Skip to main content

Advertisement

SpringerLink
Log in

Anxiety and depression in adult-onset Still’s disease patients and associations with health-related quality of life

  • Original Article
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

Abstract

Objective

Adult-onset Still’s disease (AOSD) is an autoinflammatory disorder leading to multiorgan involvements. We sought to investigate mood status and the health-related quality of life (HRQoL) in these patients.

Methods

In this study, 82 AOSD patients and 82 age- and sex-matched healthy controls were included. Demographic and clinical data of recruited patients were collected. The Hospital Anxiety and Depression Scale (HADS) and Medical Outcomes Survey Short Form-36 (SF-36) were used to evaluate the mood status and quality of life, respectively. Spearman correlation and multivariable linear regression analyses were used to assess the disease-related risk factors associated with anxiety and depression.

Results

Forty-four active and thirty-eight relieved patients were enrolled. We found that scores of both HADS anxiety (HADS-A) and depression (HADS-D) subscales in active AOSD were significantly higher than inactive patients, which were significantly higher than controls. Moreover, the HADS-A was positively correlated to the patient’s global assessment (PGA), pain, and dosage of prednisone, and the HADS-D was positively correlated to systemic score, PGA, and pain. Female, high dosage of corticosteroids, and PGA more than 50 had a significant association with HADS-A score, while the sore throat and PGA more than 50 had a significant association with HADS-D score. Furthermore, AOSD patients’ anxiety and depression had a negative impact on HRQoL.

Conclusion

Active AOSD patients tended to be anxious and depressed, suffering from poorer HRQoL compared to patients in remission. Therefore, the evaluation of mental health and HRQoL should be included in AOSD patients’ long-term management.

Key Points

• Adult-onset Still’s disease (AOSD) is a systemic inflammatory disorder leading to multiorgan involvement. This study was so far the first published research focuses on AOSD patients’ mental involvement and health-related quality of life (HRQoL).

• Active AOSD patients were more tended to be anxious and depressive and suffered from poorer HRQoL compared to inactive patients.

• Patients’ anxiety and depression were associated with impaired HRQoL.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Feist E, Mitrovic S, Fautrel B (2018) Mechanisms, biomarkers and targets for adult-onset Still’s disease. Nat Rev Rheumatol 14(10):603–618. https://doi.org/10.1038/s41584-018-0081-x

    Article  PubMed  PubMed Central  Google Scholar 

  2. Ruscitti P, Cipriani P, Masedu F, Iacono D, Ciccia F, Liakouli V, Guggino G, Carubbi F, Berardicurti O, Di Benedetto P, Valenti M, Triolo G, Valentini G, Giacomelli R (2016) Adult-onset Still’s disease: evaluation of prognostic tools and validation of the systemic score by analysis of 100 cases from three centers. BMC Med 14(1):194. https://doi.org/10.1186/s12916-016-0738-8

    Article  PubMed  PubMed Central  Google Scholar 

  3. Gerfaud-Valentin M, Jamilloux Y, Iwaz J, Seve P (2014) Adult-onset Still’s disease. Autoimmun Rev 13(7):708–722. https://doi.org/10.1016/j.autrev.2014.01.058

    Article  CAS  PubMed  Google Scholar 

  4. Giacomelli R, Ruscitti P, Shoenfeld Y (2018) A comprehensive review on adult onset Still’s disease. J Autoimmun 93:24–36. https://doi.org/10.1016/j.jaut.2018.07.018

    Article  PubMed  Google Scholar 

  5. Ruscitti P, Giacomelli R (2018) Pathogenesis of adult onset Still’s disease: current understanding and new insights. Expert Rev Clin Immunol 14(11):965–976. https://doi.org/10.1080/1744666X.2018.1533403

    Article  CAS  PubMed  Google Scholar 

  6. Zeng T, Zou YQ, Wu MF, Yang CD (2009) Clinical features and prognosis of adult-onset Still’s disease: 61 cases from China. J Rheumatol 36(5):1026–1031. https://doi.org/10.3899/jrheum.080365

    Article  CAS  PubMed  Google Scholar 

  7. Michelsen B, Kristianslund EK, Sexton J, Hammer HB, Fagerli KM, Lie E, Wierod A, Kalstad S, Rodevand E, Kroll F, Haugeberg G, Kvien TK (2017) Do depression and anxiety reduce the likelihood of remission in rheumatoid arthritis and psoriatic arthritis? Data from the prospective multicentre NOR-DMARD study. Ann Rheum Dis 76(11):1906–1910. https://doi.org/10.1136/annrheumdis-2017-211284

