Skip to main content
Top

16-08-2017 | Depression | Practical approach | Article

Identification and Treatment Optimization of Comorbid Depression in Rheumatoid Arthritis

Journal: Rheumatology and Therapy

Authors: Mellissa H. Withers, Louella T. Gonzalez, George A. Karpouzas

Publisher: Springer Healthcare

Abstract

Patients with rheumatoid arthritis (RA) suffer from high rates of depression but depression often remains undiagnosed and untreated among RA patients. Because of its high prevalence and its profound impact on functional disability and health-related quality of life, prompt recognition and management of comorbid depression is urgently needed in patients with RA. Rheumatologists face the challenge of addressing depression in their clinical interactions with patients. The purpose of this paper is to present the prevalence of comorbid depression in RA, to delineate the consequences of depression among RA patients, to discuss the barriers to the identification of depression among RA patients, and to outline a set of recommendations to identify and treat comorbid depression that could be implemented within the rheumatology clinic setting. A comprehensive approach to the management of both physical and mental health needs of RA patients can aid in improving patient overall quality of life. New clinical protocols should be developed to include routine depression screening as part of the rheumatology visit. Patient education to address misconceptions, knowledge gaps, and destigmatize depression is also recommended. More counseling resources, including emotional support groups, are necessary to provide treatment for those suffering from depression. Such interventions could help mitigate disability, improve quality of life, patient function, and overall satisfaction.
Literature
1.
American Psychiatric Association (APA). Diagnostic and statistical manual of mental disorders, 5th edn. 2013. http://​dsm.​psychiatryonline​.​org/​doi/​book/​10.​1176/​appi.​books.​9780890425596. Accessed 19 April 2017.
2.
Dickens CA, McGowan L, Clark-Carter D, et al. Depression in rheumatoid arthritis: a systematic review of the literature with meta-analysis. Psychosom Med. 2002;64:52–60.PubMed
3.
Covic T, Tyson G, Spencer D, Howe G. Depression in rheumatoid arthritis patients: demographic, clinical, and psychological predictors. J Psychosom Res. 2006;60:469–76.PubMed
4.
Nicassio PM. Understanding the role and significance of gender differences in pain and depression in Chinese elders with osteoarthritis. Pain. 2007;130:6–7.PubMed
5.
Isik A, Koca SS, Ozturk A, Mermi O. Anxiety and depression in patients with rheumatoid arthritis. Clin Rheumatol. 2007;26:872–8.PubMed
6.
Clarke DM, Currie KC. Depression, anxiety, and their relationship with chronic diseases: a review of the epidemiology, risk, and treatment evidence. Med J Aust. 2009;191:S54–60.
7.
Wolfe K, Michaud K. Predicting depression in rheumatoid arthritis: the signal importance of pain extent and fatigue, and comorbidity. Arthritis Rheum. 2009;61:667–73.PubMed
8.
Lok EYC, Mok CC, Cheng CW, Cheung EFC. Prevalence and determinants of psychiatric disorders in patients with rheumatoid arthritis. Psychosomatics. 2010;51:338–338.e8.PubMed
9.
Matcham F, Rayner L, Steer S, Hotopf M. The prevalence of depression in rheumatoid arthritis: a systematic review and meta-analysis. Rheumatology. 2013;52:2136–48.PubMedPubMedCentral
10.
Dougados M, Perrodeau E, Fayet F, et al. Impact of a nurse led program of patient self-assessment of disease activity on the management of rheumatoid arthritis: results of a prospective, multicentre, randomized, control trial (COMEDRA). Ann Rheum Dis. 2013;72:150.
11.
Eusden J, Matcham F, Hotopf M, et al. The relationship between mental health, disease severity, and genetic disorders in early rheumatoid arthritis. Psychosom Med. 2017. http://​insights.​ovid.​com/​crossref?​an=​00006842-900000000-98839. Accessed 29 April 2017.
12.
US National Institute of Mental Health. National Survey on Drug Use and Health (NSDUH). 2015. https://​www.​nimh.​nih.​gov/​health/​topics/​depression/​index.​shtml. Accessed 25 May 2017.
