Lapeyronie Hospital, Montpellier I University, UMR 5535, EA2415, Montpellier, France, Lille University Hospital, Lille 2 University, Lille, Tours University Hospital, UMR CNRS 7292, University of Tours, Tours and La Colombiere Hospital, CHRU Montpellier I University, Montpellier, France.
Lapeyronie Hospital, Montpellier I University, UMR 5535, EA2415, Montpellier, France, Lille University Hospital, Lille 2 University, Lille, Tours University Hospital, UMR CNRS 7292, University of Tours, Tours and La Colombiere Hospital, CHRU Montpellier I University, Montpellier, France. b-combe@chu-montpellier.
Rheumatology (Oxford). 2015 Mar;54(3):520-7. doi: 10.1093/rheumatology/keu371. Epub 2014 Sep 14.
RA is a chronic disease with frequent psychological co-morbidities, of which depression and anxiety are two common manifestations. We aimed to identify predictive factors of psychological distress in a large prospective cohort of very early RA patients.
ESPOIR (Etude et Suivi des Polyarthrites Indifférenciées Récentes) is a multicentre, longitudinal and prospective cohort study of patients with early arthritis (<6 months disease duration). The study sample comprised 641 patients with very early RA according to the 2010 ACR/European League Against Rheumatism RA criteria from the ESPOIR cohort. Psychological distress was assessed over 3 years by the five-item Mental Health Inventory questionnaire at various time points (baseline, 6, 12, 18, 24 and 36 months). Logistic regression with a generalized estimating equation model was used to analyse the association of disease variables and risk of psychological distress.
At baseline, 46.9% of RA patients were screened as positive for psychological distress. Over 3 years, psychological distress decreased significantly, with a prevalence of 25.8% at 36 months. The HAQ Disability Index (HAQ-DI) score was the most important factor predicting psychological distress over 3 years [odds ratio 2.10 (95% CI 1.41, 3.14)-3.59 (2.29, 5.63)]. Baseline biological and radiological variables and treatment regimens were not associated with distress.
Psychological distress in very early RA is frequent and the HAQ-DI score is a predictor of depression and anxiety in these patients. A psychological evaluation in patients with early RA is important for further individual psychiatric diagnosis and management.
类风湿关节炎（RA）是一种慢性疾病，常伴有心理共病，其中抑郁和焦虑是两种常见表现。我们旨在确定大样本早期 RA 患者中心理困扰的预测因素。
ESPOIR（近期未分化多关节炎的研究和随访）是一项多中心、纵向和前瞻性队列研究，纳入了早期关节炎（病程<6 个月）患者。该研究样本包括来自 ESPOIR 队列的 641 例符合 2010 年 ACR/EULAR RA 标准的早期 RA 患者。在不同时间点（基线、6、12、18、24 和 36 个月），使用五分量表心理健康量表评估 3 年内的心理困扰。使用广义估计方程模型的逻辑回归分析疾病变量与心理困扰风险的相关性。
基线时，46.9%的 RA 患者被筛查为存在心理困扰。3 年内，心理困扰显著下降，36 个月时的患病率为 25.8%。HAQ 残疾指数（HAQ-DI）评分是预测 3 年内心理困扰的最重要因素[比值比 2.10（95%CI 1.41，3.14）-3.59（2.29，5.63）]。基线时的生物学和放射学变量以及治疗方案与困扰无关。
早期 RA 患者的心理困扰较为常见，HAQ-DI 评分是这些患者抑郁和焦虑的预测因素。对早期 RA 患者进行心理评估对于进一步的个体精神诊断和管理很重要。
