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Temporal associations between the different domains of rheumatoid arthritis disease activity and the onset of patient-reported depressive symptoms

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Abstract

Background

Depression is a frequently occurring comorbid condition in patients with rheumatoid arthritis (RA), and research into the temporal relationships regarding its onset has mainly focused on functional status. The study aim was to examine temporal associations of the diverse measures of RA disease activity with incident self-reports of depressive symptoms.

Methods

RA patients from the Consortium of Rheumatology Researchers of North America (CORRONA) registry were utilized. Cox regression was used to assess the lagged time-varying association of RA disease activity with the incident onset of depressive symptoms as measured using a single-item depression question. Predictor variables included joint counts, global assessments, pain, function, serum biomarkers, and composite disease activity. Hazard ratios (HRs) comparing categorical quintiles were estimated with 95 % confidence intervals.

Results

Every metric of disease activity, except inflammatory markers, were significantly associated with the self-reported onset of depressive symptoms. Adjusted HRs comparing fifth quintiles to first quintiles were the following: CDAI = 2.3 [2.1–2.7]; pain = 2.3 [2.0–2.6]; SJC = 1.4 [1.4–1.6]. When examining successive self-reports (two consecutive), the magnitude of the associations greatly increased: CDAI = 3.6 [2.5–5.0].

Conclusions

The data suggest depressive symptom onset in RA patients is related to measures reported by the patient: pain, functional status, and global disease activity; and measures reported by providers, rather than biological markers. The magnitude of the associations, however, were greater for the patient-reported measures when compared to physician assessments, implying that patients’ experience of their disease activity may be a precipitating factor of depression onset.

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References

  1. Lok EY, Mok CC, Cheng CW, Cheung EF (2010) Prevalence and determinants of psychiatric disorders in patients with rheumatoid arthritis. Psychosomatics 51:338–338.e8

    Article  PubMed  Google Scholar 

  2. Uguz F, Akman C, Kucuksarac S, Tufekci O (2009) Anti-tumor necrosis factor-alpha therapy is associated with less frequent mood and anxiety disorders in patients with rheumatoid arthritis. Psychiatry Clin Neurosci 63:50–55

    Article  CAS  PubMed  Google Scholar 

  3. Abdel-Nasser AM, Abd El-Azim S, Taal E, El-Badawy SA, Rasker JJ, Valkenburg HA (1998) Depression and depressive symptoms in rheumatoid arthritis patients: an analysis of their occurrence and determinants. Br J Rheumatol 37:391–397

    Article  CAS  PubMed  Google Scholar 

  4. Frank RG, Beck NC, Parker JC, Kashani JH, Elliott TR, Haut AE, Smith E, Atwood C, Brownlee-Duffeck M, Kay DR (1988) Depression in rheumatoid arthritis. J Rheumatol 15:920–925

    CAS  PubMed  Google Scholar 

  5. Joyce AT, Smith P, Khandker R, Melin JM, Singh A (2009) Hidden cost of rheumatoid arthritis (RA): estimating cost of comorbid cardiovascular disease and depression among patients with RA. J Rheumatol 36:743–752

    Article  PubMed  Google Scholar 

  6. Lowe B, Willand L, Eich W, Zipfel S, Ho AD, Herzog W, Fiehn C (2004) Psychiatric comorbidity and work disability in patients with inflammatory rheumatic diseases. Psychosom Med 66:395–402

    PubMed  Google Scholar 

  7. Ang D, Choi H, Kroenke K, Wolfe F (2005) Comorbid depression is an independent risk factor for mortality in patients with rheumatoid arthritis. J Rheumatol 32:1013–1019

    PubMed  Google Scholar 

  8. Scherrer JF, Virgo KS, Zeringue A, Bucholz KK, Jacob T, Johnson RG, True WR, Carney RM, Freedland KE, Xian H, Caplan L, McDonald J, Eisen SA (2009) Depression increases risk of incident myocardial infarction among Veterans Administration patients with rheumatoid arthritis. Gen Hosp Psychiatry 31:353–359

