早期类风湿关节炎患者心理健康、疾病严重程度与抑郁症遗传风险之间的关系
The Relationship Between Mental Health, Disease Severity, and Genetic Risk for Depression in Early Rheumatoid Arthritis.
作者信息
Euesden Jack, Matcham Faith, Hotopf Matthew, Steer Sophia, Cope Andrew P, Lewis Cathryn M, Scott Ian C
机构信息
From the SGDP Centre (Euesden, Lewis), and Department of Psychological Medicine (Matcham, Hotopf), Institute of Psychiatry, Psychology & Neuroscience, King's College London; Department of Rheumatology (Steer), Weston Education Centre, King's College Hospital; Academic Department of Rheumatology (Cope, Scott), Centre for Molecular and Cellular Biology of Inflammation, and Department of Medical and Molecular Genetics (Lewis, Scott), King's College London, London; MRC Integrative Epidemiology Unit (Euesden), School of Social and Community Medicine, University of Bristol, Bristol; and Research Institute for Primary Care & Health Sciences (Scott), Primary Care Sciences, Keele University, Staffordshire, United Kingdom.
出版信息
Psychosom Med. 2017 Jul/Aug;79(6):638-645. doi: 10.1097/PSY.0000000000000462.
OBJECTIVE
Reduced mental health (MH) is prevalent in rheumatoid arthritis (RA). Although longitudinal studies are limited, there is evidence that depression is associated with worse disease outcomes. We evaluated reciprocal relationships between MH, RA severity, and genetic risks for depression for 2 years in a well-characterized cohort of RA patients.
METHODS
We evaluated 520 early RA patients previously enrolled to two clinical trials. MH was measured using the short form-36 MH domain and mental component summary scores (MCS). MCS/MH associations over 2 years with disease activity (disease activity score on a 28-joint count), disability (health assessment questionnaire), pain visual analog scale scores, and a weighted genetic risk score for depression were tested using linear mixed-effects and regression models.
RESULTS
Poorer MH was associated with worse RA outcomes. Lower MCS scores (indicating worse MH) were seen in patients with a greater genetic risk for depression (weighted genetic risk score: coefficient = -1.21, p = .013). Lower baseline MCS was associated with lower 2-year improvements in disease activity score on a 28-joint count (coefficient = -0.02, p < .001), pain (coefficient = -0.33, p < .001), and health assessment questionnaire (coefficient = -0.01, p = .006). Baseline MCS was associated with changes in the swollen joint count (coefficient = -0.09, p < .001) and patient global assessment (coefficient = -0.28, p < .001) but not the tender joint count (p = .983) and erythrocyte sedimentation rate (p = .973). Only baseline pain visual analog scale (coefficient = -0.07, p = .002) was associated with 2-year changes in MCS.
CONCLUSIONS
Reduced baseline MH was associated with lower improvements in disease activity, disability, and pain for 2 years, supporting current national guidelines recommending screening for depression in RA. Pain had a bidirectional relationship with MH. Depression genetic risk had a significant association with MH.
目的
心理健康状况下降在类风湿关节炎（RA）中很常见。尽管纵向研究有限，但有证据表明抑郁与更差的疾病结局相关。我们在一组特征明确的RA患者队列中评估了心理健康、RA严重程度和抑郁遗传风险之间的双向关系，为期2年。
方法
我们评估了先前入选两项临床试验的520例早期RA患者。使用简明健康调查量表（Short Form-36）心理健康领域量表和心理成分综合评分（MCS）来测量心理健康状况。使用线性混合效应模型和回归模型测试了2年内MCS/心理健康状况与疾病活动度（28个关节计数的疾病活动评分）、残疾程度（健康评估问卷）、疼痛视觉模拟量表评分以及抑郁加权遗传风险评分之间的关联。
结果
较差的心理健康状况与更差的RA结局相关。抑郁遗传风险更高的患者（加权遗传风险评分：系数=-1.21，p=0.013）的MCS评分更低（表明心理健康状况更差）。较低的基线MCS与28个关节计数的疾病活动评分（系数=-0.02，p<0.001）、疼痛（系数=-0.33，p<0.001）和健康评估问卷（系数=-0.01，p=0.006）的2年改善情况较差相关。基线MCS与肿胀关节计数的变化（系数=-0.09，p<0.001）和患者整体评估（系数=-0.28，p<0.001）相关，但与压痛关节计数（p=0.983）和红细胞沉降率（p=0.973）无关。只有基线疼痛视觉模拟量表（系数=-0.07，p=0.002）与MCS的2年变化相关。
结论
基线心理健康状况下降与2年内疾病活动度、残疾程度和疼痛的改善情况较差相关，支持当前国家指南建议对RA患者进行抑郁筛查。疼痛与心理健康状况存在双向关系。抑郁遗传风险与心理健康状况有显著关联。
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