Depression Increases Pain In Patients With Rheumatoid Arthritis.
Depression has been classified as a mood disorder or affective disorder. Mood is defined as a pervasive and sustained emotion that, in the extreme, markedly affects a person's perception of the world and ability to adequately function in society. Mood disorders are among the most common encountered in clinical practice and are divided into depressive disorders and bipolar disorders. There are over 187 million adults in the United States - and about 19 million of these people will experience a depressive episode in any given year, making depression the most common psychiatric disorder encountered in general medical practice. Women are two to three times more likely to experience depression than men. Depression is a one-two punch that knocks the sufferer out of the ring on a daily basis. Number one, the symptoms themselves make life miserable. Number two, the depressed individual struggles to function and keep up with the life's normal demands. Conventional treatment for depression is aimed both at reducing symptoms and helping the individual regain the ability to function they once enjoyed. Usually the treatment includes psychotherapy and the use of anti-depressant medications.
Like the more common form of arthritis known medically as "osteoarthritis," rheumatoid arthritis is a chronic condition that inflicts joint pain and loss of mobility on the sufferer. But rheumatoid arthritis is an altogether different disease than the arthritis that virtually everyone has, at least to some degree, by age seventy-five or so. Rheumatoid arthritis, also identified by the thankfully brief acronym "RA," strikes the joint linings first. All joints are covered by a thin "synovial membrane" that reduces the friction between adjacent joints. Thanks to the synovial membrane, the surface of a joint is slipperier than a wet ice rink. Current medical thinking views rheumatoid arthritis as an "autoimmune disease." In autoimmune diseases, for reasons that are not completely understood, the immune system attacks the body's own tissue as though it were a foreign invader. People with rheumatoid arthritis produce an immunity-related substance called "rheumatoid factor" that targets the synovial membrane. The consequences are severe pain and inflammation, joint disfigurement, and loss of joint movement and function.
The published results from two recent studies indicate that depression increases pain associated with rheumatoid arthritis. The first trial investigated the interrelationship between levels of depression symptoms, C-reactive protein (CRP) level, and pain, confirming a significant positive association between depressive symptoms and CRP level in RA. The study included 218 patients with RA who completed self-administered questionnaires that surveyed their sociodemographic characteristics, smoking and drinking habits, onset year of the disease, current pain, and a well-validated self-report inventory used to assess the severity of depressive symptoms. Researchers also analyzed serum CRP levels, which are produced by the liver and rises during incidents of acute inflammation such as found in rheumatoid arthritis. It was found that inflammation and depression each independently increased the likelihood of severe pain. The second study included 133 married patients with RA who completed questionnaires, including the Rheumatoid Arthritis Disease Activity Index and the Disabilities of the Arm, Shoulder, and Hand, assessing disease activity and disability at two time points one year apart. Both the patients and their spouses completed the Center for Epidemiologic Studies Depression Scale, a standardized community measure of depression at both time points. The results revealed that higher levels of spouse depressive symptoms at the initial assessment predicted worse disease course over a one-year period for their partners with rheumatoid arthritis. Both studies appear to indicate the importance of addressing the psychological symptoms of depression in patients with RA and their spouses along with treatments focused on reducing inflammation.1 2
1 Kojima M, Kojima T, Suzuki S, et al. Depression, inflammation, and pain in patients with rheumatoid arthritis. Arthritis Care Res. Aug2009;61(8):1018-1024.
2 Lam M, Lehman AJ, Puterman E, et al. Spouse depression and disease course among persons with rheumatoid arthritis. Arthritis Care Res. Aug2009;61(8):1011-1017.