    Article  PubMed  Google Scholar 

  9. Sleath B, Chewning B, de Vellis BM, Weinberger M, de Vellis RF, Tudor G, Beard A (2008) Communication about depression during rheumatoid arthritis patient visits. Arthritis Rheum 59:186–191

    Article  PubMed  Google Scholar 

  10. Kahn KL, MacLean CH, Liu H, Rubenstein LZ, Wong AL, Harker JO, Chen WP, Fitzpatrick DM, Bulpitt KJ, Traina SB, Mittman BS, Hahn BH, Paulus HE (2007) The complexity of care for patients with rheumatoid arthritis: metrics for better understanding chronic disease care. Med Care 45:55–65

    Article  PubMed  Google Scholar 

  11. Sheehy C, Murphy E, Barry M (2006) Depression in rheumatoid arthritis—underscoring the problem. Rheumatology (Oxford) 45:1325–1327

    Article  CAS  Google Scholar 

  12. Iwata M, Ota KT, Duman RS (2013) The inflammasome: pathways linking psychological stress, depression, and systemic illnesses. Brain Behav Immun 31:105–114

    Article  CAS  PubMed  Google Scholar 

  13. Ruscio AM, Seitchik AE, Gentes EL, Jones JD, Hallion LS (2011) Perseverative thought: a robust predictor of response to emotional challenge in generalized anxiety disorder and major depressive disorder. Behav Res Ther 49:867–874

    Article  PubMed Central  PubMed  Google Scholar 

  14. Maes M (2011) Depression is an inflammatory disease, but cell-mediated immune activation is the key component of depression. Prog Neuropsychopharmacol Biol Psychiatry 35:664–675

    Article  CAS  PubMed  Google Scholar 

  15. Kojima M, Kojima T, Suzuki S, Oguchi T, Oba M, Tsuchiya H, Sugiura F, Kanayama Y, Furukawa TA, Tokudome S, Ishiguro N (2009) Depression, inflammation, and pain in patients with rheumatoid arthritis. Arthritis Rheum 61:1018–1024

    Article  PubMed  Google Scholar 

  16. Godha D, Shi L, Mavronicolas H (2010) Association between tendency towards depression and severity of rheumatoid arthritis from a national representative sample: the Medical Expenditure Panel Survey. Curr Med Res Opin 26:1685–1690

    Article  PubMed  Google Scholar 

  17. Isik A, Koca SS, Ozturk A, Mermi O (2007) Anxiety and depression in patients with rheumatoid arthritis. Clin Rheumatol 26:872–878

    Article  PubMed  Google Scholar 

  18. Sinclair VG, Wallston KA (2010) Psychological vulnerability predicts increases in depressive symptoms in individuals with rheumatoid arthritis. Nurs Res 59:140–146

    Article  PubMed  Google Scholar 

  19. Doeglas DM, Suurmeijer TP, van den Heuvel WJ, Krol B, van Rijswijk MH, van Leeuwen MA, Sanderman R (2004) Functional ability, social support, and depression in rheumatoid arthritis. Qual Life Res 13:1053–1065

    Article  CAS  PubMed  Google Scholar 

  20. Neugebauer A, Katz PP, Pasch LA (2003) Effect of valued activity disability, social comparisons, and satisfaction with ability on depressive symptoms in rheumatoid arthritis. Health Psychol 22:253–262

    Article  PubMed  Google Scholar 

  21. Katz PP, Neugebauer A (2001) Does satisfaction with abilities mediate the relationship between the impact of rheumatoid arthritis on valued activities and depressive symptoms? Arthritis Rheum 45:263–269

    Article  CAS  PubMed  Google Scholar 

  22. 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 51:713–719

    Article  CAS  PubMed  Google Scholar 

  23. 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 29:2327–2336

    PubMed  Google Scholar 

  24. Rathbun AM, Reed GW, Harrold LR (2013) The temporal relationship between depression and rheumatoid arthritis disease activity, treatment persistence and response: a systematic review. Rheumatology (Oxford) 52:1785–1794

