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Clinical Rheumatology

, Volume 32, Issue 12, pp 1751–1757 | Cite as

The relationship between disease activity and depressivesymptoms severity and optimism—results from the IMPROVED study

  • L. Heimans
  • K. V. C. Wevers-de Boer
  • K. Visser
  • H. K. Ronday
  • G. M. Steup-Beekman
  • M. van Oosterhout
  • T. W. J. Huizinga
  • E. J. Giltay
  • R. C. van der Mast
  • C. F. Allaart
Original Article

Abstract

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.

Keywords

Depressive symptoms severity Disease activity Methotrexate Optimism Prednisone Rheumatoid arthritis 

Notes

Acknowledgments

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.

Funding

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.

Disclosures

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.

References

  1. 1.
    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
  2. 2.
    Covic T, Tyson G, Spencer D, Howe G (2006) Depression in rheumatoid arthritis patients: demographic, clinical, and psychological predictors. J Psychosom Res 60:469–476PubMedCrossRefGoogle Scholar
  3. 3.
    Kekow J, Moots R, Khandker R, Melin J, Freundlich B, Singh A (2011) Improvements in patient-reported outcomes, symptoms of depression and anxiety, and their association with clinical remission among patients with moderate-to-severe active early rheumatoid arthritis. Rheumatology (Oxford) 50:401–409CrossRefGoogle Scholar
  4. 4.
    Pincus T, Griffith J, Pearce S, Isenberg D (1996) Prevalence of self-reported depression in patients with rheumatoid arthritis. Br J Rheumatol 35:879–883PubMedCrossRefGoogle Scholar
  5. 5.
    O’Brien SM, Scott LV, Dinan TG (2004) Cytokines: abnormalities in major depression and implications for pharmacological treatment. Hum Psychopharmacol 19:397–403PubMedCrossRefGoogle Scholar
  6. 6.
    Maes M, Bosmans E, De Jongh R, Kenis G, Vandoolaeghe E, Neels H (1997) Increased serum IL-6 and IL-1 receptor antagonist concentrations in major depression and treatment resistant depression. Cytokine 9:853–858PubMedCrossRefGoogle Scholar
  7. 7.
    Da Silva JA, Jacobs JW, Kirwan JR, Boers M, Saag KG, Ines LB et al (2006) Safety of low dose glucocorticoid treatment in rheumatoid arthritis: published evidence and prospective trial data. Ann Rheum Dis 65:285–293PubMedCrossRefGoogle Scholar
  8. 8.
    Fietta P, Fietta P, Delsante G (2009) Central nervous system effects of natural and synthetic glucocorticoids. Psychiatr Clin Neurosci 63:613–622CrossRefGoogle Scholar
  9. 9.
    Huscher D, Thiele K, Gromnica-Ihle E, Hein G, Demary W, Dreher R et al (2009) Dose-related patterns of glucocorticoid-induced side effects. Ann Rheum Dis 68:1119–1124PubMedCrossRefGoogle Scholar
  10. 10.
    Brown ES (2009) Effects of glucocorticoids on mood, memory, and the hippocampus. Treatment and preventive therapy. Ann N Y Acad Sci 1179:41–55PubMedCrossRefGoogle Scholar
  11. 11.
    Scheier MF, Carver CS (1985) Optimism, coping, and health: assessment and implications of generalized outcome expectancies. Health Psychol 4:219–247PubMedCrossRefGoogle Scholar
  12. 12.
    Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO III et al (2010) 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League against rheumatism collaborative initiative. Ann Rheum Dis 69:1580–1588PubMedCrossRefGoogle Scholar
  13. 13.
    Siegert CE, Vleming LJ, Vandenbroucke JP, Cats A (1984) Measurement of disability in Dutch rheumatoid arthritis patients. Clin Rheumatol 3:305–309PubMedCrossRefGoogle Scholar
  14. 14.
    Beck A (2002) BDI-II-NL: De nederlandse versie van de Beck depression inventory 2nd edGoogle Scholar
  15. 15.
    Scheier MF, Carver CS, Bridges MW (1994) Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): a reevaluation of the life orientation test. J Pers Soc Psychol 67:1063–1078PubMedCrossRefGoogle Scholar
