Department of Rheumatology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, 710061, China.
Clin Rheumatol. 2018 Jan;37(1):179-184. doi: 10.1007/s10067-017-3874-4. Epub 2017 Oct 23.
Vitamin D deficiency may be associated with depression in the general population. This study aimed to describe the prevalence of depression and anxiety in rheumatoid arthritis (RA) patients from Northwestern China and identify associations of Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA) scores with serum vitamin D level in these patients. We recruited 161 RA patients inform the First Affiliated Hospital of Xi'an Jiaotong University during Nov. 2016 to Feb. 2017. All patients completed a survey including HAMD and HAMA scales. RA activity (DAS28) was scored by a rheumatologist, and serum 25-OH-D3 levels were measured by electrochemiluminescence immunoassay. The data were analyzed using the SPSS16.0 based on "possible and probable" cut points for HAMD and HAMA. About 62 and 60% of patients had some degrees of depression and anxiety, respectively. The mean of serum 25-OH-D3 levels in RA patients with depression was 15.24 ± 8.78 ng/mL, which was significantly lower than those without depression (24.68 ± 10.98 ng/mL, p = 0.009). Despite negative correlations between serum 25-OH-D3 level and the score of HAMD (r = - 0.520, p < 0.001) or HAMA (r = - 0.469, p < 0.001), there was a positive correlations between DAS28and the score of HAMD (r = 0.459, p = 0.001) or HAMA (r = 0.486, p < 0.001). The multivariate logistic regression showed that disease duration, serum 25-OH-D3 level, and treatment of tumor necrosis factor inhibitor were associated with depression/anxiety in RA patients. Our study shows a high prevalence of depression and anxiety in RA patients from Northwestern China. Both disease activity of RA and low serum 25-OH-D3 level are associated with the severity of depression and anxiety. It is imperative for clinicians to screen hypovitaminosis of vitamin D and depression/anxiety in RA patients.
维生素 D 缺乏可能与普通人群中的抑郁有关。本研究旨在描述中国西北地区类风湿关节炎（RA）患者的抑郁和焦虑患病率，并确定 Hamilton 抑郁量表（HAMD）和 Hamilton 焦虑量表（HAMA）评分与这些患者血清维生素 D 水平的相关性。我们于 2016 年 11 月至 2017 年 2 月招募了西安交通大学第一附属医院的 161 例 RA 患者。所有患者均完成了包括 HAMD 和 HAMA 量表在内的调查。RA 活动度（DAS28）由风湿病学家评分，血清 25-OH-D3 水平通过电化学发光免疫测定法测量。基于 HAMD 和 HAMA 的“可能”和“很可能”切点，使用 SPSS16.0 对数据进行分析。约 62%和 60%的患者分别存在不同程度的抑郁和焦虑。患有抑郁的 RA 患者的血清 25-OH-D3 水平平均值为 15.24±8.78ng/mL，明显低于无抑郁的患者（24.68±10.98ng/mL，p=0.009）。尽管血清 25-OH-D3 水平与 HAMD 评分（r=-0.520，p<0.001）或 HAMA 评分（r=-0.469，p<0.001）之间呈负相关，但 DAS28 与 HAMD 评分（r=0.459，p=0.001）或 HAMA 评分（r=0.486，p<0.001）之间呈正相关。多变量 logistic 回归显示，疾病持续时间、血清 25-OH-D3 水平和肿瘤坏死因子抑制剂治疗与 RA 患者的抑郁/焦虑有关。本研究表明，中国西北地区 RA 患者的抑郁和焦虑患病率较高。RA 的疾病活动度和低血清 25-OH-D3 水平均与抑郁和焦虑的严重程度相关。临床医生迫切需要筛查 RA 患者的维生素 D 缺乏症和抑郁/焦虑症。