    Article  PubMed  Google Scholar 

  8. Kochar B, Barnes EL, Long MD, Cushing KC, Galanko J, Martin CF, Raffals LE, Sandler RS (2018) Depression is associated with more aggressive inflammatory bowel disease. Am J Gastroenterol 113(1):80–85. https://doi.org/10.1038/ajg.2017.423

    Article  PubMed  Google Scholar 

  9. Chi H, Liu D, Sun Y, Hu Q, Liu H, Cheng X, Ye J, Shi H, Yin Y, Liu M, Wu X, Zhou Z, Teng J, Yang C, Su Y (2018) Interleukin-37 is increased in adult-onset Still’s disease and associated with disease activity. Arthritis Res Ther 20(1):54. https://doi.org/10.1186/s13075-018-1555-6

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Jia J, Shi H, Liu M, Liu T, Gu J, Wan L, Teng J, Liu H, Cheng X, Ye J, Su Y, Sun Y, Gong W, Yang C, Hu Q (2019) Cytomegalovirus infection may trigger adult-onset Still’s disease onset or relapses. Front Immunol 10:898. https://doi.org/10.3389/fimmu.2019.00898

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Hu Q, Gong W, Gu J, Geng G, Li T, Tian R, Yang Z, Zhang H, Shao L, Liu T, Wan L, Jia J, Yang C, Shi Y, Shi H (2018) Plasma microRNA profiles as a potential biomarker in differentiating adult-onset Still’s disease from sepsis. Front Immunol 9:3099. https://doi.org/10.3389/fimmu.2018.03099

    Article  CAS  PubMed  Google Scholar 

  12. Hu QY, Zeng T, Sun CY, Luo CN, Liu S, Ding TT, Ji ZF, Lu A, Yimaiti K, Teng JL, Cheng XB, Ye JN, Su YT, Shi H, Sun Y, Chi HH, Zhou ZC, Chen LJ, Xu J, Jiang LD, Wu LJ, Lin J, Yang CD, Liu HL (2019) Clinical features and current treatments of adult-onset Still's disease: a multicentre survey of 517 patients in China. Clin Exp Rheumatol 37 Suppl 121(6):52–57

    PubMed  Google Scholar 

  13. Zou YQ, Lu LJ, Li SJ, Zeng T, Wang XD, Bao CD, Chen SL, Yang CD (2008) The levels of macrophage migration inhibitory factor as an indicator of disease activity and severity in adult-onset Still’s disease. Clin Biochem 41(7–8):519–524. https://doi.org/10.1016/j.clinbiochem.2008.01.008

    Article  CAS  PubMed  Google Scholar 

  14. Sun Y, Wang Z, Chi H, Hu Q, Ye J, Liu H, Cheng X, Shi H, Zhou Z, Teng J, Yang C, Su Y (2019) Elevated serum levels of interleukin-10 in adult-onset Still’s disease are associated with disease activity. Clin Rheumatol 38:3205–3210. https://doi.org/10.1007/s10067-019-04642-x

    Article  PubMed  Google Scholar 

  15. Li Z, Liu HL, Chen J, Zeng T, He L, Li M, Luo C, Liu S, Ding TT, Yimaiti K, Teng J, Li X, Ding Y, Cheng X, Zhou J, Ye J, Ji J, Su YT, Shi H, Sun Y, Gao C, Hu Q, Chi H, Yuan X, Zhou Z, Wang D, Wang K, Li CG, Sun Y, Niu Y, Chen LJ, Xu J, Wu L, Zhou Z, Pan D, Niu H, Shi Y, Yang C (2020) Both HLA class I and II regions identified as genome-wide significant susceptibility loci for adult-onset Still’s disease in Chinese individuals. Ann Rheum Dis 79(1):161–163. https://doi.org/10.1136/annrheumdis-2019-215239

    Article  PubMed  Google Scholar 

  16. Yamaguchi M, Ohta A, Tsunematsu T, Kasukawa R, Mizushima Y, Kashiwagi H, Kashiwazaki S, Tanimoto K, Matsumoto Y, Ota T et al (1992) Preliminary criteria for classification of adult Still’s disease. J Rheumatol 19(3):424–430

