Influence of successful psychopharmacotherapy of anxiety-depressive spectrum disorders on the severity of chronic fatigue in patients with rheumatoid arthritis

Cover Page

Cite item

Full Text

Abstract

Aim. To assess the influence of psychopharmacotherapy (PPT) of anxiety and depressive disorders on fatigue severity in patients with rheumatoid arthritis (RA).

Materials and methods. 128 RA-patients were included. Severity of fatigue was measured with fatigue severity scale (FSS), clinically important fatigue was diagnosed in patients with FSS≥4. Anxiety and depressive disorders (ADD) were diagnosed by a licensed psychiatrist in 123 (96.1%) of RA-patients in accordance with ICD-10 in semi-structured interview. Severity of depression and anxiety was evaluated with Montgomery–Asberg Depression Rating Scale (MADRS) and Hamilton Anxiety Rating Scale (HAM-A). RA-patients with ADD were divided into the following treatment groups: 1 – сDMARDs (n=39), 2 – сDMARDs+PPT (sertraline or mianserine), n=43, 3 – сDMARDs+bDMARDs (n=32), 4 – сDMARDs+bDMARDs+PPT (sertraline or mianserine), n=9. Biologics treatment duration varied from 1 to 5 years, antidepressants – from 6 to 96 weeks. 83 (67.5%) RA patients were assessed at five-years follow-up. Multinominal logistic regression analysis was conducted to determine factors associated with clinically important fatigue.

Results. Multinominal logistic regression analysis showed clinically important fatigue at baseline to be positively associated (OR 13.57; 95% CI 3.044–60.486; p=0.01) and remission of ADD – negatively associated (OR 0.162; 95% CI 0.032–0.809; p=0.027), with clinically important fatigue at 5 years follow-up (R2=0.385, p<0.0001).

Conclusion. Due to significant relationship between mental health status, antidepressants treatment and clinically important fatigue in RA-patients, all patients reporting clinically important fatigue should be recommended mental health counselling by a licensed psychiatrist.

About the authors

Anton A. Abramkin

Nasonova Research Institute of Rheumatology

Email: 79096237832@ya.ru
ORCID iD: 0000-0002-1504-5645

врач-ревматолог

Russian Federation, Moscow

Tatiana A. Lisitsyna

Nasonova Research Institute of Rheumatology

Email: 79096237832@ya.ru
ORCID iD: 0000-0001-9437-406X

вед. науч. сотр. лаб. сосудистой ревматологии

Russian Federation, Moscow

Dmitrii Y. Veltishchev

Moscow Research Institute of Psychiatry – branch of the Serbsky National Medical Research Center of Psychiatry and Narcology, Moscow, Russia; Pirogov Russian National Research Medical University

Email: 79096237832@ya.ru
ORCID iD: 0000-0001-5210-2605

рук. отд-ния психических расстройств при соматических заболеваниях МНИИП – филиала ФГБУ «НМИЦ ПН им. В.П. Сербского», проф. каф. психиатрии ФДПО ФГАОУ ВО «РНИМУ им. Н.И. Пирогова»

Russian Federation, Moscow; Moscow

Olga F. Seravina

Moscow Research Institute of Psychiatry – branch of the Serbsky National Medical Research Center of Psychiatry and Narcology

Author for correspondence.
Email: 79096237832@ya.ru
ORCID iD: 0000-0001-5839-4637

науч. сотр. отд-ния психических расстройств при соматических заболеваниях

Russian Federation, Moscow

Oksana B. Kovalevskaya

Moscow Research Institute of Psychiatry – branch of the Serbsky National Medical Research Center of Psychiatry and Narcology

Email: 79096237832@ya.ru
ORCID iD: 0000-0001-6573-4337

науч. сотр. отд-ния психических расстройств при соматических заболеваниях

Russian Federation, Moscow

Svetlana I. Glukhova

Nasonova Research Institute of Rheumatology

Email: 79096237832@ya.ru
ORCID iD: 0000-0002-4285-0869

cт. науч. сотр. лаб. медико-социальных проблем ревматологии

Russian Federation, Moscow

Evgeny L. Nasonov

Nasonova Research Institute of Rheumatology; Sechenov First Moscow State Medical University (Sechenov University)

Email: nasonov@irramn.ru
ORCID iD: 0000-0002-1598-8360

акад. РАН, д-р мед. наук, проф., науч. рук. ФГБНУ «НИИ ревматологии им. В.А. Насоновой», проф. ФГАОУ ВО «Первый МГМУ им. И.М. Сеченова»

