Chronic pain and depression in patients with rheumatoid arthritis: results of five - year follow - up


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Abstract

The aim of the study was to analyze the factors affecting chronic pain in patients with rheumatoid arthritis (RA). Materials and methods. 128 patients with reliable diagnosis of RA [111 (86.7%) women and 17 (13.3%) men] were examined. The mean age of patients was 47.4±11.3 years, the median duration of the disease was 96 [48; 228] months. When included in the study in most patients, the activity of RA in DAS28 was moderate (n=56; 43.7%) or high (n=48; 37.5%). BPI (Brief Pain Inventory) scale was used to determine the severity of pain and its impact on various aspects of life. The anxiety - depressive spectrum disorders (ADDs) were diagnosed by psychiatrist during a semistructured interview according to ICD-10 criteria in 123 (96.1%) patients. The severity of depression was determined by the Montgomery-Asberg depression rating scale, anxiety - by Hamilton anxiety scale. For the diagnosis of cognitive impairment used clinical and psychological techniques. Psychopharmacotherapy (PPhT) by antidepressants or anxiolytics is offered to all patients with ADDs, 52 of them agreed to treatment, 71 patients refused. The next groups selected depending on the therapy: 1st - with conventional disease - modifying antirheumatic drugs (cDMARDs; n=39), 2nd - with cDMARDs+PPhT (n=43), 3d - with cDMARDs + biologic (b) DMARDs (n=32), 4th - with cDMARD+bDMARDs+PPhT (n=9). The dynamics of ADDs and outcomes of RA in 5 years were evaluated in 83 (67.5%) patients. Results. When included in the study, 94 (75.2%) patients with RA had moderate and severe pain. According to the regression analysis, the maximum intensity pain in BPImax after 5 years of follow - up associated not the only factors connected with RA - high DAS28, the serum level of C-reactive protein, the degree of radiological stage and functional insufficiency, duration of RA and a lesser duration of glucocorticoids intake, but also with continuing depressive episodes in the framework of recurrent depression and the initial presence of cognitive impairment. The severity of pain after 5 years of follow - up was higher in RA patients receiving only сDMARDs, without the use of bDMARDs and in the absence of PPhT associated with ADDs. Conclusion. Depressive episode within recurrent major depression is a significant factor in the chronicity of pain in patients with RA. Timely effective PPhT of depression, selected taking into account depression structure and personal characteristics of the patient, leads to a steady decrease in the severity of pain in patients with RA.

About the authors

T A Lisitsyna

V.A. Nasonova Scientific and Research Institute of Rheumatology

Email: talisitsyna@rambler.ru
д.м.н., в.н.с. лаб. сосудистой ревматологии ФГБНУ «НИИР им. В.А. Насоновой»; ORCID: 0000-0001-9437-406X Moscow, Russia

A A Abramkin

V.A. Nasonova Scientific and Research Institute of Rheumatology

аспирант ФГБНУ «НИИР им. В.А. Насоновой» Moscow, Russia

D Yu Veltishchev

Moscow Research Institute of Psychiatry - Branch National Medical Research Center of Psychiatry and Narcology, Ministry of Health of Russia; Pirogov Russian National Research Medical University, Ministry of Health of Russia, department of psychiatry

д.м.н., проф., руководитель отд-ния психических расстройств при соматических заболеваниях Московского научно-исследовательского института психиатрии - филиала ФГБУ «Национальный медицинский исследовательский центр психиатрии и наркологии им. В.П. Сербского»; проф. каф. психиатрии ФДПО «РНИМУ им. Н.И. Пирогова» Moscow, Russia

O F Seravina

Moscow Research Institute of Psychiatry - Branch National Medical Research Center of Psychiatry and Narcology, Ministry of Health of Russia

н.с. отд-ния психических расстройств при соматических заболеваниях Московского научно-исследовательского института психиатрии - филиала ФГБУ «Национальный медицинский исследовательский центр психиатрии и наркологии им. В.П. Сербского» Moscow, Russia

O B Kovalevskaya

Moscow Research Institute of Psychiatry - Branch National Medical Research Center of Psychiatry and Narcology, Ministry of Health of Russia

н.с. отд-ния психических расстройств при соматических заболеваниях Московского научно-исследовательского института психиатрии - филиала ФГБУ «Национальный медицинский исследовательский центр психиатрии и наркологии им. В.П. Сербского» Moscow, Russia

A E Zeltyn

Moscow Research Institute of Psychiatry - Branch National Medical Research Center of Psychiatry and Narcology, Ministry of Health of Russia

к.м.н., ст.н.с. отделения психических расстройств при соматических заболеваниях Московского научно-исследовательского института психиатрии - филиала ФГБУ «Национальный медицинский исследовательский центр психиатрии и наркологии им. В.П. Сербского» Moscow, Russia

S I Glukhova

V.A. Nasonova Scientific and Research Institute of Rheumatology

к.ф-м.н., н.с. лаб. научно-организационных проблем ревматологии ФГБНУ «НИИР им. В.А. Насоновой» Moscow, Russia

E L Nasonov

V.A. Nasonova Scientific and Research Institute of Rheumatology; I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)

акад. РАН, д.м.н., проф., научный руководитель ФГБНУ «НИИР им. В.А. Насоновой»; зав. каф. ревматологии Института профессионального образования ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Moscow, Russia

V N Krasnov

Moscow Research Institute of Psychiatry - Branch National Medical Research Center of Psychiatry and Narcology, Ministry of Health of Russia; Pirogov Russian National Research Medical University, Ministry of Health of Russia, department of psychiatry

д.м.н., проф., зав. каф. психиатрии ФДПО «РНИМУ им. Н.И. Пирогова» Moscow, Russia

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