    CAS  PubMed  Google Scholar 

  17. Li Q, Lin Y, Hu C, Xu Y, Zhou H, Yang L, Xu Y (2016) The Chinese version of hospital anxiety and depression scale: psychometric properties in Chinese cancer patients and their family caregivers. Eur J Oncol Nurs 25:16–23. https://doi.org/10.1016/j.ejon.2016.09.004

    Article  PubMed  Google Scholar 

  18. Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67(6):361–370. https://doi.org/10.1111/j.1600-0447.1983.tb09716.x

    Article  CAS  PubMed  Google Scholar 

  19. McHorney CA, Ware JE Jr, Lu JF, Sherbourne CD (1994) The MOS 36-item Short-Form Health Survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Med Care 32(1):40–66. https://doi.org/10.1097/00005650-199401000-00004

    Article  CAS  PubMed  Google Scholar 

  20. Li L, Wang HM, Shen Y (2003) Chinese SF-36 Health Survey: translation, cultural adaptation, validation, and normalisation. J Epidemiol Community Health 57(4):259–263. https://doi.org/10.1136/jech.57.4.259

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Pouchot J, Sampalis JS, Beaudet F, Carette S, Decary F, Salusinsky-Sternbach M, Hill RO, Gutkowski A, Harth M, Myhal D et al (1991) Adult Still’s disease: manifestations, disease course, and outcome in 62 patients. Medicine (Baltimore) 70(2):118–136

    Article  CAS  Google Scholar 

  22. Girard C, Rech J, Brown M, Allali D, Roux-Lombard P, Spertini F, Schiffrin EJ, Schett G, Manger B, Bas S, Del Val G, Gabay C (2016) Elevated serum levels of free interleukin-18 in adult-onset Still’s disease. Rheumatology (Oxford) 55(12):2237–2247. https://doi.org/10.1093/rheumatology/kew300

    Article  CAS  Google Scholar 

  23. Schonau V, Schett G (2018) Response to: the value of 18(F)-FDG-PET/CT in identifying the cause of fever of unknown origin (FUO) and inflammation of unknown origin (IUO): data from a prospective study. Ann Rheum Dis 77(8):e53. https://doi.org/10.1136/annrheumdis-2017-212520

    Article  CAS  PubMed  Google Scholar 

  24. Nirmala N, Brachat A, Feist E, Blank N, Specker C, Witt M, Zernicke J, Martini A, Junge G (2015) Gene-expression analysis of adult-onset Still’s disease and systemic juvenile idiopathic arthritis is consistent with a continuum of a single disease entity. Pediatr Rheumatol Online J 13:50. https://doi.org/10.1186/s12969-015-0047-3

    Article  PubMed  PubMed Central  Google Scholar 

  25. Minoia F, Bovis F, Davi S, Horne A, Fischbach M, Frosch M, Huber A, Jelusic M, Sawhney S, McCurdy DK, Silva CA, Rigante D, Unsal E, Ruperto N, Martini A, Cron RQ, Ravelli A, Pediatric Rheumatology International Trials Organization tCA, Rheumatology Research Alliance tPRCSG, the Histiocyte S (2019) Development and initial validation of the MS score for diagnosis of macrophage activation syndrome in systemic juvenile idiopathic arthritis. Ann Rheum Dis 78(10):1357–1362. https://doi.org/10.1136/annrheumdis-2019-215211

    Article  CAS  PubMed  Google Scholar 

  26. Sampalis JS, Esdaile JM, Medsger TA Jr, Partridge AJ, Yeadon C, Senecal JL, Myhal D, Harth M, Gutkowski A, Carette S et al (1995) A controlled study of the long-term prognosis of adult Still’s disease. Am J Med 98(4):384–388. https://doi.org/10.1016/s0002-9343(99)80318-0

    Article  CAS  PubMed  Google Scholar 

  27. Soliday E, Grey S, Lande MB (1999) Behavioral effects of corticosteroids in steroid-sensitive nephrotic syndrome. Pediatrics 104(4):e51. https://doi.org/10.1542/peds.104.4.e51

    Article  CAS  PubMed  Google Scholar 

  28. Gonzalez-Perez O, Ramos-Remus C, Garcia-Estrada J, Luquin S (2001) Prednisone induces anxiety and glial cerebral changes in rats. J Rheumatol 28(11):2529–2534

