Psychiatry department, University Hospital of Saint Etienne, Saint Etienne, France; INSERM, U1028; CNRS, UMR5292; Lyon Neuroscience Research Center, PSYR2 Team, Lyon, France.
Rheumatology department, University Hospital of Saint Etienne, Saint Etienne, France; Inserm U1059, Equipe LBTO, Université de Lyon, Saint-Étienne, France.
Joint Bone Spine. 2021 Oct;88(5):105200. doi: 10.1016/j.jbspin.2021.105200. Epub 2021 Apr 28.
Depression constitutes the most frequent comorbid condition associated with rheumatoid arthritis (RA), with prevalence rates ranging from 14% to 48%. This wide range can be explained by several factors including subtypes of depression considered, instrument of measure (i.e. self-questionnaires versus clinical interview), threshold applied but also the overlap of symptoms between the two conditions. Despite being a frequent comorbid condition in RA, depressive states are repeatedly underdiagnosed and thus, often remain untreated. Consequences are dramatic as conclusive evidence show that depression deleteriously impacts just about all outcomes of RA, including disease activity, arthritis-related complications, level of pain, chance of remission, quality of life and mortality. Importantly, links between depression and RA appear to be bidirectional as if RA patients show increased prevalence of depression. Conversely, patients with depression compared to the general population have higher risk to develop RA. Among the factors explaining this strong association between depression and RA, recent advances have underlined the putative role of models based on the inflammatory hypothesis. Pro-inflammatory cytokines such as tumor necrosis factor, interleukin (IL)-1, IL-6, and IL-18 are involved in RA pathogenesis, but also in depression. Furthermore, the connections between the central nervous system, the peripheral system and the immune system are now better understood. As a consequence of the strong comorbidity and the aggravate prognostic, the management of patient showing this dual diagnosis should be carefully monitor. The common physiopathology also opens the path to utilization of RA treatment in severe depression or treatment-resistant depression.
抑郁症是与类风湿关节炎（RA）相关的最常见合并症，患病率从 14%到 48%不等。这种差异很大程度上可以归因于多种因素，包括所考虑的抑郁症亚型、测量工具（即自我问卷与临床访谈）、所应用的阈值以及两种疾病症状的重叠。尽管抑郁症是 RA 的常见合并症，但它经常被漏诊，因此常常得不到治疗。其后果是严重的，因为确凿的证据表明，抑郁症会对 RA 的所有结局产生负面影响，包括疾病活动度、关节炎相关并发症、疼痛程度、缓解机会、生活质量和死亡率。重要的是，抑郁症与 RA 之间的联系似乎是双向的，因为 RA 患者的抑郁症患病率似乎更高。相反，与一般人群相比，患有抑郁症的患者患 RA 的风险更高。在解释抑郁症与 RA 之间这种强烈关联的诸多因素中，最近的进展强调了基于炎症假说的模型的潜在作用。肿瘤坏死因子、白细胞介素（IL）-1、IL-6 和 IL-18 等促炎细胞因子参与了 RA 的发病机制，但也与抑郁症有关。此外，中枢神经系统、外周系统和免疫系统之间的联系现在也得到了更好的理解。由于这种强合并症和加重的预后，对于出现这种双重诊断的患者，应密切监测其管理情况。共同的病理生理学也为在严重抑郁症或治疗抵抗性抑郁症中使用 RA 治疗开辟了道路。