Russian Federation, Moscow; Moscow

References

  1. Katz P. Fatigue in Rheumatoid Arthritis. Curr Rheumatol Rep. 2017;19(5):25. doi: 10.1007/s11926-017-0649-5
  2. Hewlett S, Chalder T, Choy E, et al. Fatigue in rheumatoid arthritis: time for a conceptual model. Rheumatology (Oxford). 2011;50(6):1004-6. doi: 10.1093/rheumatology/keq282
  3. Overman CL, Kool MB, Da Silva JAP, Geenen R. The prevalence of severe fatigue in rheumatic diseases: an international study. Clin Rheumatol. 2016;35(2):409-15. doi: 10.1007/s10067-015-3035-6
  4. Pollard LC, Choy EH, Gonzalez J, et al. Fatigue in rheumatoid arthritis reflects pain, not disease activity. Rheumatology. 2006;45(7):885-9. doi: 10.1093/rheumatology/kel021
  5. Druce KL, Jones GT, Macfarlane GJ, Basu N. Patients receiving anti-TNF therapies experience clinically important improvements in RA-related fatigue: Results from the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis. Rheumatol (Oxford). 2015;54(6):964-71. doi: 10.1093/rheumatology/keu390
  6. Gossec L, Steinberg G, Rouanet S, Combe B. Fatigue in rheumatoid arthritis: Quantitative findings on the efficacy of tocilizumab and on factors associated with fatigue. The French multicentre prospective PEPS study. Clin Exp Rheumatol. 2015;33(5):664-70
  7. Krupp LB, LaRocca NG, Muir-Nash J, Steinberg AD. The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol. 1989;46(10):1121-3. doi: 10.1001/archneur.1989.00520460115022
  8. Ream E, Richardson A. Fatigue: A concept analysis. Int J Nurs Stud. 1996;33(5):519-29. doi: 10.1016/0020-7489(96)00004-1
  9. Nordin Å, Taft C, Lundgren-Nilsson Å, Dencker A. Minimal important differences for fatigue patient reported outcome measures-a systematic review. BMC Med Res Methodol. 2016;16(1):62. doi: 10.1186/s12874-016-0167-6
  10. Meade T, Manolios N, Cumming SR, et al. Cognitive Impairment in Rheumatoid Arthritis: A Systematic Review. Arthritis Care Res (Hoboken). 2018;70(1):39-52. doi: 10.1002/acr.23243
  11. Nikolaus S, Bode C, Taal E, van de Laar MAFJ. Fatigue and Factors Related to Fatigue in Rheumatoid Arthritis: A Systematic Review. Arthritis Care Res (Hoboken). 2013;65(7):1128-46. doi: 10.1002/acr.21949
  12. Matcham F, Ali S, Hotopf M, Chalder T. Psychological correlates of fatigue in rheumatoid arthritis: A systematic review. Clin Psychol Rev. 2015;39:16-29. doi: 10.1016/j.cpr.2015.03.004
  13. Van Dartel SAA, Repping-Wuts JWJ, Van Hoogmoed D, et al. Association between fatigue and pain in rheumatoid arthritis: Does pain precede fatigue or does fatigue precede pain? Arthritis Care Res. 2013;65(6):862-9. doi: 10.1002/acr.21932
  14. Grøn KL, Ørnbjerg LM, Hetland ML, et al. The association of fatigue, comorbidity burden, disease activity, disability and gross domestic product in patients with rheumatoid arthritis. Results from 34 countries participating in the Quest-RA programme. Clin Exp Rheumatol. 2014;32(6):869-77
  15. Novaes GS, Perez MO, Beraldo MBB, et al. Correlation of fatigue with pain and disability in rheumatoid arthritis and osteoarthritis, respectively. Rev Bras Reumatol. 2011;51(5):447-55. doi: 10.1590/S0482-50042011000500005.
  16. Rongen-van Dartel SAA, Repping-Wuts H, Donders R, et al. A multidimensional “path analysis” model of factors explaining fatigue in rheumatoid arthritis. Clin Exp Rheumatol. 34(2):200-6. DOI: 27049923
  17. Feldthusen C, Grimby-Ekman A, Forsblad-D’Elia H, et al.Explanatory factors and predictors of fatigue in persons with rheumatoid arthritis: A longitudinal study. J Rehabil Med. 2016;48(5):469-76. doi: 10.2340/16501977-2090
  18. Żołnierczyk-Zreda D, Jędryka-Góral A, Bugajska J, et al.The relationship between work, mental health, physical health, and fatigue in patients with rheumatoid arthritis: A cross-sectional study. J Health Psychol. 2020;25(5):665-73. doi: 10.1177/1359105317727842
