The relationship between disease activity and depressivesymptoms severity and optimism—results from the IMPROVED study
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To assess depressive symptoms severity and dispositional optimism in patients with recent onset arthritis both before and after 4 months treatment. Two hundred twenty-two patients with recent onset RA and undifferentiated arthritis in the IMPROVED study filled out the Beck Depression Inventory (BDI-II) to assess depressive symptoms severity and the Life Orientation Test Revised (LOT-R) to measure optimism before and after 4 months of treatment. All patients were treated with methotrexate 25 mg/week and prednisone 60 mg/day (tapered to 7.5 mg/day in 7 weeks). Linear regression analysis was used to assess the association between the disease activity score (DAS) and its components (tender joint count, general well-being measured with a visual analogue scale (VAS), swollen joint count, and erythrocyte sedimentation rate) with the BDI-II an LOT-R scores. In general, depressive symptoms were mild. The DAS was an independent predictor of depressive symptoms scores both at baseline and after 4 months follow-up, in particular tender joint count and VAS global health. Disease activity was not associated with the level of optimism. Nevertheless, patients who achieved clinical remission improved significantly more in both depression score and optimism score than patients who did not. Patients with early arthritis report improvement in depressive symptoms and optimism with improvement in disease activity and achieving clinical remission. Depression scores are associated with pain and unwell being but not with swollen joint counts and inflammatory parameters.
KeywordsDepressive symptoms severity Disease activity Methotrexate Optimism Prednisone Rheumatoid arthritis
We would like to thank all patients as well as the following rheumatologists (other than the authors) who participated in the IMPROVED study group (registered in the ISRCTN register number 11916566 and the EudraCT number 2006-006186-16) (all locations are in The Netherlands): W.M. de Beus (Medical Center Haaglanden, Leidschendam), C. Bijkerk (Reinier de Graaf Gasthuis, Delft), M.H.W. de Bois (Medical Center Haaglanden, The Hague), M. de Buck (Medical Center Haaglanden, Leidschendam), G. Collée (Medical Center Haaglanden, The Hague), J.A.P.M. Ewals (Haga Hospital, The Hague), R.J. Goekoop (Haga Hospital, The Hague), Y.P.M. Goekoop-Ruiterman (Haga Hospital, The Hague), B.A.M. Grillet (Zorgsaam, Terneuzen), J.H.L.M. van Groenendael (Franciscus Hospital, Roosendaal), L.R. Lard (Medical Center Haaglanden, Leidschendam), E.T.H. Molenaar (Groene Hart Hospital, Gouda), A.J. Peeters (Reinier de Graaf Gasthuis, Delft), N. Riyazi (Haga hospital, The Hague), A.A. Schouffoer (Groene Hart Hospital, Gouda), P.E.H. Seys (Lievensberg hospital, Bergen op Zoom), P.B.J. de Sonnaville (Oosterschelde Hospital, Goes), I. Speyer (Bronovo Hospital, The Hague), and M.L. Westedt (Bronovo Hospital, The Hague). We would also like to thank all other rheumatologists and trainee rheumatologists who enrolled patients in this study and all research nurses for their contributions.
The study was designed by the investigators and financially supported by Abbott. Data collection, trial management, data analyses, and preparation of the manuscript were performed by the authors.
Dr Huizinga and Allaart received speaker fees from various companies, each less than $5,000 per year. The other authors have disclosed no conflicts of interest.
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