Rheumatoid Arthritis: Emotional Toll May Be Declining

Laird Harrison

December 04, 2013

The depression and anxiety associated with rheumatoid arthritis have decreased in the last 20 years, along with disabilities from the disease, researchers report in an article published online December 3 in Arthritis Care & Research.

The study of 1151 Dutch people treated for rheumatoid arthritis showed that the proportion with depression dropped from 25% in 1993 to 14% in 2011.

"We're very, very pleased with what we found," first author Cécile L. Overman, MSc, from the Department of Clinical and Health Psychology, Utrecht University, the Netherlands, told Medscape Medical News. "I think it's a hopeful message."

Arthritis can disable patients and lead to depression and anxiety, but more effective drugs for the disease have reached the market in the last 20 years. In addition, lifestyle recommendations for patients have shifted from rest to exercise, and clinicians also do more to encourage their patients to live full lives, Overman and colleagues note.

To measure how these changes in treatment have affected patients' emotional states, the authors reviewed records of patients diagnosed with rheumatoid arthritis. They evaluated the patients' emotional well-being, using their scores on the Impact of Rheumatic Diseases on General Health and Lifestyle questionnaire, and disability, using the patients' response on the Disability Index of the Health Assessment Questionnaire. The investigators also assessed disease activity, using erythrocyte sedimentation rate and the Thompson articular index.

Of the 1151 patients, 1060 provided all the data needed at diagnosis and 768 provided all the data needed at both diagnosis and follow-up.

The researchers compiled data into 5-year cohorts and produced a comparison of assessments at diagnosis from 1990 to 1994 and from 2004 to 2008, along with assessments at follow-up in 1994 to 1998 and 2007 to 2011.

Table. Emotional Symptoms and Disability

  Diagnosis, 1990 - 1994 Follow-up, 1994 - 1998 Diagnosis, 2004 - 2008 Follow-up, 2007 - 2011
Depression 43% 25% 32% 14%
Anxiety 34% 23% 21% 12%
Disability 64% 53% 60% 31%

The improvement in these symptoms at diagnosis across the 2 decades was statistically significant (P = .01 for depression, .001 for anxiety, and .02 for disability).

The researchers also found a significant correlation between reduced disease activity and reduced depression, anxiety, and disability, although they cautioned that they could not prove a cause and effect.

The new drugs might also influence the patients' moods biologically, perhaps by blocking cytokines, they write.

The reason that fewer patients showed anxiety, depression, and disability at diagnosis may be that they are being diagnosed earlier, before the full effect of the disease hits them, Overman said. "Maybe people are reaching out sooner nowadays than 20 years ago," she said. Public health authorities have encouraged early treatment, and because of the Internet, information is more easily available, allowing patients to diagnose themselves.

Patients diagnosed in 2004 to 2008 were younger at the time of diagnosis than patients diagnosed in 1990 to 1994. They were also better educated and had a higher socioeconomic status and longer life expectancy, all of which are factors that might have contributed to their emotional well-being. However, the emotional distress of the general population worsened during the same period, even as education, socioeconomic status, and life expectancy improved.

Some evidence suggests treating rheumatoid arthritis within the first 6 weeks of its onset can effectively cure the disease, Patience White, MD, a spokesperson for the American Arthritis Foundation, told Medscape Medical News.

"As a practicing rheumatologist, I would say what they are reporting is exactly like what I have been seeing," said Dr. White, a professor of medicine and pediatrics at George Washington University in Washington, DC. The data also correspond to the findings in much shorter-term studies in the United States, she noted.

"The study is remarkable because they have been looking at it for such a long time," she added. "I certainly think it adds to the literature. The message here is that people with inflammatory arthritis do well and have full life."

This study is supported by a grant of the Faculty of Social and Behavioral Sciences of Utrecht University and by unrestricted grants of the Dutch Arthritis Foundation. The authors and Dr. White have disclosed no relevant financial relationships.

Arthritis Care Res. Published online December 3, 2013. Abstract

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