13.
Escalante A, Rincon I, Mulrow CD. Symptoms of depression and psychological distress among Hispanics with rheumatoid arthritis. Arthritis Care Res. 2000;13:156–67.PubMed
14.
Del Rincon I, Battafarano DF, Arroyo RA, Murphy FT, Fischbach M, Escalante A. Ethnic variation in the clinical manifestations of rheumatoid arthritis: role of HLA-DRB1 alleles. Arthritis Rheum. 2003;49:200–8.PubMed
15.
Bruce B, Fries JF, Murtagh KN. Health status disparities in ethnic minority patients with rheumatoid arthritis: a cross-sectional study. J Rheumatol. 2007;34:1475–9.PubMed
16.
Yazici Y, Kautiainen H, Sokka T. Differences in clinical status measures in different ethnic/racial groups with early rheumatoid arthritis: implications for interpretation of clinical trial data. J Rheumatol. 2007;34:311–5.PubMed
17.
Margaretten M, Yelin E, Imboden J, et al. Predictors of depression in a multiethnic cohort of patients with rheumatoid arthritis. Arthritis Rheumatol. 2009;61:1586–91.
18.
Margaretten M, Barton J, Julian L, et al. Socioeconomic determinants of disability and depression in patients with rheumatoid arthritis. Arthritis Care Res. 2011;63:24–246.
19.
Karpouzas GA, Dolatabadi S, Moran R, Li N, Nicassio M, Wiseman MH. Correlates and predictors of disability in vulnerable US Hispanics with rheumatoid arthritis. Arthritis Care Res (Hoboken). 2012;64:1274–81.
20.
McBurney CA, Vina ER. Racial and ethnic disparities in rheumatoid arthritis. Curr Rheumatol Rep. 2012;14:463–71.PubMed
21.
Withers M, Moran R, Nicassio P, Weisman M, Karpouzas G. Perspectives of vulnerable Hispanics with rheumatoid arthritis on depression: awareness, barriers to disclosure, and treatment options. Arthritis Care Res. 2015;67:484–92.
22.
Katz PP, Barton J, Trupin L, et al. Poverty, depression, or Lost in translation? Ethnic and language variation in patient-reported outcomes in rheumatoid arthritis. Arthritis Care Res (Hoboken). 2016;68(5):621–8.
23.
Dowdy SW, Dwyer KA, Smith CA, Wallston KA. Gender and psychological well-being of persons with rheumatoid arthritis. Arthritis Care Res. 1996;9:449–56.PubMed
24.
Theis KA, Hootman JM, Helmick GG, et al. State-specific prevalence of arthritis-attributable work limitation—United States, 2003 (reprinted from MMWR, vol 56, pg 1045–1049, 2007). JAMA. 2007;298:2255–6.
25.
Jacob L, Rockel T, Kostev K. Depression risk in patients with rheumatoid arthritis in the United Kingdom. 2017. http://​www.​medengine.​com/​Redeem/​C3F7F0602F129F4E​. Accessed 29 April 2007.
26.
Wright SJ, Barnard MU, Olson NY, Austin JS, Lindsley CB. Communication issues of young adults with arthritis. Arthritis Rheum. 1998;41:S250.
27.
Packham JC, Hall MA, Pimm TJ. Long-term follow-up of 246 adults with juvenile idiopathic arthritis: predictive factors for mood and pain. Rheumatology. 2002;41:1444–9.PubMed
28.
Plach SK, Napholz L, Kelber ST. Social, health, and age differences associated with depressive disorders in women with rheumatoid arthritis. Int J Aging Human Dev. 2005;61:179–94.
29.
Patten SB, Williams JV, Lavorato DH, et al. Patterns of association of chronic medical conditions and major depression. Epidemiol Psychiatr Sci. 2016;27:1–9.
30.
Evers AWM, Kraaimaat FW, Geenen R, Jacobs JWG, Bijlsma JWJ. Long-term predictors of anxiety and depressed mood in early rheumatoid arthritis: a 3 and 5 year follow up. J Rheumatol. 2002;29:2327–36.PubMed
31.