  16. 16.
    van de Rest O, de Goede J, Sytsma F, Oude Griep LM, Geleijnse JM, Kromhout D et al (2010) Association of n-3 long-chain PUFA and fish intake with depressive symptoms and low dispositional optimism in older subjects with a history of myocardial infarction. Br J Nutr 103:1381–1387PubMedCrossRefGoogle Scholar
  17. 17.
    Zenger M, Glaesmer H, Hockel M, Hinz A (2011) Pessimism predicts anxiety, depression and quality of life in female cancer patients. Jpn J Clin Oncol 41:87–94PubMedCrossRefGoogle Scholar
  18. 18.
    Prevoo ML, van Gestel AM, van’t Hof M, van Rijswijk MH, van de Putte LB, van Riel PL (1996) Remission in a prospective study of patients with rheumatoid arthritis. American Rheumatism Association preliminary remission criteria in relation to the disease activity score. Br J Rheumatol 35:1101–1105PubMedCrossRefGoogle Scholar
  19. 19.
    Margaretten M, Julian L, Katz P, Yelin E (2011) Depression in patients with rheumatoid arthritis: description, causes and mechanisms. Int J Clin Rheumtol 6:617–623PubMedCrossRefGoogle Scholar
  20. 20.
    Ryerson CJ, Arean PA, Berkeley J, Carrieri-Kohlman VL, Pantilat SZ, Landefeld CS et al (2012) Depression is a common and chronic comorbidity in patients with interstitial lung disease. Respirology 17:525–532PubMedCrossRefGoogle Scholar
  21. 21.
    Spiegel D, Sands S, Koopman C (1994) Pain and depression in patients with cancer. Cancer 74:2570–2578PubMedCrossRefGoogle Scholar
  22. 22.
    Brown GK, Nicassio PM, Wallston KA (1989) Pain coping strategies and depression in rheumatoid arthritis. J Consult Clin Psychol 57:652–657PubMedCrossRefGoogle Scholar
  23. 23.
    Wrosch C, Scheier MF (2003) Personality and quality of life: the importance of optimism and goal adjustment. Qual Life Res 12(Suppl 1):59–72PubMedCrossRefGoogle Scholar
  24. 24.
    Geers AL, Wellman JA, Helfer SG, Fowler SL, France CR (2008) Dispositional optimism and thoughts of well-being determine sensitivity to an experimental pain task. Ann Behav Med 36:304–313PubMedCrossRefGoogle Scholar
  25. 25.
    Kurtz ME, Kurtz JC, Given CW, Given BA (2008) Patient optimism and mastery-do they play a role in cancer patients' management of pain and fatigue? J Pain Symptom Manage 36:1–10PubMedCrossRefGoogle Scholar
  26. 26.
    Fournier M, De Ridder D, Bensing J (2002) Optimism and adaptation to chronic disease: the role of optimism in relation to self-care options of type 1 diabetes mellitus, rheumatoid arthritis and multiple sclerosis. Br J Health Psychol 7:409–432PubMedCrossRefGoogle Scholar
  27. 27.
    McBain H, Shipley M, Newman S (2012) The impact of appearance concerns on depression and anxiety in rheumatoid arthritis. Muscoskel CareGoogle Scholar
  28. 28.
    van Hoogmoed D, Fransen J, Bleijenberg G, van Riel P (2010) Physical and psychosocial correlates of severe fatigue in rheumatoid arthritis. Rheumatology (Oxford) 49:1294–1302CrossRefGoogle Scholar

Copyright information

© Clinical Rheumatology 2013

Authors and Affiliations

  • L. Heimans
    • 1
  • K. V. C. Wevers-de Boer
    • 1
  • K. Visser
    • 1
  • H. K. Ronday
    • 2
  • G. M. Steup-Beekman
    • 3
  • M. van Oosterhout
    • 4
  • T. W. J. Huizinga
    • 1
  • E. J. Giltay
    • 5
  • R. C. van der Mast
    • 5
  • C. F. Allaart
    • 1
  1. 1.Department of RheumatologyLeiden University Medical CenterLeidenThe Netherlands
  2. 2.Department of RheumatologyHaga HospitalThe HagueNetherlands
  3. 3.Department of RheumatologyBronovo HospitalThe HagueNetherlands
  4. 4.Department of RheumatologyGroene Hart HospitalGoudaNetherlands
  5. 5.Department of PsychiatryLeiden University Medical CenterLeidenNetherlands

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