Effect of Physical State on Pain Mediated Through Emotional Health in Rheumatoid Arthritis
Effect of Physical State on Pain Mediated Through Emotional Health in Rheumatoid Arthritis
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DOI：
10.1002/acr.23779
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发表时间：
2019-09-01
影响因子：
4.7
通讯作者：
Mimori, Tsuneyo
中科院分区：
文献类型：
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作者：
Nakagami, Yukako;Sugihara, Genichi;Mimori, Tsuneyo
目的疼痛是类风湿关节炎（RA）患者的主要症状之一。RA疼痛是由特定的身体变化引起的，例如关节破坏，因此被用作疾病活动标志物。虽然疼痛也可能受到情绪因素的影响，但情绪健康的影响和情绪健康对疼痛的间接影响都没有量化。方法对548例RA患者进行问卷调查。使用医院焦虑和抑郁量表（HADS）评估情绪健康。在实践中常规使用的措施被用来评估身体状态和疼痛。为了量化身体状态对情绪健康的影响，以及身体和情绪健康对疼痛的影响，我们使用了结构方程模型，将情绪健康，身体状态和疼痛作为潜在变量。结果焦虑和抑郁（HADS评分≥ 8分）的患病率分别为18.7%和29.4%。情绪健康受到身体状况的显著影响（β = 0.21）。疼痛受身体（β = 0.54）和情绪健康（β = 0.29）的影响。身体状态对疼痛的影响是由情绪健康介导的，这种介导效应（β = 0.06）占总效应的10.2%。结论RA患者疼痛的程度不仅受直接躯体状态的影响，而且受情绪健康的中介作用。我们的研究结果表明，情绪因素应考虑到评估类风湿关节炎疾病的活动。
Objective Pain is one of the main symptoms of patients with rheumatoid arthritis (RA). Pain in RA is caused by specific physical changes, such as joint destruction, and is therefore used as a disease activity marker. Although pain can also be influenced by emotional factors, neither the effect of emotional health nor the indirect effect of the physical state mediated by emotional health on pain has been quantified. Methods A total of 548 patients with RA participated. Emotional health was assessed using the Hospital Anxiety and Depression Scale (HADS). Measures routinely used in practice were used to evaluate the physical state and pain. To quantify the effects of the physical state on emotional health, and the effects of both physical and emotional health on pain, we used structural equation modeling, with emotional health, physical state, and pain as latent variables. Results The prevalence of anxiety and depression (HADS score >= 8 for each) among patients with RA was 18.7% and 29.4%, respectively. Emotional health was significantly influenced by the physical state (beta = 0.21). Pain was affected by physical (beta = 0.54) and emotional health (beta = 0.29). The effect of the physical state on pain was mediated by emotional health, with this mediation effect (beta = 0.06) accounting for 10.2% of the total effect. Conclusion The magnitude of pain in RA is determined by the mediation effect of emotional health as well as the direct physical state. Our findings suggest that emotional factors should be taken into account when assessing RA disease activity.