Li X, Gignac MAM, Anis AH. The indirect costs of arthritis resulting from unemployment, reduced performance, and occupational changes while at work. Med Care. 2006;44:304–10.PubMed
32.
Katz PP, Yelin EH. Prevalence and correlates of depressive symptoms among persons with rheumatoid arthritis. J Rheumatol. 1993;20:790–6.PubMed
33.
Katon W, Lin E, Kroenkem K. The association of depression and anxiety with medical symptom burden in patients with chronic medical illness. Gen Hosp Psychiatry. 2007;29:147–55.PubMed
34.
Katz PP, Yelin EH. The development of depressive symptoms among women with rheumatoid arthritis. The role of function. Arthritis Rheum. 1995;38:49–56.PubMed
35.
Wolfe F. A reappraisal of HAQ disability in rheumatoid arthritis. Arthritis Rheum. 2000;43:2751–61.PubMed
36.
Katz PP, Yelin EH. Activity loss and the onset of depressive symptoms: do some activities matter more than others? Arthritis Rheum. 2001;44:1194–202.PubMed
37.
El-Miedany YM, El Rasheed AH. Is anxiety a more common disorder than depression in rheumatoid arthritis? Joint Bone Spine. 2002;69:300–6.PubMed
38.
Cadena J, Vinaccia S, Perez A, Rico MI, Hinojosa R. The impact of disease activity on the quality of life, mental health status, and family dysfunction among Colombian patients with rheumatoid arthritis. J Clin Rheumatol. 2003;9:142–50.PubMed
39.
Covic T, Adamson B, Spencer D, Howe G. A biopsychosocial model of pain and depression in rheumatoid arthritis: a 12-month longitudinal study. Rheumatology. 2003;42:1287–94.PubMed
40.
Neugebauer A, Katz PP. Impact of social support on valued activity disability and depressive symptoms in patients with rheumatoid arthritis. Arthritis Rheum. 2004;51:586–92.PubMed
41.
Nakajima A, Kamitsuji S, Saito A, et al. Disability and patient’s appraisal of general health contribute to depressed mood in rheumatoid arthritis in a large clinical study in Japan. Mod Rheumtaol. 2006;16:151–7.
42.
Katz P, Morris A. Time use patterns among women with rheumatoid arthritis: association with functional limitations and psychology status. Rheumatology. 2007;46:490–5.PubMed
43.
Smith BW, Zautra AJ. The effects of anxiety and depression on weekly pain in women with arthritis. Pain. 2008;138:354–61.PubMedPubMedCentral
44.
Atal SA, Ceceli E, Okumu M, et al. The evaluation of pain in patients with rheumatoid arthritis. Pain Pract. 2009;9:31.
45.
Van’t Land H, Verdurmen J, Ten Have M, et al. The association between arthritis and psychiatric disorders; results from a longitudinal population-based study. J Psychosom Res. 2010;68:187–93.
46.
Morris A, Yelin EH, Panopalis P, et al. Long-term patterns of depression and associations with health and function in a panel study of rheumatoid arthritis. J Health Psychol. 2011;16:667–77.PubMedPubMedCentral
47.
Rezai F, Doost HTN, Molavi H, Abedi MR, Karimifar M. Depression and pain in patients with rheumatoid arthritis: mediating role of illness perception. Egypt Rheumatol. 2014;36:57–64.
48.
Benka J, Nagyova I, Rosenberger J, et al. Social participation in early and established rheumatoid arthritis patients. Disabil Rehabil. 2016;38:1172–9.PubMed
49.
Joyce AT, Smith P, Khandker R, Melin JM, Singh A. Hidden cost of rheumatoid arthritis (RA): estimating cost of comorbid cardiovascular disease and depression among patients with RA. J Rheumatol. 2009;36:743–52.PubMed
50.
DiMatteo MR, Lepper HS, Croghan TW. Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence. Arch Intern Med. 2000;160:2101–7.PubMed
51.
McNamara D, Stebbings S, Highton J. Severe osteoarthritis is associated with similar fatigue and greater pain scores than rheumatoid arthritis, at comparable levels of disability. Rheumatology. 2007;46:160.
