuclear antibodies in psychiatric patients. Acta Psychiatr Scand 89(4):289–290PubMedGoogle Scholar
  37. 37.
    Legros S, Mendlewicz J, Wybran J (1985) Immunoglobulins, autoantibodies and other serum protein fractions in psychiatric disorders. Eur Arch Psychiatry Neurol Sci 235:9–11PubMedCrossRefGoogle Scholar
  38. 38.
    Ahokas A (1986) Immunoglobulin and C3 abnormalities in acute psychiatric disorders. Acta Psychiatr Scand 74:542–547PubMedGoogle Scholar
  39. 39.
    DeLisi LE, King AC, Targum S (1984) Serum immunoglobulin concentrations in patients admitted to an acute psychiatric in-patient service. Br J Psychiatry 145:661–665PubMedCrossRefGoogle Scholar
  40. 40.
    Balaita C, Iscrulescu C, Sarbulescu A (1992) Serum immunoglobulin levels in schizoaffective disorders (manic and depressive). Rom J Neurol Psychiatry 30:63–71PubMedGoogle Scholar
  41. 41.
    Sane AS, Chawla MS, Chokshi SA, Mathur V, Barad DP, Shah VC, Patel MJ (1990) Serum immunoglobulin status of psychiatric in-patients. Panminerva Med 32:88–91PubMedGoogle Scholar
  42. 42.
    Herbert TB, Cohen S (1993) Depression and immunity: a meta-analytic review. Psychol Bull 113(3):472–486PubMedCrossRefGoogle Scholar
  43. 43.
    Irwin M (2002) Psychonueroimmunology of depression: clinical implications. Brain Behav Immun 16:1–16PubMedCrossRefGoogle Scholar
  44. 44.
    Spivak B, Radwan M, Bartur P, Mester R, Weizman A (1995) Antinuclear autoantibodies in chronic schizophrenia. Acta Psychiatr Scand 92:266–269PubMedGoogle Scholar
  45. 45.
    Wolfe F, Cathey MA, Kleinheksel SM, Amos SP, Hoffman RG, Young DY, Hawley DJ (1984) Psychological status in primary fibrositis and fibrositis associated with rheumatoid arthritis. J Rheumatol 11:500–506PubMedGoogle Scholar
  46. 46.
    Crotty M, McFarlane AC, Brooks PM, Hopper JL, Bieri D, Taylor SJ (1994) The psychosocial and clinical status of younger women with early rheumatoid arthritis: a longitudinal study with frequent measures. Br J Rheumatol 33(8):754–760PubMedCrossRefGoogle Scholar
  47. 47.
    Bradley LA, Young LD, Anderson KO, Turner RA, Agudelo CA, McDaniel LK et al (1987) Effects of psychological therapy on pain behaviour of rheumatoid arthritis patients. Arthritis Rheum 30:1105–1115PubMedCrossRefGoogle Scholar
  48. 48.
    Klein JF (1992) Adverse psychiatric effects of systemic glucocorticoid therapy. Am Fam Phys 46(5):1469–1474Google Scholar
  49. 49.
    Jiang HK, Chang DM (1999) Non-steroidal anti-inflammatory drugs with adverse psychiatric reactions: five case reports. Clin Rheumatol 18(4):339–345PubMedCrossRefGoogle Scholar
  50. 50.
    Jacobs JW, Geenen R, Evers AW, van Jaarsveld CH, Kraaimaat FW, Bijlsma JW (2001) Short term effects of corticosteroid pulse treatment on disease activity and the wellbeing of patients with active rheumatoid arthritis. Ann Rheum Dis 60(1):61–64PubMedCrossRefGoogle Scholar

Copyright information

© Clinical Rheumatology 2006

Authors and Affiliations

  • Ahmet Isik
    • 1
  • Suleyman Serdar Koca
    • 1
    • 3
    Email author
  • Abdullah Ozturk
    • 1
  • Osman Mermi
    • 2
  1. 1.Faculty of Medicine, Department of RheumatologyFirat UniversityElazigTurkey
  2. 2.Faculty of Medicine, Department of PsychiatryFirat UniversityElazigTurkey
  3. 3.Firat UniversityElazigTurkey

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