    Article  Google Scholar 

  25. Kremer J (2005) The CORRONA database. Ann Rheum Dis 64(4):iv37–iv41

    PubMed Central  PubMed  Google Scholar 

  26. Aletaha D, Nell VP, Stamm T, Uffmann M, Pflugbeil S, Machold K, Smolen JS (2005) Acute phase reactants add little to composite disease activity indices for rheumatoid arthritis: validation of a clinical activity score. Arthritis Res Ther 7:R796–R806

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  27. Prevoo ML, Vant Hof MA, Kuper HH, van Leeuwen MA, van de Putte LB, van Riel PL (1995) Modified disease activity scores that include twenty-eight-joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum 38:44–48

    Article  CAS  PubMed  Google Scholar 

  28. Anderson J, Sayles H, Curtis JR, Wolfe F, Michaud K (2010) Converting modified health assessment questionnaire (HAQ), multidimensional HAQ, and HAQII scores into original HAQ scores using models developed with a large cohort of rheumatoid arthritis patients. Arthritis Care Res (Hoboken) 62:1481–1488

    Article  Google Scholar 

  29. Wolfe F, Michaud K (2009) Predicting depression in rheumatoid arthritis: the signal importance of pain extent and fatigue, and comorbidity. Arthritis Rheum 61:667–673

    Article  PubMed  Google Scholar 

  30. Avasarala JR, Cross AH, Trinkaus K (2003) Comparative assessment of Yale Single Question and Beck Depression Inventory Scale in screening for depression in multiple sclerosis. Mult Scler 9:307–310

    Article  PubMed  Google Scholar 

  31. Heagerty PJ, Zheng Y (2005) Survival model predictive accuracy and ROC curves. Biometrics 61:92–105

    Article  PubMed  Google Scholar 

  32. Gönen M, Heller G (2005) Concordance probability and discriminatory power in proportional hazards regression. Biometrika 92:965–970

    Article  Google Scholar 

  33. Schoenfeld D (1980) Chi-squared goodness-of-fit tests for the proportional hazards regression model. Biometrika 67:145–153

    Article  Google Scholar 

  34. Sparling YH, Younes N, Lachin JM, Bautista OM (2006) Parametric survival models for interval-censored data with time-dependent covariates. Biostatistics 7:599–614

    Article  PubMed  Google Scholar 

  35. Gutierrez RG (2002) Parametric frailty and shared frailty survival models. Stata Journal 2:22–44

    Google Scholar 

  36. 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 60:61–64

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  37. Kekow J, Moots RJ, Emery P, Durez P, Koenig A, Singh A, Pedersen R, Robertson D, Freundlich B, Sato R (2010) Patient-reported outcomes improve with etanercept plus methotrexate in active early rheumatoid arthritis and the improvement is strongly associated with remission: the COMET trial. Ann Rheum Dis 69:222–225

    Article  CAS  PubMed  Google Scholar 

  38. Dowlati Y, Herrmann N, Swardfager W, Liu H, Sham L, Reim EK, Lanctot KL (2010) A meta-analysis of cytokines in major depression. Biol Psychiatry 67:446–457

    Article  CAS  PubMed  Google Scholar 

  39. Felger JC, Miller AH (2012) Cytokine effects on the basal ganglia and dopamine function: the subcortical source of inflammatory malaise. Front Neuroendocrinol 33:315–327

  40. Cavanagh J, Paterson C, McLean J, Pimlott S, McDonald M, Patterson J, Wyper D, McInnes I (2010) Tumour necrosis factor blockade mediates altered serotonin transporter availability in rheumatoid arthritis: a clinical, proof-ofconcept study. Ann Rheum Dis 69:1251–1252

  41. Lapidus KA, Gabbay V, Mao X, Johnson A, Murrough JW, Mathew SJ, Shungu DC (2014) In vivo (1)H MRS study of potential associations between glutathione, oxidative stress and anhedonia in major depressive disorder. Neurosci Lett 569:74–79

