Depression and its association with disease activity and quality of life in patients with rheumatoid arthritis at the Kenyatta National Hospital

Abstract

Rheumatoid arthritis is a systemic inflammatory disease that affects the synovial membrane, resulting in the structural damage of cartilage, bone  and ligaments. The course of RA differs between patients, and its severity can range from selflimiting disease to severe destruction and systemic complications. RA affects patients physically, psychologically and socially. Patients experience pain, joint swelling, stiffness, functional limitations and fatigue and overall poor quality of life. In addition, they report anxiety and depressive symptoms and concerns about increased physical limitations. Experiencing psychological distress may inflate the subjective severity of patient-reported symptoms such as pain and tenderness. Furthermore, patients experience a loss of independence and restrictions in participation, i.e. a decrease in socializing which may in turn propagate symptoms of depression. An accurate description of the relationship between depression, disease severity and quality of life is necessary for our setting. If an interaction exists, then there is a group of vulnerable patients who could benefit from earlier identification of depression and the impact their  disease has on HRQoL and appropriate management provided.

Objective: To determine the prevalence of depression and the relationship between depression, disease activity and quality of life in ambulatory patients with rheumatoid arthritis at the Kenyatta National  Hospital.

Design: A descriptive-cross sectional study.

Methods: The study was carried out at the rheumatology clinic at the Kenyatta National Hospital. The study population included ambulatory patients with a diagnosis of rheumatoid arthritis who were above the age of 14 years. Seventy four patients with rheumatoid arthritis were studied. The PHQ-9 and SF-36 were used to asses for depression and quality of life respectively. Statistical associations of patients’ characteristics, co-morbid depression and HRQoL scores were analyzed using Chi-square test.

Results: The prevalence of comorbid depression in patients with rheumatoid arthritis at the outpatient clinic in KNH using the PHQ-9 was 28.4%, of
which 13.5% had mild depression, 9.5% had moderate depression and 5.4% had severe depression. Patients with poorer physical health quality of life scores were more likely to be depressed (p=0.041). Patients who had poorer energy scores, poorer emotional well-being scores and poorer social functioning scores were significantly more likely to be depressed.

Conclusion: In the study population of rheumatoid arthritis, the prevalence of depression is much higher than the prevalence of depression in the  general population. The chronic disease has also led to poor quality of life due to the debilitating nature of the disease. Statistical negative  correlation was found between sub types of quality of life scores related to energy, emotional well-being and social functioning. Poor physical health scores were found to be correlated to presence of depression. The population has greater disease activity which leads to poor physical health and poor mental health.

Key words: Rheumatoid arthritis, Depression, Quality of life, Disease  activity