调查类风湿关节炎患者的情绪障碍症状与疾病活动度和功能状态之间的相关性。
Investigation of the correlation between mood disorder symptoms and disease activity and functional status in rheumatoid arthritis patients.
机构信息
Division of Rheumatology, Department of Internal Medicine, Dışkapı Yıldırım Beyazıt Education and Research Hospital, Health Sciences University, Ankara, Turkey
Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
出版信息
Turk J Med Sci. 2021 Dec 13;51(6):3008-3016. doi: 10.3906/sag-2107-283.
BACKGROUND/AIM: To investigate the correlation between depressive-anxiety symptoms, mixed features, disease activity, and functional status in patients with rheumatoid arthritis (RA) in the light of the shared underlying etiology in both disorders.
MATERIALS AND METHODS
The study included 556 patients with RA. RA disease activity was measured using the Disease Activity Score 28-joint count C reactive protein (DAS28-CRP), and the patients were evaluated by a Health Assessment Questionnaire (HAQ). The Hospital Anxiety and Depression Scale (HADS), Mood Disorder Questionnaire (MDQ), and Modified Hypomania Checklist (mHCL) were used to evaluate the mixed depression and bipolarity status of the patients.
RESULTS
Of the patients, 430 (77.3%) were female and 126 (22.7%) were male. The median age was 57 years, the median HAQ score was 0.55 points, and the median DAS28-CRP score was 4.1 points. The evaluation of the patients by DAS28-CRP revealed that 58.5% of the patients had moderate and severe disease activity, while only 23.4% of them were in remission. The group using the combination of synthetic disease-modifying anti-rheumatic drugs (sDMARD) and steroid therapy had significantly higher HAD-depression, HAD-anxiety, mHCL, DAS28-CRP, HAQ, and MDQ scores than the group using sDMARD alone. The grouping of the patients based on the DAS28-CRP cut-off scores showed that the patients with moderate and severe disease activity had significantly higher HADS, mHCL, MDQ scores than those in remission and those with mild disease activity (p < 0.001).
CONCLUSION
Disease severity and functional status in RA can be affected by comorbid anxiety-depressive and mixed symptoms. Therefore, clinicians should consider screening the depressive-anxiety and mixed mood symptoms of RA patients. Moreover, patients who use steroid therapy are more susceptible to mood symptoms (anxiety, depression, bipolarity), which should also be considered during the follow-up of patients.
背景/目的：鉴于两种疾病具有共同的潜在病因，本研究旨在探讨类风湿关节炎（RA）患者的抑郁-焦虑症状、混合特征、疾病活动度和功能状态之间的相关性。
材料和方法
本研究纳入了 556 例 RA 患者。使用疾病活动评分 28 关节计数 C 反应蛋白（DAS28-CRP）评估 RA 疾病活动度，并用健康评估问卷（HAQ）对患者进行评估。采用医院焦虑抑郁量表（HADS）、心境障碍问卷（MDQ）和改良躁狂检查表（mHCL）评估患者的混合抑郁和双相状态。
结果
患者中，430 例（77.3%）为女性，126 例（22.7%）为男性。中位年龄为 57 岁，中位 HAQ 评分为 0.55 分，中位 DAS28-CRP 评分为 4.1 分。根据 DAS28-CRP 的评估，58.5%的患者有中度和重度疾病活动，而只有 23.4%的患者处于缓解状态。使用联合合成疾病修饰抗风湿药物（sDMARD）和类固醇治疗的患者 HAD 抑郁、HAD 焦虑、mHCL、DAS28-CRP、HAQ 和 MDQ 评分显著高于仅使用 sDMARD 的患者。根据 DAS28-CRP 截断值对患者进行分组，结果显示，中度和重度疾病活动患者的 HADS、mHCL、MDQ 评分显著高于缓解和轻度疾病活动患者（p<0.001）。
结论
RA 中的疾病严重程度和功能状态可能会受到共病焦虑-抑郁和混合症状的影响。因此，临床医生应考虑对 RA 患者的抑郁-焦虑和混合情绪症状进行筛查。此外，使用类固醇治疗的患者更容易出现情绪症状（焦虑、抑郁、双相），这也应在患者随访期间加以考虑。
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