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Inflammatory markers and risk factors of RA patients with depression and application of different scales in judging depression

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Abstract

To evaluate the association of inflammatory markers and depression in RA patients and the risk factors in RA with depression, a cross-sectional study was conducted in a cohort of RA patients from southern China.Two hundred-fifteen RA patients were enrolled. The demographic and disease-related characteristics were recorded and inflammatory markers in sera were measured. RA patients were guided to fill out PHQ-9 scale by themselves, the psychological state was evaluated by psychiatry experts and graded according to the HAMD-17 scale. The consistency of the two scales in judging depression was evaluated. RA with depression group had HAMD-17 scores greater than 7. The levels of CRP, ESR, fibrinogen, SAA, IL-2, IL-6, TNF-α, IFN-γ, IL-4, and IL-10 were measured and compared. Logistic regression analysis was performed to find the risk factors of RA with different depression levels. One hundred-five (48.84%) RA patients had HAMD-17 scores greater than 7. High consistency was found between HAMD-17 and PHQ-9 in predicting depression. RA patients with depression were more likely to have tender joints, lower income, no employment, higher disease activity, joint deformities and glucocorticoid treatment. The depressed RA patients had higher serum levels of IL-6, CRP, fibrinogen, and SAA. IL-6, CRP, fibrinogen, and SAA were positive correlated with depression in RA patients. PHQ-9 can replace HAMD-17 in clinical application to judge depression.

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References

  1. Nerurkar L, Siebert S, McInnes IB, Cavanagh J (2019) Rheumatoid arthritis and depression: an inflammatory perspective. Lancet Psychiat 6(2):164–173

    Article  Google Scholar 

  2. Matcham F, Rayner L, Steer S, Hotopf M (2013) The prevalence of depression in rheumatoid: arthritis a systematic review and meta-analysis. Rheumatology (Oxford) 52(12):2136–2148

    Article  Google Scholar 

  3. Jacob L, Rockel T, Kostev K (2017) Depression risk in patients with rheumatoid arthritis in the United Kingdom. Rheumatol Ther 4(1):195–200

    Article  Google Scholar 

  4. Zhou YQ, Liu Z, Liu ZH, Chen SP, Li M, Shahveranov A et al (2016) Interleukin-6: an emerging regulator of pathological pain. J Neuroinflammation 13(1):141

    Article  Google Scholar 

  5. Sekiguchi M, Sekiguchi Y, Konno S, Kobayashi H, Homma Y, Kikuchi S (2009) Comparison of neuropathic pain and neuronal apoptosis following nerve root or spinal nerve compression. Eur Spine J 18(12):1978–1985

    Article  Google Scholar 

  6. Dowlati Y, Herrmann N, Swardfager W, Liu H, Sham L, Reim EK et al (2010) A meta-analysis of cytokines in major depression. Biol Psychiatry 67(5):446–457

    Article  CAS  Google Scholar 

  7. Miller AH, Maletic V, Raison CL (2009) Inflammation and its discontents: the role of cytokines in the pathophysiology of major depression. Biol Psychiatry 65(9):732–741

    Article  CAS  Google Scholar 

  8. Cheon YH, Lee SG, Kim M, Kim HO, Sun SY, Park KS et al (2018) The association of disease activity, pro-inflammatory cytokines, and neurotrophic factors with depression in patients with rheumatoid arthritis. Brain Behav Immun 73:274–281

    Article  CAS  Google Scholar 

  9. Albeltagy ES, Elaziz S, Abozaid SY, El ZH, Elhamed S (2021) Interleukin 6, interleukin 17, disease-related and contextual factor association with depression, and its severity in patients with rheumatoid arthritis. Clin Rheumatol 40(3):895–904

    Article  Google Scholar 

  10. Matcham F, Davies R, Hotopf M, Hyrich KL, Norton S, Steer S et al (2018) The relationship between depression and biologic treatment response in rheumatoid arthritis: an analysis of the British Society for Rheumatology Biologics Register. Rheumatology (Oxford) 57(5):835–843

