Association of depression in rheumatoid arthritis: a single centre experience

Abstract

Background: To identify clinically important predictors of Rheumatoid Arthritis (RA) associated self-reported depression (SRD) in Eastern India.Methods: A questionnaire-based study was conducted among adult RA patients attending Rheumatology clinic at KPC Medical College and Hospital, Kolkata between 1st January 2016 to 31st December 2016.Results: A total of 246 questionnaires were returned (responder rate: 64.9%). 180 (47.49%) completed pairs were selected and were subsequently analyzed. Most RA patients had disease >5 years (61%), belonged to rural background (>50%) and middle-income group (43.3%). 89 patients (49.4%) reported having another major disease. Nearly 13% (working age group) claimed to be unemployed due to ‘health reasons.’ Unconditional logistic regression revealed that SRD was also related to work status (p <0.01). The prevalence of depression in RA group 21% (95% CI 15.5-26.9%), which was significantly higher (p <0.01) compared to non-RA cohort (8%; 95% CI 4-11.9). The mean score of SRD were consistently higher in females with RA (p <0.01). Treatment-naïve patients had higher incidence of depression compared to patients on >3 months of DMARDs (38% versus 17%; p<0.05). Moreover, SRD was higher in presence of co-morbidities, highest being in cancer (HR: 2.39, 95% CI 1.41-4.18), followed by chronic renal disease (HR: 2.26, 95% CI 1.05-4.12) and stroke (HR: 1.79, 95% CI 1.02-2.92).Conclusions: Depression is significantly higher patients with early RA. Pain level and work status is related, and may implicate a vicious circle. Early psychiatric evaluation may improve pain scores in RA.