52.
Julian LJ, Yelin E, Yazdany J, et al. Depression, medication adherence, and service utilization in systemic lupus erythematosus. Arthritis Rheum. 2009;61:240–6.PubMedPubMedCentral
53.
Nicassio PM, Ormseth SR, Kay M, et al. The contribution of pain and depression to self-reported sleep disturbance in patients with rheumatoid arthritis. Pain. 2012;153:107–12.PubMed
54.
Katz P. Causes and consequences of fatigue in rheumatoid arthritis. Curr Opin Rheumatol. 2017;29:269–76.PubMed
55.
Pincus T. Is mortality increased in patients with rheumatoid arthritis? J Musculoskelet Med. 1988;5:27–46.
56.
Scherrer JF, Virgo KS, Zeringue A, et al. Depression increases risk of incident myocardial infarction among veterans administration patients with rheumatoid arthritis. Gen Hosp Psych. 2009;31:353–9.
57.
Fuller-Thomson E, Shaked Y. Factors associated with depression and suicidal ideation among individuals with arthritis or rheumatism: findings from a representative community survey. Arthritis Rheum. 2009;61:944–50.PubMed
58.
Treharne GJ, Lyons AC, Kitas GD. Suicidal ideation in patients with rheumatoid arthritis: research may help identify patients at high risk. BMJ. 2000;321:1290.PubMedPubMedCentral
59.
Ang DC, Choi H, Kroenke K, Wolfe F. Comorbid depression is an independent risk factor for mortality in patients with rheumatoid arthritis. J Rheumatol. 2005;32:1013–9.PubMed
60.
Karpouzas GA, Draper T, Moran R, et al. Trends in functional disability and determinants of clinically meaningful change over time in hispanic patients with rheumatoid arthritis in the US. Arthritis Care Res (Hoboken). 2017;69(2):294–8.
61.
Bazzichi L, Maser J, Piccinni A, et al. Quality of life in rheumatoid arthritis: impact of disability and lifetime depressive spectrum symptomatology. Clin Exp Rheumatol. 2005;23:783–8.PubMed
62.
Piccini A, Maser JD, Bazzichi L, et al. Clinical significance of lifetime mood and panic-agoraphobic spectrum symptoms on quality of life of patients with rheumatoid arthritis. Compr Psychiatry. 2006;47:201–8.
63.
Ormseth SR, Draper TL, Irwin MR, et al. A multidimensional model of disability and role functioning in rheumatoid arthritis. Arthritis Care Res. 2015;67(12):1686–92.
64.
Doeglas DM, Suurmeijer TPBM, van den Heuvel WJA, et al. Functional ability, social support, and depression in rheumatoid arthritis. Qual Life Res. 2004;13:1053–65.PubMed
65.
Katz PP, Neugebauer A. Does satisfaction with abilities mediate the relationship between the impact of rheumatoid arthritis on valued activities and depressive symptoms? Arthritis Rheum. 2001;45:263–9.PubMed
66.
Michaud K, Wolfe F. Comorbidities in rheumatoid arthritis. Best Pract Res Clin Rheumatol. 2007;21:885–906.PubMed
67.
Neugebauer A, Katz PP, Pasch LA. Effect of valued activity disability, social comparisons, and satisfaction with ability on depressive symptoms in rheumatoid arthritis. Health Psychol. 2003;22(3):253–62.PubMed
68.
Nicassio PM. The problem of detecting and managing depression in the rheumatology clinic. Arthritis Care Res. 2008;59:155–8.
69.
Roubille C, Richer V, Starnino T, et al. Evidence-based recommendations for the management of comorbidities in rheumatoid arthritis, psoriasis, and psoriatic arthritis: expert opinion of the Canadian Dermatology-Rheumatology Comorbidity Initiative. J Rheumatol. 2015;42:1767–80.PubMed
70.
Pinto-Gouveia J, Costa J, Maroco J. The first 2-years of rheumatoid arthritis: the influence of acceptance on pain, physical limitation and depression. J Health Psychol. 2013;20:102–12.PubMed
71.