  42. Hill S, Dziedzic K, Thomas E, Baker SR, Croft P (2007) The illness perceptions associated with health and behavioural outcomes in people with musculoskeletal hand problems: findings from the North Staffordshire Osteoarthritis Project (NorStOP). Rheumatology (Oxford) 46:944–951

  43. Hale ED, Treharne GJ, Kitas GD (2007) The common-sense model of self-regulation of health and illness: how can we use it to understand and respond to our patients' needs?. Rheumatology (Oxford) 46:904–906

  44. Zimmerman M, Ruggero CJ, Chelminski I, Young D, Posternak MA, Friedman M, Boerescu D, Attiullah N (2006) Developing brief scales for use in clinical practice: the reliability and validity of single-item self-report measures of depression symptom severity, psychosocial impairment due to depression, and quality of life. J Clin Psychiatry 67:1536–1541

  45. Kobau R, Safran MA, Zack MM, Moriarty DG, Chapman D (2004) Sad, blue, or depressed days, health behaviors and health-related quality of life, Behavioral Risk Factor Surveillance System, 1995-2000. Health Qual Life Outcomes 2:40

  46. Margolis KL, Lihong Q, Brzyski R, Bonds DE, Howard BV, Kempainen S, Simin L, Robinson JG, Safford MM, Tinker LT, Phillips LS, Women Health Initiative Investigators (2008) Validity of diabetes self-reports in the Women's Health Initiative: comparison with medication inventories and fasting glucose measurements. Clin Trials 5:240–247

  47. Long K, Sudha S, Mutran EJ (1998) Elder-proxy agreement concerning the functional status and medical history of the older person: the impact of caregiver burden and depressive symptomatology. J Am Geriatr Soc 46:1103–1111

  48. Mukerji SS, Duffy SA, Fowler KE, Khan M, Ronis DL, Terrell JE (2007) Comorbidities in head and neck cancer: agreement between self-report and chart review. Otolaryngol Head Neck Surg 136:536–542

  49. Pilling S, Anderson I, Goldberg D, Meader N, Taylor C, Two Guideline Development Groups (2009) Depression in adults, including those with a chronic physical health problem: summary of NICE guidance. BMJ 339:b4108

  50. Cordingley L, Prajapati R, Plant D, Maskell D, Morgan C, Ali FR, Morgan AW, Wilson AG, Isaacs JD, BRAGGSS, Barton A, (2013) Impact of psychological factors on subjective disease activity assessments in patients with severe rheumatoid arthritis. Arthritis Care Res (Hoboken)

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Acknowledgments

This study was funded by the Consortium of Rheumatology Researchers of North America (CORRONA). In the last two years AbbVie, Amgen, Genentech, Horizon Pharma, Lilly, Momenta, Novartis, Pfizer, Regeneron, Vertex, and UCB have supported CORRONA through contract subscriptions.

Disclosures

Dr. Leslie R. Harrold is a consulting epidemiologist to CORRONA Inc., and Dr. George W. Reed is the Chief Statistical Officer of the CORRONA registry. Dr. Alan M. Rathbun has no conflicts of interest to disclose.

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Authors and Affiliations

  1. University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD, 21201, USA

    Alan M. Rathbun

  2. University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA

    Leslie R. Harrold & George W. Reed

  3. CORRONA Inc., Southborough, MA, USA

    George W. Reed

  4. Department of Epidemiology and Public Health, University of Maryland School of Medicine, Howard Hall Suite 200, 660 W. Redwood Street, Baltimore, MD, 21201, USA

    Alan M. Rathbun

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  1. Alan M. Rathbun
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  2. Leslie R. Harrold
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  3. George W. Reed
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Correspondence to Alan M. Rathbun.

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Rathbun, A.M., Harrold, L.R. & Reed, G.W. Temporal associations between the different domains of rheumatoid arthritis disease activity and the onset of patient-reported depressive symptoms. Clin Rheumatol 34, 653–663 (2015). https://doi.org/10.1007/s10067-014-2759-z

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  • DOI: https://doi.org/10.1007/s10067-014-2759-z

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