Disease activity and functional status and their relation to depression in patients with rheumatoid arthritis

Abstract

Background: Rheumatoid arthritis (RA), one of the commonest forms of inflammatory arthritis, has significant societal impact with regards to cost, induction of disability and loss of productivity. This impact is magnified in the presence of comorbid mood disorders, as these constitute independent factors for unexplained flares and relapses.
Objective: The primary purpose of our study was to determine the correlation between disease activity and depression in RA patients.
Methods: Patients with RA attending rheumatology clinic at Aga Khan University Hospital, Nairobi were recruited into the study. The  patients’ disease activity and functional status were assessed using the Clinical Disease Activity Index and the Stanford Health Assessment Questionnaire respectively, whereas the level of depression was evaluated using the Patient Health Questionnaire-9. Pearson’s correlation coefficient was calculated for the disease activity and functional status versus the depression scores, and relationship between the disease activity and depression scores was analyzed using Chi square tables.
Results: A total of 60 patients were enrolled into the study, whose mean age was 48.8 ± 13.6 years. There were 52 females (86.7%). The  mean duration of RA symptoms was 71.6 ± 86.6 months, with the mean duration of RA treatment being 43.4 ± 64.5 months. Among the study participants, 28.3% had mild depression whereas 35% had moderate/severe depression. There was a strong positive correlation between disease activity and   depression (p<0.001), as well as between physical disability and depression.
Conclusion: This study found depressive symptoms in 63.3% of the patients, in spite of the study population being relatively young and having short duration of disease. The significant correlation observed between disease activity and depression illustrates the high  likelihood of undiagnosed comorbid depression as a co-existing factor in persistently active disease, poor response to therapy and unexplained flare-ups in the Kenyan RA population.