Within Our Reach-funded Study Finds Increased Risk for Depression Among At-risk Populations of RA Patients
A study recently published in Arthritis & Rheumatism found that patients with rheumatoid arthritis from multiethnic backgrounds have nearly double the rate of depressive symptoms compared to middle class white patients with RA. The project also examined predictors of depression, and concluded that physical disability — not acute disease activity — is the principle predictor of depression in patients with RA.
Rheumatoid arthritis is a chronic disease that causes pain, stiffness, swelling, and limitation in the motion and function of multiple joints. Disability occurs when a patient can no longer perform a task they once could, while acute RA disease activity is measured by swollen joints, tender joints, and inflammatory markers in patient assessments.
The study followed 172 patients at San Francisco General Hospital’s outpatient rheumatology clinic and found that 40 percent of this multiethnic, low-income cohort had symptoms of at least moderate depression. However, Asian patients had lower scores compared with other patients in the cohort.
The study also indicates that physical disabilities are the principal causes of depression rather than acute disease activity. Patients can tolerate symptoms such as swelling and tenderness without becoming depressed, the research shows. However, when they can no longer perform certain tasks because of disability, many patients develop depressive symptoms. Based on these findings, the researchers concluded that rheumatologists should continue to make disability prevention a priority through their treatment choices and should encourage additional screening for depression — especially in at-risk populations.
Among the researchers on this project were Edward Yelin, PhD, Professor in Residence of Medicine and Health Policy, Division of Rheumatology, and Mary Margaretten, MD, Assistant Adjunct Professor of Medicine, both of the University of California – San Francisco. Dr. Yelin is a recent recipient of an ACR Research and Education Foundation’s Within Our Reach: Finding a Cure for Rheumatoid Arthritis RA research grant.
"I think what was shocking is that the rate is twice as high in one group versus another," Dr. Yelin said. "When that happens you would think that it would be driven by different factors, but it seems to be driven by the same ones, including disability and age."
Dr. Margaretten said the study’s findings demonstrate why it’s important for practicing rheumatologists to screen for depression — especially in patients from diverse ethnic backgrounds and lower socioeconomic status. The study also provides further evidence of the benefit to staving off disability as long as possible. "Disability certainly has psychological consequences," she said.
Dr. Yelin said future research might seek to understand why Asian patients — despite severe disease and low socioeconomic status — report less depression. "Is it because they are more stoic?" he asked. "Do the measures we use not work as well for them? Do they have more cultural support?"
An estimated 1.3 million Americans have RA, and the disease typically affects women twice as often as men. Patients with depression have more RA-related physician visits and hospitalizations. They are also more likely to discontinue use of medications and anti-tumor necrosis factor alpha therapy compared to patients without depression, according to the study. Through the Within Our Reach: Finding a Cure for Rheumatoid Arthritis campaign, the REF is committing millions to accelerate innovative RA research that is not being done elsewhere, which will impact medical breakthroughs in RA and other rheumatic diseases. Since the advent of the campaign, the Foundation has awarded $18 million to 45 investigators and has risen over $26 million.