    CAS  PubMed  Google Scholar 

  29. Wohl Y, Mashiah J, Kutz A, Hadj-Rabia S, Cohen AD (2015) Pemphigus and depression comorbidity: a case control study. Eur J Dermatol 25(6):602–605. https://doi.org/10.1684/ejd.2015.2649

    Article  CAS  PubMed  Google Scholar 

  30. Hu Q, Shi H, Zeng T, Liu H, Su Y, Cheng X, Ye J, Yin Y, Liu M, Zheng H, Wu X, Chi H, Zhou Z, Jia J, Sun Y, Teng J, Yang C (2019) Increased neutrophil extracellular traps activate NLRP3 and inflammatory macrophages in adult-onset Still's disease. Arthritis Res Ther 21(1):9. https://doi.org/10.1186/s13075-018-1800-z

    Article  PubMed  PubMed Central  Google Scholar 

  31. Nerurkar L, Siebert S, McInnes IB, Cavanagh J (2019) Rheumatoid arthritis and depression: an inflammatory perspective. Lancet Psychiatry 6(2):164–173. https://doi.org/10.1016/S2215-0366(18)30255-4

    Article  PubMed  Google Scholar 

  32. Tarakci E, Yeldan I, Kaya Mutlu E, Baydogan SN, Kasapcopur O (2011) The relationship between physical activity level, anxiety, depression, and functional ability in children and adolescents with juvenile idiopathic arthritis. Clin Rheumatol 30(11):1415–1420. https://doi.org/10.1007/s10067-011-1832-0

    Article  PubMed  Google Scholar 

  33. McDonough E, Ayearst R, Eder L, Chandran V, Rosen CF, Thavaneswaran A, Gladman DD (2014) Depression and anxiety in psoriatic disease: prevalence and associated factors. J Rheumatol 41(5):887–896. https://doi.org/10.3899/jrheum.130797

    Article  PubMed  Google Scholar 

  34. Postal M, Lapa AT, Sinicato NA, de Oliveira PK, Peres FA, Costallat LT, Fernandes PT, Marini R, Appenzeller S (2016) Depressive symptoms are associated with tumor necrosis factor alpha in systemic lupus erythematosus. J Neuroinflammation 13:5. https://doi.org/10.1186/s12974-015-0471-9

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Hanly JG, Su L, Urowitz MB, Romero-Diaz J, Gordon C, Bae SC, Bernatsky S, Clarke AE, Wallace DJ, Merrill JT, Isenberg DA, Rahman A, Ginzler EM, Petri M, Bruce IN, Dooley MA, Fortin P, Gladman DD, Sanchez-Guerrero J, Steinsson K, Ramsey-Goldman R, Khamashta MA, Aranow C, Alarcon GS, Fessler BJ, Manzi S, Nived O, Sturfelt GK, Zoma AA, van Vollenhoven RF, Ramos-Casals M, Ruiz-Irastorza G, Lim SS, Kalunian KC, Inanc M, Kamen DL, Peschken CA, Jacobsen S, Askanase A, Theriault C, Thompson K, Farewell V (2015) Mood disorders in systemic lupus erythematosus: results from an international inception cohort study. Arthritis Rheum 67(7):1837–1847. https://doi.org/10.1002/art.39111

    Article  Google Scholar 

  36. Labrenz F, Ferri F, Wrede K, Forsting M, Schedlowski M, Engler H, Elsenbruch S, Benson S, Costantini M (2019) Altered temporal variance and functional connectivity of BOLD signal is associated with state anxiety during acute systemic inflammation. Neuroimage 184:916–924. https://doi.org/10.1016/j.neuroimage.2018.09.056

    Article  PubMed  Google Scholar 

  37. Zhang L, Zhang X, Zheng J, Liu Y, Wang J, Wang G, Zhang HP, Kang Y, Peng ZG, Ji YL, Wang L, Gibson PG, Wang G (2019) Depressive symptom-associated IL-1beta and TNF-alpha release correlates with impaired bronchodilator response and neutrophilic airway inflammation in asthma. Clin Exp Allergy 49(6):770–780. https://doi.org/10.1111/cea.13346

    Article  CAS  PubMed  Google Scholar 

  38. Hou R, Garner M, Holmes C, Osmond C, Teeling J, Lau L, Baldwin DS (2017) Peripheral inflammatory cytokines and immune balance in generalised anxiety disorder: case-controlled study. Brain Behav Immun 62:212–218. https://doi.org/10.1016/j.bbi.2017.01.021