Linton SJ, Nicholas MK, MacDonald S, et al. The role of depression and catastrophizing in musculoskeletal pain. Eur J Pain. 2011;15(4):416–22.PubMed
72.
Edwards RR, Bingham CO, Bathon J, Haythornthwaite JA. Catastrophizing and pain in arthritis, fibromyalgia, and other rheumatic diseases. Arthritis Rheum. 2006;55:325–32.PubMed
73.
Evers AW, Verhoeven EW, van Middendorp H, et al. Does Stress affect the joints? Daily stressors, stress vulnerability, immune and HPA axis activity, and short-term disease and symptoms fluctuation in rheumatoid arthritis. Ann Rheum Dis. 2014;73:1683–8.PubMed
74.
Edwards RR, Cahalan C, Mensing G, Smith M, Haythornthwaite JA. Pain, catastrophizing, and depression in rheumatic diseases. Nat Rev Rheumatol. 2011;7:216–24.PubMed
75.
Sleath B, Chewning B, de Vellis BM, et al. Communication about depression during rheumatoid arthritis patient visits. Arthritis Rheum. 2008;15:186–91.
76.
Nicassio PM, Irani M. Depression in rheumatoid arthritis. Rheumatologist. 2012. http://​www.​the-rheumatologist.​org/​article/​depression-in-rheumatoid-arthritis/​4/​. Accessed 29 April 2017.
77.
Cuijpers P, Andersson G, Donker T, et al. Psychological treatment of depression: results of a series of meta-analyses. Nord J Psychiatry. 2011;65:354–64.PubMed
78.
Fiest KM, Hitchon CA, Bernstein CN, et al. Defining the burden and managing the effects of psychiatric comorbidity in chronic immunoinflammatory disease. Systematic review and meta-analysis of interventions for depression and anxiety in persons with rheumatoid arthritis. J Clin Rheumatol. 2017. doi:10.​1097/​RHU.​0000000000000489​.PubMed
79.
Garfenski N, Kraaij V, Benoist M, Bout Z, Karels E, Smit A. Effect of a cognitive behavioral self-help intervention on depression, anxiety, and coping self-efficacy in people with rheumatic disease. Arthritis Care Res. 2013;65:1077–84.
80.
Pradhan E, Baumgarten M, Langenberg P, et al. Effect of mindfulness-based stress reduction in rheumatoid arthritis patients. Arthritis Rheum. 2007;57:1134–42.PubMed
81.
Zautra AJ, Davis MC, Reich JW, et al. Comparison of cognitive behavioral and mindfulness meditation interventions on adaptation to rheumatoid arthritis for patients with and without history of recurrent depression. J Consult Clin Psychol. 2008;76:408–21.PubMed
82.
Kelley GA, Kelley KS. Exercise reduces depressive symptoms in adults with arthritis: evidential value. Med Sci Sports Exerc. 2016;48(5 Suppl 1):607.PubMedCentral
83.
Kelley GA, Kelley KS, Hootman JM. Effects of exercise on depression in adults with arthritis: a systematic review with meta-analysis of randomized controlled trials. Arthritis Res Therapy. 2015;17(1):21.
84.
Neuberger GB, Aaronson LS, Gajewski B, et al. Predictors of exercise and effects of exercise on symptoms, function, aerobic fitness, and disease outcomes of rheumatoid arthritis. Arthritis Rheum. 2007;57(6):943–52.PubMed
85.
Herring MP, Puetz TW, O’connor PJ, Dishman RK. Effects of exercise training on depressive symptoms among patients with a chronic illness: a systematic review and meta-analysis of randomized controlled trials. Arch Int Med. 2012;172:101–11.
86.
Maiden NL, Hurst NP, Lochhead A, Carson AJ, Sharpe M. Quantifying the burden of emotional ill-health amongst patients referred to a specialist rheumatology service. Rheumatology. 2003;42:750–7.PubMed
87.
Kroenke K, Spitzer RL. The PHQ-9: a new depression and diagnostic severity measure. Psychiatr Ann. 2002;32(9):509–15.