  19. Silva CFR, Duarte C, Ferreira RJO, et al. Depression, disability and sleep disturbance are the main explanatory factors of fatigue in rheumatoid arthritis: a path analysis model. Clin Exp Rheumatol. 2020;38(2):314-21.
  20. Druce KL, Basu N. Predictors of fatigue in rheumatoid arthritis. Rheumatology. 2019;58(Suppl.5):29-34. doi: 10.1093/rheumatology/kez346
  21. van Hoogmoed D, Fransen J, Bleijenberg G, van Riel P. Physical and psychosocial correlates of severe fatigue in rheumatoid arthritis. Rheumatology (Oxford).2010;49(7):1294-302. doi: 10.1093/rheumatology/keq043
  22. Olsen CL, Lie E, Kvien TK, Zangi HA. Predictors of Fatigue in Rheumatoid Arthritis Patients in Remission or in a Low Disease Activity State. Arthritis Care Res. 2016;68(7):1043-8. doi: 10.1002/acr.22787
  23. Druce KL, Jones GT, MacFarlane GJ, Basu N. Determining pathways to improvements in fatigue in rheumatoid arthritis: Results from the British Society for Rheumatology Biologics Register for rheumatoid arthritis. Arthritis Rheumatol. 2015;67(9):2303-10. doi: 10.1002/art.39238
  24. Druce KL, Bhattacharya Y, Jones GT, et al. Most patients who reach disease remission following anti-TNF therapy continue to report fatigue: Results from the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis. Rheumatol (Oxford). 2016;55(10):1786-90. doi: 10.1093/rheumatology/kew241
  25. The ICD-10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research. Geneva: WHO; 1993.
  26. Aletaha D, Neogi T, Silman AJ, et al. 2010 Rheumatoid arthritis classification criteria: An American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum. 2010;62(9):2569-81. doi: 10.1002/art.27584
  27. Насонов ЕЛ. Ревматология. Российские Клинические Рекомендации. М.: ГЭОТАР-Медиа; 2017 [Nasonov EL. Rheumatology. Russian Clinical Guidelines. Moscow: GEOTAR-Media, 2017 (in Russian)].
  28. Амирджанова В.Н., Койлубаева Г.Н., Горячев Д.В., и др. Валидация русско-язычной версии Health Assessment Questionnaire (HAQ). Научно-практическая ревматология. 2004;(2):59-64 [Amirdzhanova VN, Koilubaeva GN, Goriachev DV, et al. Validatsiia russko-iazychnoi versii Health Assessment Questionnaire (HAQ). Nauchno-prakticheskaia revmatologiia. 2004;(2):59-64 (in Russian)].
  29. Fransen J, van Riel PLCM. The Disease Activity Score and the EULAR Response Criteria. Rheum Dis Clin North Am. 2009;35(4):745-57. doi: 10.1016/j.rdc.2009.10.001
  30. van Gestel AM, Prevoo ML, van ’t Hof MA, et al. Development and validation of the European League Against Rheumatism response criteria for rheumatoid arthritis. Comparison with the preliminary American College of Rheumatology and the World Health Organization/International League Against Rheumatism Criteria. Arthritis Rheum. 1996;39(1):34-40. doi: 10.1002/art.1780390105
  31. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361-70. doi: 10.1111/j.1600-0447.1983.tb09716.x
  32. Hamilton M. The assessment of anxiety states by rating. Br J Med Psychol. 1959;32(1):50-5. doi: 10.1111/j.2044-8341.1959.tb00467.x
  33. Montgomery SA, Asberg M. A new depression scale designed to be sensitive to change. Br J Psychiatry. 1979;134:382-9. doi: 10.1192/bjp.134.4.382
  34. Лурия А.Р. Высшие корковые функции человека и их нарушения при локальных поражениях мозга. 2-е изд. М.: МГУ, 1962 [Luria AR. Higher cortical functions of a person and their disorders in local brain lesions. 2nd ed. Moscow: MGU, 1962 (in Russian)].
  35. Херсонский Б.Г. Метод пиктограмм в психодиагностике психических заболеваний. Киев: Здоровье, 1988 [Khersonskii BG. The method of pictograms in the psychodiagnostics of mental illness. Kiev: Health, 1988 (in Russian)].