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Rossi S, Sacchetti L, Napolitano F, De Chiara V, Motta C, Studer V, Musella A, Barbieri F, Bari M, Bernardi G, Maccarrone M, Usiello A, Centonze D (2012) Interleukin-1beta causes anxiety by interacting with the endocannabinoid system. J Neurosci 32(40):13896–13905. https://doi.org/10.1523/JNEUROSCI.1515-12.2012

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Swartz JR, Prather AA, Di Iorio CR, Bogdan R, Hariri AR (2017) A functional interleukin-18 haplotype predicts depression and anxiety through increased threat-related amygdala reactivity in women but not men. Neuropsychopharmacology 42(2):419–426. https://doi.org/10.1038/npp.2016.129

    Article  CAS  PubMed  Google Scholar 

  41. Schiltz JC, Sawchenko PE (2002) Distinct brain vascular cell types manifest inducible cyclooxygenase expression as a function of the strength and nature of immune insults. J Neurosci 22(13):5606–5618

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Pan W, Stone KP, Hsuchou H, Manda VK, Zhang Y, Kastin AJ (2011) Cytokine signaling modulates blood-brain barrier function. Curr Pharm Des 17(33):3729–3740. https://doi.org/10.2174/138161211798220918

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Feldon M, Farhadi PN, Brunner HI, Itert L, Goldberg B, Faiq A, Wilkerson J, Rose KM, Rider LG, Miller FW, Giannini EH (2017) Predictors of reduced health-related quality of life in adult patients with idiopathic inflammatory myopathies. Arthritis Care Res 69(11):1743–1750. https://doi.org/10.1002/acr.23198

    Article  Google Scholar 

  44. Yilmaz N, Can M, Oner FA, Kalfa M, Emmungil H, Karadag O, Yildiz F, Kimyon G, Yilmazer B, Gerdan V, Bilge SY, Ilhan B, Cobankara V, Kasifoglu T, Cefle A, Kisacik B, Onat AM, Akar S, Onen F, Erken E, Kiraz S, Aksu K, Keser G, Mumcu G, Direskeneli H (2013) Impaired quality of life, disability and mental health in Takayasu's arteritis. Rheumatology (Oxford) 52(10):1898–1904. https://doi.org/10.1093/rheumatology/ket238

    Article  Google Scholar 

Download references

Acknowledgments

Authors would like to thank the innovative research team of high-level local universities in Shanghai and all patients participated in this study.

Funding

This work was supported by the National Natural Science Foundation of China (81801600) and the Shanghai Sailing Program (18YF1414500).

Author information

Author notes

  1. Huihui Chi, Haiyan Jin and Zhihong Wang contributed equally to this work.

Authors and Affiliations

  1. Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China

    Huihui Chi, Zhihong Wang, Hui Shi, Xinyao Wu, Liyan Wan, Jialin Teng, Yue Sun, Honglei Liu, Xiaobing Cheng, Junna Ye, Qiongyi Hu, Zhuochao Zhou, Jieyu Gu, Jinchao Jia, Tingting Liu, Xin Qiao, Chengde Yang & Yutong Su

  2. Department of Psychiatry, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China

    Haiyan Jin

  3. Clinical Research Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China

    Tienan Feng

  4. Department of Rheumatology, Xinhua Hospital Chongming Branch Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 202150, China

    Ting Zeng

Authors
  1. Huihui Chi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Haiyan Jin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Zhihong Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tienan Feng
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ting Zeng
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hui Shi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Xinyao Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Liyan Wan
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Jialin Teng
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Yue Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Honglei Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Xiaobing Cheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Junna Ye
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Qiongyi Hu
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Zhuochao Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Jieyu Gu
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Jinchao Jia
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Tingting Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Xin Qiao
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. Chengde Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  21. Yutong Su
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Chengde Yang or Yutong Su.

Ethics declarations

All patients provided written informed consent for participation in the survey and the use of data for publication. This survey was approved by the Institutional Research Ethics Committee of Ruijin Hospital (ID: 2016-61), Shanghai, China. All were conducted in accordance with the Helsinki declaration.

Disclosures

None.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

ESM 1

(DOCX 36 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chi, H., Jin, H., Wang, Z. et al. Anxiety and depression in adult-onset Still’s disease patients and associations with health-related quality of life. Clin Rheumatol 39, 3723–3732 (2020). https://doi.org/10.1007/s10067-020-05094-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-020-05094-4

Keywords

Search

Navigation