    Article  Google Scholar 

  11. Hamilton M (1960) A rating scale for depression. J Neurol Neurosurg Psychiatry 23:56–62

    Article  CAS  Google Scholar 

  12. Kroenke K, Spitzer RL, Williams JB (2001) The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 16(9):606–613

    Article  CAS  Google Scholar 

  13. Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, Healey LA, Kaplan SR, Liang MH, Luthra HS, et al (1988) The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 31(3):315–24. https://doi.org/10.1002/art.1780310302

  14. Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham 3rd CO, Birnbaum NS, Burmester GR, Bykerk VP, Cohen MD, Combe B, Costenbader KH, Dougados M, Emery P, Ferraccioli G, Hazes JMW, Hobbs K, Huizinga TWJ, Kavanaugh A, Kay J, Kvien TK, Laing T, Mease P, Ménard HA, Moreland LW,  Naden RL, Pincus T, Smolen JS, Stanislawska-Biernat E,Symmons D, Tak PP, Upchurch KH, Vencovský J, Wolfe F, Hawker G (2010) Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Multicenter Study Arthritis Rheum 62(9):2569–81. https://doi.org/10.1002/art.27584

  15. Zimmerman M, Martinez JH, Young D, Chelminski I, Dalrymple K (2013) Severity classification on the Hamilton Depression Rating Scale. J Affect Disord 150(2):384–388

    Article  Google Scholar 

  16. Spitzer RL, Kroenke K, Williams JB (1999) Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary care evaluation of mental disorders. Patient Health Questionnaire. JAMA 282(18):1737–1744

    Article  CAS  Google Scholar 

  17. Aletaha D, Ward MM, Machold KP, Nell VP, Stamm T, Smolen JS (2005) Remission and active disease in rheumatoid arthritis: defining criteria for disease activity states. Arthritis Rheum 52(9):2625–2636

    Article  Google Scholar 

  18. First MB (2013) Diagnostic and statistical manual of mental disorders, 5th edition, and clinical utility. Editorial J Nerv Ment Dis 201(9):727–9. https://doi.org/10.1097/NMD.0b013e3182a2168a

  19. Faith MS, Matz PE, Jorge MA (2002) Obesity-depression associations in the population. J Psychosom Res 53(4):935–942

    Article  Google Scholar 

  20. Kranjac AW, Nie J, Trevisan M, Freudenheim JL (2017) Depression and body mass index, differences by education: evidence from a population-based study of adult women in the U.S. Buffalo-Niagara region. Obes Res Clin Pract 11(1):63–71

    Article  Google Scholar 

  21. Tang D, Bu T, Feng Q, Liu Y, Dong X (2020) Differences in overweight and obesity between the North and South of China. Am J Health Behav 44(6):780–793

    Article  Google Scholar 

  22. Sherine EG (2001) The epidemiology of rheumatoid arthritis. Rev Rheum Dis Clin N Am 27(2):269–81. https://doi.org/10.1016/s0889-857x(05)70201-5

  23. Sullivan PW, Ghushchyan V, Huang XY, Globe DR (2010) Influence of rheumatoid arthritis on employment, function, and productivity in a nationally representative sample in the United States. J Rheumatol 37(3):544–549

    Article  Google Scholar 

  24. Lee SA, Ju YJ, Han KT, Choi JW, Yoon HJ, Park EC (2017) The association between loss of work ability and depression: a focus on employment status. Int Arch Occup Environ Health 90(1):109–116

    Article  Google Scholar 

  25. Kageyama G, Onishi A, Ueda Y, Naka I, Tsuda K, Okano T et al (2019) Subjective well-being among rheumatoid arthritis patients. Int J Rheum Dis 22(10):1863–1870

    Article  Google Scholar 

  26. Pariante CM, Lightman SL (2008) The HPA axis in major depression: classical theories and new developments. Trends Neurosci 31(9):464–468

    Article  CAS  Google Scholar 

  27. Keller J, Gomez R, Williams G, Lembke A, Lazzeroni L, Murphy GJ et al (2017) HPA axis in major depression: cortisol, clinical symptomatology and genetic variation predict cognition. Mol Psychiatry 22(4):527–536

