Psychosocial
Abstract 864/123: Psychological Distress Predicts Common Health Outcomes in Early Inflammatory Arthritis
Authors: Orin Schieir, Murray Baron, Phyllis Zelkowitz, Karl Looper, Margaret Purden, Laeora Berkson, Mary Ann Fitzcharles, Michel Gagne, Bruce Garfield, Marie Hudson, Harb Kang, Morton Kapusta, Jiri Krasny, Henri Menard, Michael Starr, Michael Stein, Craig Watts. McGill University, Montreal, PQ, Canada
INTRODUCTION: Early Inflammatory Arthritis (EIA) includes patients with RA but also with Undifferentiated Inflammatory Arthritis (UI). The prevalence of psychological distress is high in IA but its contribution, in comparison to measures of disease activity, to commonly measured outcomes has not been extensively investigated. This study examines the relationship between psychological distress and disease outcomes in EIA.
METHODS: 149 patients with EIA ( >1 swollen joints, duration > 6 weeks & < 1 year, no specific diagnosis other than RA) completed a physical examination and questionnaires assessing psychological distress (CESD), pain (McGill Pain Questionnaire (MPQ)), disability (HAQ) and quality of life (WHODASII). Pearson’s correlation coefficient was calculated to assess the association between variables of interest.
RESULTS: 33.6% of respondents reported scores in the depressive range (score > 16) of the CESD and 22.6% scored > 19, a cutoff often used in RA.
Table 1. Correlation between distress, disease activity and pain, functioning and quality of life in early inflammatory arthritis patients.
|
CESD |
Swollen Joints |
|
|
Pain |
.484 |
.404 |
|
Physical functioning |
.494 |
.380 |
|
Quality of life |
.706 |
.322 |
In multiple stepwise regression analyses, psychological distress accounted for more variance in pain (R²=0.227, p<0.001) and physical functioning (R²=0.240, p<0.001) than the number of swollen joints (R²=0.074, p<0.001 and (R²=0.054, p<0.001) respectively, and psychological distress was the only predictor of scores on a measure of health related quality of life (R²=0.493, p<0.001).
CONCLUSION: Early Inflammatory Arthritis patients have a high prevalence of psychological distress. Psychological distress may be a more significant contributor to commonly measured health outcomes in Early Inflammatory Arthritis than is the number of swollen joints, a commonly used objective measure of disease activity/severity.
Editorial note: This is an interesting study that builds on previous work, mostly in established RA patients, demonstrating that depressive symptoms are more strongly associated pain, functioning and quality of life than disease activity markers. These data suggest that level of depressive symptoms are also common in EIA patients and may play an important role in perceptions of pain, functioning and quality of life. Depression is treatable. Employing effective treatments among patients with high levels of depressive symptoms may improve perceptions of pain, quality of life and disability. Clinicians should consider assessing depressive symptoms at regular intervals among RA and EIA patients.