Email this article Successful psychopharmacotherapy of anxiety and depressive disorders improve functional limitations in patients with rheumatoid arthritis
- Authors: Abramkin A.A.1, Lisitsyna T.A.1, Veltishchev D.Y.2,3, Seravina O.F.2, Kovalevskaya O.B.2, Glukhova S.I.1, Nasonov E.L.1,4
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Affiliations:
- Nasonova Research Institute of Rheumatology
- Moscow Research Institute of Psychiatry – branch of the Serbsky National Medical Research Center of Psychiatry and Narcology
- Pirogov Russian National Research Medical University
- Sechenov First Moscow State Medical University (Sechenov University)
- Issue: Vol 94, No 5 (2022)
- Pages: 616-621
- Section: Original articles
- URL: https://journals.rcsi.science/0040-3660/article/view/108777
- DOI: https://doi.org/10.26442/00403660.2022.05.201514
- ID: 108777
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Abstract
Aim. To compare changes in functional limitations in patients with rheumatoid arthritis (RA) and comorbid anxiety and depressive disorders (ADD) treated with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) alone or in combination with biologic DMARDs (bDMARDs) and/or psychopharmacotherapy (PPT), and to determine predictors of HAQ treatment response.
Materials and methods. 128 RA-patients were enrolled, 86% were women with a mean age of 47.4±11.3 (M±SD) years and a median of RA duration – 96 [48; 228] months. Disease activity was assessed using DAS28, functional limitations – using Health Assessment Questionnaire (HAQ). The Minimal Clinical Important Difference in HAQ was considered to be 0.22. ADD were diagnosed by a licensed psychiatrist in 123 (96.1%) of RA-pts in accordance with ICD-10 in semi-structured interview. Severity of depression and anxiety was evaluated with Montgomery–Asberg Depression Rating Scale and Hamilton Anxiety Rating Scale. RA-pts with ADD were divided into the following treatment groups: 1 – сsDMARDs (n=39), 2 – сsDMARDs + PPT (sertraline or mianserine; n=43), 3 – сsDMARDs + bDMARDs (n=32), 4 – сsDMARDs + bDMARDs + PPT (sertraline or mianserine; n=9); 83 (67.5%) patients were assessed at 5-years follow-up. Multivariable logistic regression was performed to determine predictors of HAQ treatment response.
Results. Only remission of anxiety and depressive symptoms at 5-yrs endpoint (OR 6.6, 95% CI 1.78–24.43, p=0.005), higher baseline HAQ (OR 2.61, 95% CI 1.12–6.11, p=0.027) and lower baseline BMI (OR 0.9, 95% CI 0.85–0.96, p=0.001) were independently associated with HAQ treatment response at 5-years follow-up.
Conclusion. While ADD do affect functional limitations in patients with RA, PPT tends to attenuate the negative impact of ADD on RA outcomes, and RA patients with functional limitations should therefore be screened for depression and long-term PPT should be recommended.
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##article.viewOnOriginalSite##About the authors
Anton A. Abramkin
Nasonova Research Institute of Rheumatology
Author for correspondence.
Email: angrydoctor2015@yandex.ru
ORCID iD: 0000-0002-1504-5645
канд. мед. наук, мл. науч. сотр. лаб. тромбовоспаления ФГБНУ «НИИ ревматологии им. В.А. Насоновой»
Russian Federation, MoscowTatiana A. Lisitsyna
Nasonova Research Institute of Rheumatology
Email: angrydoctor2015@yandex.ru
ORCID iD: 0000-0001-9437-406X
д-р мед. наук, вед. науч. сотр. лаб. тромбовоспаления ФГБНУ «НИИ ревматологии им. В.А. Насоновой»
Russian Federation, MoscowDmitry Yu. Veltishchev
Moscow Research Institute of Psychiatry – branch of the Serbsky National Medical Research Center of Psychiatry and Narcology; Pirogov Russian National Research Medical University
Email: angrydoctor2015@yandex.ru
ORCID iD: 0000-0001-5210-2605
д-р мед. наук, рук. отд-ния психических расстройств при соматических заболеваниях Московского НИИ психиатрии – филиала ФГБУ «НМИЦ ПН им. В.П. Сербского», проф. каф. психиатрии ФГАОУ ВО «РНИМУ им. Н.И. Пирогова»
Russian Federation, Moscow; MoscowOlga F. Seravina
Moscow Research Institute of Psychiatry – branch of the Serbsky National Medical Research Center of Psychiatry and Narcology
Email: angrydoctor2015@yandex.ru
ORCID iD: 0000-0001-5839-4637
науч. сотр. отд-ния психических расстройств при соматических заболеваниях Московского НИИ психиатрии – филиала ФГБУ «НМИЦ ПН им. В.П. Сербского»
Russian Federation, MoscowOksana B. Kovalevskaya
Moscow Research Institute of Psychiatry – branch of the Serbsky National Medical Research Center of Psychiatry and Narcology
Email: angrydoctor2015@yandex.ru
ORCID iD: 0000-0001-6573-4337
науч. сотр. отд-ния психических расстройств при соматических заболеваниях Московского НИИ психиатрии – филиала ФГБУ «НМИЦ ПН им. В.П. Сербского»
Russian Federation, MoscowSvetlana I. Glukhova
Nasonova Research Institute of Rheumatology
Email: angrydoctor2015@yandex.ru
ORCID iD: 0000-0002-4285-0869
канд. физ.-мат. наук, ст. науч. сотр. лаб. медико-социальных проблем ревматологии ФГБНУ «НИИ ревматологии им. В.А. Насоновой»
Russian Federation, MoscowEvgeny L. Nasonov
Nasonova Research Institute of Rheumatology; Sechenov First Moscow State Medical University (Sechenov University)
Email: angrydoctor2015@yandex.ru
ORCID iD: 0000-0002-1598-8360
акад. РАН, д-р мед. наук, проф., науч. рук. ФГБНУ «НИИ ревматологии им. В.А. Насоновой», зав. каф. ревматологии ФГАОУ ВО «Первый МГМУ им. И.М. Сеченова» (Сеченовский Университет)
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