  36. Зейгарник Б.В. Патология Мышления. 2-е изд. М.: МГУ, 1962 [Zejgarnik BV. Pathology of Thinking. 2nd ed. Moscow: MGU, 1962 (in Russian)].
  37. Альманах Психологических Тестов. 3-е изд. М.: КСП, 1995 [Almanac of Psychological Tests. 3rd ed. Moscow: KSP, 1995 (in Russian)]
  38. Рубинштейн С.Я. Экспериментальные методики патопсихологии и опыт применения их в клинике. Ред. Бутенко Г. М.: Изд-во института психотерапии, 2010 [Rubinstein SYa. Experimental methods of pathopsychology and experience of their application in the clinic. Ed. Butenko G. Moscow: Publishing house of the Institute of Psychotherapy, 2010 (in Russian)].
  39. American Psychiatric Association. Task Force on DSM-IV. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR. American Psychiatric Association, 2000.
  40. Герасимов АН. Медицинская статистика: учебное пособие. М.: Мед. информ. агентство, 2007 [Gerasimov AN. Medical Statistics: a tutorial. Moscow: Med. inform. agency, 2007 (in Russian)].
  41. Choy EH. Effect of biologics and targeted synthetic disease-modifying anti-rheumatic drugs on fatigue in rheumatoid arthritis. Rheumatol (Oxford). 2019;58(Suppl. 5)V51-5. doi: 10.1093/rheumatology/kez389
  42. Chauffier K, Salliot C, Berenbaum F, Sellam J. Effect of biotherapies on fatigue in rheumatoid arthritis: A systematic review of the literature and meta-analysis. Rheumatology. 2012;51(1):60-8. doi: 10.1093/rheumatology/ker162
  43. Pae C-U, Marks DM, Patkar AA, et al. Pharmacological treatment of chronic fatigue syndrome: focusing on the role of antidepressants. Expert Opin Pharmacother. 2009;10(10):1561-70. doi: 10.1517/14656560902988510
  44. Üçeyler N, Häuser W, Sommer C. A systematic review on the effectiveness of treatment with antidepressants in fibromyalgia syndrome. Arthritis Rheum. 2008;59(9):1279-98. doi: 10.1002/art.24000
  45. Häuser W, Bernardy K, Üçeyler N, Sommer C. Treatment of fibromyalgia syndrome with antidepressants: A meta-analysis. JAMA. 2009;301(2):198-209. doi: 10.1001/jama.2008.944
  46. Madsen SG, Danneskiold-Samsøe B, Stockmarr A, Bartels E. Correlations between fatigue and disease duration, disease activity, and pain in patients with rheumatoid arthritis: a systematic review. Scand J Rheumatol. 2016;45(4):255-61. doi: 10.3109/03009742.2015.1095943
  47. Van Steenbergen HW, Tsonaka R, Huizinga TWJ, et al. Fatigue in rheumatoid arthritis; A persistent problem: A large longitudinal study. RMD Open. 2015;1(1):e000041. doi: 10.1136/rmdopen-2014-000041
  48. Nicassio PM, Ormseth SR, Custodio MK, et al. A multidimensional model of fatigue in patients with rheumatoid arthritis. J Rheumatol. 2012;39(9):1807-13. doi: 10.3899/jrheum.111068
  49. Szady P, Bączyk G, Kozłowska K. Fatigue and sleep quality in rheumatoid arthritis patients during hospital admission. Reumatologia. 2017;55(2):65-72. doi: 10.5114/reum.2017.67600
  50. Albayrak Gİ, Balkarli A, Can B, et al. Pain, depression levels, fatigue, sleep quality, and quality of life inelderly patients with rheumatoid arthritis. Turkish J Med Sci. 2017;47(3):847-53. doi: 10.3906/sag-1603-147
  51. Лисицына Т.А., Вельтищев Д.Ю., Герасимов А.Н., и др. Выраженность усталости и ее связь с депрессией, болью и воспалительной активностью при ревматоидном артрите. Терапевтический архив. 2013;85(5):8-15 [Lisitsyna TA, Veltishchev DY, Gerasimov AN, et al. The magnitude of fatigue and its association with depression, pain, and inflammatory activity in rheumatoid arthritis. Terapevticheskii Arkhiv (Ter. Arkh.). 2013;85(5):8-15 (in Russian)].

Copyright (c) 2021 Consilium Medicum

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
 
 


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies