Researchers have confirmed a significant positive association between depressive symptoms and C-reactive protein (CRP) level in rheumatoid arthritis.

Rheumatoid arthritis is a chronic autoimmune disease that causes inflammation of the joints and surrounding tissues. More than 1.3 million adults in the U.S. suffer from RA with 75% of those afflicted being women. Patients with rheumatoid arthritis experience pain, stiffness, swelling, and deterioration of joints. Severe chronic pain accompanied by progressive joint destruction, disability, and disfigurement is known to increase the risk of experiencing emotional disturbances, with rheumatoid arthritis patients twice as likely to be depressed as people in the general population. Emotional wellness for persons with rheumatoid arthritis plays a critical role in disease course and disability.

A second study further explored depression in spouses of persons with rheumatoid arthritis, finding that higher levels of spouse depression predicted worse disease course for the person with rheumatoid arthritis over a 1-year period.

The first study, led by Masayo Kojima, evaluated 218 rheumatoid arthritis patients who completed self-administered questionnaires that surveyed their sociodemographic characteristics, smoking and drinking habits, onset year of rheumatoid arthritis, and current pain, and a well-validated self-report inventory used to assess the severity of depressive symptoms. Blood samples from study participants were taken to measure their CRP levels. CRP is a plasma protein that is produced by the liver and rises during incidents of acute inflammation such as found in rheumatoid arthritis. Rheumatoid arthritis treatments are often focused on reducing such inflammation.

According to this study, the inflammation and depression each independently increased the likelihood of severe pain. The combined effects of high CRP levels and depression predicted severe pain even more strongly.

"Results of our research demonstrate the potential for clinicians to improve pain control by addressing their patients' psychological symptoms in addition to conducting anti-inflammation therapy," stated Dr. Kojima. The study indicates for those patients reporting severe pain without CRP level elevation, psychotherapy and/or psychotropic medication might have priority. "A clinical approach that takes into account both the body and the mind could have benefits and could enable optimal pain control," recommend the authors.

In the second study, Anita DeLongis and colleagues examined the role of spouse mood in the disability and disease course of rheumatoid arthritis patients. A total of 133 married rheumatoid arthritis patients completed questionnaires, including the Rheumatoid Arthritis Disease Activity Index and the Disabilities of the Arm, Shoulder, and Hand, assessing rheumatoid arthritis disease activity and disability at two time points one year apart. Both the patients and their spouses completed the Center for Epidemiologic Studies Depression Scale, a standardized community measure of depression at both time points.

Higher levels of spouse depressive symptoms at the initial assessment predicted worse disease course over a one-year period for their partners with rheumatoid arthritis, even after controlling for characteristics of the person with rheumatoid arthritis such as initial levels of depression, disability, disease activity, age, number of years married, education, disease duration, and employment.

"Our findings highlight the key role played by the spouse in disease course of individuals with rheumatoid arthritis, and point to the importance of including the spouse in clinical interventions," concluded the authors. "The mood and mental health of the marital partner or other key members of the family may be critically important to consider in developing more effective and evidence-based treatment for rheumatoid arthritis patients," added Dr. DeLongis.
References:
1. Masayo Kojima, et al. Depression, Inflammation, and Pain in Patients with Rheumatoid Arthritis. Arthritis Care & Research, Volume 61 Issue 8, Pages 1018 - 1024. DOI 10.1002/art.24647.
2. Anita DeLongis, et al. Spouse Depression and Disease Course Among Persons With Rheumatoid Arthritis. Arthritis Care & Research, Volume 61 Issue 8, Pages 1011 - 1017. DOI 10.1002/art.24510.