Division of Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy.
Department of Medicine, University of Verona, Verona, Italy.
Clin Rheumatol. 2021 May;40(5):1893-1902. doi: 10.1007/s10067-020-05417-5. Epub 2020 Oct 3.
Depression is commonly associated with psoriatic arthritis (PsA), but its risk factors in these patients are largely unrecognized. Pro-inflammatory cytokines involved in the pathogenesis of PsA have been associated with depression in patients without autoimmune diseases. The aim of this study was to establish whether PsA patients with and without depressive symptoms differed for general or clinical variables and serum cytokines milieu.
One hundred and fifty consecutive patients with PsA were screened for depressive symptoms with Hospital Anxiety and Depression Scale (HADS-D). Patients with and without depressive symptoms were compared according to the prevalence of general risk factors for depression, comorbidities, PsA features and serum IL-6, TNF-α, and IL-17A.
Fifty-eight patient (38.7%) had a depressive mood. Depressive symptoms were associated with female sex (p = 0.03) and current smoking (p = 0.05). Patients with and without depressive symptoms did not differ for general risk factors for depression and comorbidities. Depressed patients had more frequently psoriatic nail disease (p = 0.02) and significant physical disability (HAQ-DI ≥ 0.5) (p < 0.01) and were more frequently in moderate or high disease activity according to DAPSA score (p = 0.01). Depressed patients had higher serum IL-6 (p < 0.01) and comparable serum IL-17A and TNF-α. A cutoff of 2.27 pg/ml of serum IL-6 had the best ability to predict an HADS-D ≥ 8 (AUC 0.666 ± 0.044; p < 0.01). Multivariate logistic regression analysis confirmed that serum IL-6 ≥ 2.27 pg/ml was independently associated with depressive symptoms (OR 3.5; CI 1.6-7.8; p < 0.01).
Higher serum Il-6 is associated with depressive symptoms. This association suggests a direct role of systemic inflammation in the modulation of mood in PsA patients. Key Points • High PsA disease activity and physical disability are associated with depression. • Higher serum levels of IL-6 are independently associated with depression in PsA. • IL-6 might play a direct role in the development of depression in PsA patients.
抑郁症通常与银屑病关节炎（PsA）相关，但这些患者的风险因素在很大程度上尚未被认识。参与 PsA 发病机制的促炎细胞因子与自身免疫性疾病患者的抑郁症有关。本研究的目的是确定是否存在抑郁症状的 PsA 患者在一般或临床变量和血清细胞因子环境方面存在差异。
对 150 例连续的 PsA 患者进行了医院焦虑和抑郁量表（HADS-D）筛查，以评估抑郁症状。根据抑郁症的一般危险因素、合并症、PsA 特征和血清白细胞介素 6（IL-6）、肿瘤坏死因子-α（TNF-α）和白细胞介素 17A（IL-17A）的水平，比较有和无抑郁症状的患者。
58 例患者（38.7%）有抑郁情绪。抑郁症状与女性（p=0.03）和当前吸烟（p=0.05）有关。有和无抑郁症状的患者在抑郁症的一般危险因素和合并症方面没有差异。有抑郁症状的患者更频繁地出现银屑病指甲疾病（p=0.02）和明显的身体残疾（HAQ-DI≥0.5）（p<0.01），并且根据 DAPSA 评分，他们更频繁地处于中度或高度疾病活动状态（p=0.01）。抑郁患者的血清 IL-6 水平更高（p<0.01），而血清 IL-17A 和 TNF-α水平相当。血清 IL-6 的截断值为 2.27pg/ml 时，对 HADS-D≥8 的预测能力最佳（AUC 0.666±0.044；p<0.01）。多变量逻辑回归分析证实，血清 IL-6≥2.27pg/ml 与抑郁症状独立相关（OR 3.5；95%CI 1.6-7.8；p<0.01）。
较高的血清 Il-6 与抑郁症状相关。这种关联表明，全身炎症在调节 PsA 患者的情绪方面可能发挥直接作用。
较高的 PsA 疾病活动度和身体残疾与抑郁相关。
较高的血清 IL-6 水平与 PsA 患者的抑郁独立相关。
IL-6 可能在 PsA 患者的抑郁发展中发挥直接作用。
