Schmukler Juan, Malfait Anne-Marie, Block Joel A, Pincus Theodore
Rush University Medical Center, Chicago, Illinois.
ACR Open Rheumatol. 2024 Oct;6(10):641-647. doi: 10.1002/acr2.11711. Epub 2024 Jul 16.
Osteoarthritis (OA) and rheumatoid arthritis (RA) are associated with similar patient disease burdens and a high prevalence of comorbid anxiety (ANX), depression (DEP), and fibromyalgia (FM). Nonetheless, these comorbidities are infrequently assessed in routine care, in part because multiple questionnaires are not feasibly completed by patients. We analyzed the prevalence of ANX, DEP, and FM in patients with OA versus patients with RA seen in routine care using indices within a single Multidimensional Health Assessment Questionnaire (MDHAQ) and associations with \ Routine Assessment of Patient Index Data 3 (RAPID3) and its component function, pain, and patient global scores.
A retrospective analysis of MDHAQ data in unselected patients with OA or RA receiving routine care at one setting included four indices within an MDHAQ: MDHAQ ANX screen, MDHAQ DEP screen, Fibromyalgia Assessment Screening Tool, and RAPID3. The prevalence of each comorbidity and associations with RAPID3 and components were analyzed in unadjusted and age-adjusted (Mantel-Haenszel) odds ratios (ORs) and 95% confidence intervals.
Overall, 40.4% of 361 patients with OA and 36.3% of 488 patients with RA screened positive for ANX, DEP, and/or FM (8.1% and 7% for all three, respectively). RAPID3 and each component were elevated significantly in patients with any positive screen result for ANX, DEP, and/or FM in both diagnoses (ORs of 2.6-35.8).
FM, DEP, and/or ANX rates were 40.4% in patients with OA and 36.3% in patients with RA, associated with significantly poorer patient status measures. Each of these three common comorbidities of patient distress may be feasibly screened for on a single MDHAQ in routine care.
骨关节炎（OA）和类风湿关节炎（RA）给患者带来的疾病负担相似，且共病焦虑（ANX）、抑郁（DEP）和纤维肌痛（FM）的患病率很高。然而，这些共病在常规护理中很少得到评估，部分原因是患者难以完成多份问卷。我们使用单一多维健康评估问卷（MDHAQ）中的指标，分析了在常规护理中就诊的OA患者与RA患者中ANX、DEP和FM的患病率，以及与患者指数数据3常规评估（RAPID3）及其组成部分功能、疼痛和患者总体评分的相关性。
对在某一机构接受常规护理的未经挑选的OA或RA患者的MDHAQ数据进行回顾性分析，MDHAQ包括四个指标：MDHAQ焦虑筛查、MDHAQ抑郁筛查、纤维肌痛评估筛查工具和RAPID3。采用未调整和年龄调整（Mantel-Haenszel）优势比（OR）及95%置信区间，分析每种共病的患病率以及与RAPID3及其组成部分的相关性。
总体而言，361例OA患者中有40.4%，488例RA患者中有36.3%的患者ANX、DEP和/或FM筛查呈阳性（三种情况均呈阳性的分别为8.1%和7%）。在两种诊断中，ANX、DEP和/或FM筛查呈阳性的患者，其RAPID3及其各组成部分均显著升高（OR为2.6 - 35.8）。
OA患者中FM、DEP和/或ANX的发生率为40.4%，RA患者中为36.3%，且与患者状况指标显著较差相关。在常规护理中，这三种常见的患者痛苦共病均可通过单一MDHAQ进行可行性筛查。
