[2009] [OP-0227] PREVALENCE OF PSYCHIATRIC DISORDERS IN RHEUMATOID ARTHRITIS PATIENTS
T.A. Lisitsyna1, D.U. Veltishchev2, O.F. Seravina2, O.B. Kovalevskaya2, A.E. Zeltyn2, Y.S. Fofanova1, E.L. Nasonov1 1Systemic Rheumatic Diseases, State Institute of Rheumatology RAMS; 2Stress-related disorders, Moscow Research Institute of Psychiatry MoH, Moscow, Russian Federation
Background: Psychiatric disorders occur in rheumatoid arthritis (RA) patients very often. Psychiatric syndromes in RA usually are stress-related and associated with disease activity and chronic pain.
Objectives: To analyze the prevalence of psychiatric morbidity in RA-pts; some disease parameters, stress, pain, age impact for the genesis of psychiatric disorders.
Methods: 75 patients with RA were enrolled in this study. All the patients met the full American College of Rheumatology criteria for RA classification. 72 patients evaluated were women (96%) and 3 – men (4%), with a median age of 52 yrs (range 46 to 55) and median disease duration of 12 yrs (range 4 to 22). The patients' disease activity was assessed using the DAS 28 scoring system. Median DAS 28 score was 4,98 (range 3.71 to 6,4). Median prednisone intake duration - 34 month (range 3 to 72). 80% of RA-pts were taking DMARDS: most of them - methotrexate (49%) and leflunomide (23%). The Brief Pain Inventory (BPI) was used for pain assessment. Severe (7-10 point in BPI scale) and moderate (5-6 points in BPI scale) pain had 74% (37% and 37% accordingly) of RA-pts. Psychiatric disorders were diagnosed in accordance with the ICD-10. Psychiatric and psychological scales and methods used: Hospital Anxiety and Depression Scale for screening, Hamilton Anxiety Rating Scale, Montgomery-Asberg Depression Rating Scale and projective psychological methods for evaluation of cognitive functions.
Results: Psychiatric disorders were found in 47 RA-pts (63%). Depressive spectrum disorders prevailed (87%): depressive episode had 32 patients (68%); adjustment disorders - 8 (17%), dysthymia - 1 (2%). Severe cognitive dysfunction was revealed in 5 (11%) patients. Cognitive dysfunction due to depression was found in 12 RA-pts (25%). One patient (2%) had bipolar disorder. 33% of RA-pts had sleep disorders. All sleep disorders were found in depressive RA-pts. 52% of RA-pts indicated stress events before the RA onset. The patients with depressive disorders did not differ significantly on the age, duration of illness, gender, disease activity (DAS 28-score) from the patients without depression. Cognitive impairments significantly often (p=0,02) were revealed in patients older 50 yrs (39% vs 9%). The patients with depression often (p<0,05) had fourth stage of RA (X-ray) (47% vs 20%) and maximal stage of functional insufficiency (24% vs 5%). The pain was more intensive in patients with depression (R=0,67, p=0,02). We found positive correlation between pain intensity (BPI max) and sleep disorders (R=0,56, p=0,026). The age of the first prednisone intake was significantly more (p< 0,05) in patients with depression (48 vs 30 yrs). The patients with depression significantly less often (p=0,037) were taking methotrexate as DMARDS (26% vs 55%).
Conclusion: The results showed high prevalence (63%) of psychiatric disorders in our patient sample. Depressive disorders prevailed in the group with very high proportion (87%). Stress events preceded the RA onset in 52% of pts. Most of the investigated individual and morbid parameters with respect to age, gender, duration of illness, disease activity were not related to the diagnosis of depressive disorders. The patients with depression had more severe X-ray stage, functional insufficiency, pain and less aggressive treatment than patients without depression.
Disclosure of Interest: None declared
Ann Rheum Dis 2009;68(Suppl3):148
Abstract Session: Depression, fatigue and rheumatoid arthrtitis
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