The Role of Depression, Anxiety, Fatigue, and Fibromyalgia on the Evaluation of the Remission Status in Patients with Rheumatoid Arthritis
The Role of Depression, Anxiety, Fatigue, and Fibromyalgia on the Evaluation of the Remission Status in Patients with Rheumatoid Arthritis
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DOI：
10.3899/jrheum.131171
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发表时间：
2014-09-01
影响因子：
3.9
通讯作者：
Direskeneli, Haner
中科院分区：
文献类型：
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作者：
Inanc, Nevsun;Yilmaz-Oner, Sibel;Direskeneli, Haner
Objective.研究抑郁、焦虑、疲劳和纤维肌痛（FM）对类风湿关节炎（RA）患者缓解状态的影响，缓解状态根据28关节疾病活动评分（DAS 28）-红细胞沉降率（ESR）和基于布尔值的美国风湿病学会/欧洲抗风湿联盟新缓解标准定义。受试者是参与基于医院的观察性队列的RA患者。在最近一次访视时符合DAS 28-ESR缓解标准的患者被邀请参加我们的研究。确定满足或不满足布尔缓解标准的患者组，并就抑郁、焦虑、疲劳（0-50）和FM的存在进行相互比较。此外，还探讨了心理社会因素与简化疾病活动指数（SDAI）缓解（以SDAI为基础的RA缓解定义）之间的关系。428例RA患者中共有87例（20%）符合DAS 28-ESR缓解标准，其中32例（37%）也符合布尔缓解标准，而55例（63%）不符合。40例患者也处于SDAI缓解期。在布尔缓解组中，2例患者患有抑郁症，2例患者患有焦虑症（p = 0.004）。在布尔非缓解组中，19例患者有抑郁症，13例有焦虑症（p = 0.04）。与未缓解组相比，布尔缓解组的焦虑（3.34 +/- 3.76 vs 5.83 +/- 4.70，p = 0.012）和抑郁（2.18 +/- 2.75 vs 4.63 +/- 4.10，p = 0.001）连续量表也较低。虽然布尔缓解组仅1例患者和布尔非缓解组7例患者检测到FM综合征（p = 0.249），但布尔缓解组患者的FM多症状困扰评分显著低于非缓解组（3.12 ± 3.25 vs 6.27 ± 5.19，p = 0.001）。布尔缓解组的平均疲劳评分为9.5 ± 10.6，布尔非缓解组为16.8 ± 12.8（p = 0.006）。在多变量分析中，患者的整体评估（PtGA）和抑郁被认为是布尔定义的独立判别因素。心理社会因素与SDAI缓解率之间也存在类似的关系。在不符合布尔缓解标准的RA患者中，为了避免过度治疗，如果PtGA评分和疾病活动变量显著不同，则必须考虑评估焦虑，疲劳，FM，特别是抑郁。
Objective. To investigate the effect of depression, anxiety, fatigue, and fibromyalgia (FM) on the remission status in patients with rheumatoid arthritis (RA), defined according to the 28-joint count Disease Activity Score (DAS28)-erythrocyte sedimentation rate (ESR) and the Boolean-based new American College of Rheumatology/European League Against Rheumatism remission criteria.Methods. The subjects were patients with RA who participated in a hospital-based observational cohort. Patients who met the DAS28-ESR remission criteria at their latest visit were invited to participate in our study. The patient groups fulfilling or not fulfilling the Boolean remission criteria were identified and compared with each other with regard to the presence of depression, anxiety, fatigue (0-50), and FM. The relationship between psychosocial factors and Simplified Disease Activity Index (SDAI) remission, which is the index-based definition of remission in RA, was also investigated.Results. A total of 87 out of 428 patients (20%) with RA met the DAS28-ESR remission criteria and 32 (37%) of these also met the Boolean remission criteria, while 55 (63%) did not. Forty patients were also in SDAI remission. In the Boolean remission group, 2 patients had depression and 2 had anxiety (p = 0.004). In the Boolean nonremission group, 19 patients had depression and 13 had anxiety (p = 0.04). Continuous scales of anxiety (3.34 +/- 3.76 vs 5.83 +/- 4.70, p = 0.012) and depression (2.18 +/- 2.75 vs 4.63 +/- 4.10, p = 0.001) were also lower in the Boolean remission group in comparison with the nonremission group. Though FM syndrome was detected in only 1 patient of the Boolean remission group and in 7 patients of the Boolean nonremission group (p = 0.249), patients' polysymptomatic distress scores of FM in the Boolean remission group were significantly lower than those of the nonremission group (3.12 +/- 3.25 vs 6.27 +/- 5.19, p = 0.001). The mean fatigue scores were 9.5 +/- 10.6 in the Boolean remission group and 16.8 +/- 12.8 in the Boolean nonremission group (p = 0.006). In multivariate analysis, patient's global assessment (PtGA) and depression were found as the independent discriminators of Boolean-based definition. Similar relationships were also observed between psychosocial factors and SDAI remission.Conclusion. In patients with RA who do not fulfill the Boolean remission criteria, to avoid overtreatment, assessment of anxiety, fatigue, FM, and especially depression must be considered if PtGA scores and disease activity variables are significantly different.