    Article  CAS  Google Scholar 

  28. Bair MJ, Robinson RL, Katon W, Kroenke K (2003) Depression and pain comorbidity: a literature review. Arch Intern Med 163(20):2433–2445

    Article  Google Scholar 

  29. Yang C, Wardenaar KJ, Bosker FJ, Li J, Schoevers RA (2019) Inflammatory markers and treatment outcome in treatment resistant depression: a systematic review. J Affect Disord 257:640–649

    Article  CAS  Google Scholar 

  30. Wium-Andersen MK, Orsted DD, Nordestgaard BG (2013) Association between elevated plasma fibrinogen and psychological distress, and depression in 73,367 individuals from the general population. Mol Psychiatry 18(8):854–855

    Article  CAS  Google Scholar 

  31. Migita K, Koga T, Torigoshi T, Maeda Y, Miyashita T, Izumi Y et al (2009) Serum amyloid A protein stimulates CCL20 production in rheumatoid synoviocytes. Rheumatology (Oxford) 48(7):741–747

    Article  CAS  Google Scholar 

  32. Bryleva EY, Keaton SA, Grit J, Madaj Z, Sauro-Nagendra A, Smart L et al (2017) The acute-phase mediator serum amyloid A is associated with symptoms of depression and fatigue. Acta Psychiatr Scand 135(5):409–418

    Article  CAS  Google Scholar 

  33. Choy E, Calabrese LH (2018) Neuroendocrine and neurophysiological effects of interleukin 6 in rheumatoid arthritis. Rheumatology (Oxford) 57(11):1885–1895

    Article  CAS  Google Scholar 

  34. Leung L, Cahill CM (2010) TNF-alpha and neuropathic pain–a review. J Neuroinflammation 7:27

    Article  Google Scholar 

  35. Kappelmann N, Lewis G, Dantzer R, Jones PB, Khandaker GM (2018) Antidepressant activity of anti-cytokine treatment: a systematic review and meta-analysis of clinical trials of chronic inflammatory conditions. Mol Psychiatry 23(2):335–343

    Article  CAS  Google Scholar 

  36. Raison CL, Rutherford RE, Woolwine BJ, Shuo C, Schettler P, Drake DF et al (2013) A randomized controlled trial of the tumor necrosis factor antagonist infliximab for treatment-resistant depression: the role of baseline inflammatory biomarkers. JAMA Psychiat 70(1):31–41

    Article  CAS  Google Scholar 

Download references

Acknowledgements

The authors thank the patients and their families for their participation.

Funding

This study was supported by the Medical and Health Science and Technology Project of Guangzhou Municipal Health Bureau (20221A011007) and Guangzhou Planned Project of Science and Technology (202206010047).

Author information

Author notes

  1. Fangfei Li, Wenjia Ai and Jinghua Ye contributed equally to this work.

Authors and Affiliations

  1. The First Affiliated Hospital of Jinan University, Guangzhou, China

    Fangfei Li

  2. The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China

    Wenjia Ai

  3. Department of Rheumatology, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, China

    Jinghua Ye, Cuicui Wang, Shiwen Yuan, Weinian Li, Zhixiang He, Yi Chen, Xiaojun Lin & Xiaoyan Cai

  4. Department of Psychiatry, M-Healthcare Clinic, Guangzhou, China

    Yunshi Xie

  5. Department of Psychiatry, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, China

    Xiaoen Mo

Authors
  1. Fangfei Li
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  2. Wenjia Ai
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  3. Jinghua Ye
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  4. Cuicui Wang
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  8. Weinian Li
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  11. Xiaojun Lin
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  12. Xiaoyan Cai
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Corresponding author

Correspondence to Xiaoyan Cai.

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Ethical approval

This research complied with the Helsinki Declaration. This study was approved by the Ethics Committee of Guangzhou First People’s Hospital (approval number K-2016–117-01) and informed consent was obtained at the time of registering enrollment.

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Li, F., Ai, W., Ye, J. et al. Inflammatory markers and risk factors of RA patients with depression and application of different scales in judging depression. Clin Rheumatol 41, 2309–2317 (2022). https://doi.org/10.1007/s10067-022-06174-3

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  • DOI: https://doi.org/10.1007/s10067-022-06174-3

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