类风湿关节炎中抑郁症状和抑郁症的流行情况的新见解——来自前瞻性多中心 VADERA II 研究的启示。
New insights into the prevalence of depressive symptoms and depression in rheumatoid arthritis - Implications from the prospective multicenter VADERA II study.
机构信息
Freelance Healthcare Data Scientist, Eckental, Germany.
Department of Internal Medicine 3 -Rheumatology and Immunology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.
出版信息
PLoS One. 2019 May 28;14(5):e0217412. doi: 10.1371/journal.pone.0217412. eCollection 2019.
OBJECTIVES
To investigate the prevalence of depressive symptoms in rheumatoid arthritis (RA) patients using two previously validated questionnaires in a large patient sample, and to evaluate depressive symptoms in the context of clinical characteristics (e.g. remission of disease) and patient-reported impact of disease.
METHODS
In this cross-sectional study, the previously validated Patient Health Questionnaire (PHQ-9) and Beck-Depression Inventory II (BDI-II) were used to assess the extent of depressive symptoms in RA patients. Demographic background, RA disease activity score (DAS28), RA impact of disease (RAID) score, comorbidities, anti-rheumatic therapy and antidepressive treatment, were recorded. Cut-off values for depressive symptomatology were PHQ-9 ≥5 or BDI-II ≥14 for mild depressive symptoms or worse and PHQ-9 ≥ 10 or BDI-II ≥ 20 for moderate depressive symptoms or worse. Prevalence of depressive symptomatology was derived by frequency analysis while factors independently associated with depressive symptomatology were investigated by using multiple logistic regression analyses. Ethics committee approval was obtained, and all patients provided written informed consent before participation.
RESULTS
In 1004 RA-patients (75.1% female, mean±SD age: 61.0±12.9 years, mean disease duration: 12.2±9.9 years, DAS28 (ESR): 2.5±1.2), the prevalence of depressive symptoms was 55.4% (mild or worse) and 22.8% (moderate or worse). Characteristics independently associated with depressive symptomatology were: age <60 years (OR = 1.78), RAID score >2 (OR = 10.54) and presence of chronic pain (OR = 3.25). Of patients classified as having depressive symptoms, only 11.7% were receiving anti-depressive therapy.
CONCLUSIONS
Mild and moderate depressive symptoms were common in RA patients according to validated tools. In routine clinical practice, screening for depression with corresponding follow-up procedures is as relevant as incorporating these results with patient-reported outcomes (e.g. symptom state), because the mere assessment of clinical disease activity does not sufficiently reflect the prevalence of depressive symptoms.
CLINICAL TRIAL REGISTRATION NUMBER
This study is registered in the Deutsches Register Klinischer Studien (DRKS00003231) and ClinicalTrials.gov (NCT02485483).
目的
使用两个先前验证过的问卷在大量患者样本中调查类风湿关节炎（RA）患者的抑郁症状发生率，并评估疾病的临床特征（例如疾病缓解）和患者报告的疾病影响背景下的抑郁症状。
方法
在这项横断面研究中，使用先前验证过的患者健康问卷（PHQ-9）和贝克抑郁量表第二版（BDI-II）评估 RA 患者的抑郁症状严重程度。记录人口统计学背景、RA 疾病活动评分（DAS28）、RA 疾病影响（RAID）评分、合并症、抗风湿治疗和抗抑郁治疗。PHQ-9≥5 或 BDI-II≥14 表示轻度抑郁症状或更严重，PHQ-9≥10 或 BDI-II≥20 表示中度抑郁症状或更严重时，抑郁症状的发生率通过频率分析得出。使用多因素逻辑回归分析调查与抑郁症状相关的独立因素。获得了伦理委员会的批准，所有患者在参与前均提供了书面知情同意书。
结果
在 1004 名 RA 患者（75.1%为女性，平均年龄±标准差为 61.0±12.9 岁，平均病程为 12.2±9.9 年，DAS28（ESR）为 2.5±1.2）中，抑郁症状的发生率为 55.4%（轻度或更严重）和 22.8%（中度或更严重）。与抑郁症状相关的独立特征是：年龄<60 岁（OR=1.78）、RAID 评分>2（OR=10.54）和存在慢性疼痛（OR=3.25）。在被归类为有抑郁症状的患者中，只有 11.7%接受了抗抑郁治疗。
结论
根据验证工具，RA 患者中常见轻度和中度抑郁症状。在常规临床实践中，筛查抑郁并进行相应的后续程序与将这些结果与患者报告的结果（例如症状状态）相结合同样重要，因为仅仅评估临床疾病活动并不能充分反映抑郁症状的发生率。
临床试验注册号
本研究在德国临床试验注册中心（DRKS00003231）和 ClinicalTrials.gov（NCT02485483）注册。
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