What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Rheumatoid arthritis (n=267). Intervention: Brazilian residence vs. German residence. Primary outcome: Prevalence of depressive symptoms (p=0.025).

October 26, 2020Open Access

Impact of clinical and psychological factors associated with depression in patients with rheumatoid arthritis: comparative study between Germany and Brazil

HMHarriet MorfUniversitätsklinikum Erlangen GPGeraldo da Rocha Castelar PinheiroUniversidade do Estado do Rio de Janeiro AVAna Beatriz Vargas‐SantosUniversidad de Costa Rica

Key Result

Depressive symptoms were significantly more prevalent in Brazilian patients with rheumatoid arthritis compared to German patients (44% vs 22.9%, p=0.025).

Study Design

Type

Cross-Sectional (n=267)

Multicenter

Yes

Structured PICO

Population

267 adults with rheumatoid arthritis from outpatient clinics in Germany and Brazil, evaluated cross-sectionally for depressive symptoms and associated clinical factors.

Outcome

Prevalence of depressive symptoms and its association with clinical and psychological factorspatient reported

Depressive symptoms are highly prevalent in rheumatoid arthritis patients, varying by country, and are associated with pain, physical limitation, and inflammation.

Main Result

Absolute Event Rate: 44% vs 22.9%

p-value: p=0.025

Limitations

Observational study design
Not possible to match the cohorts for socioeconomic factors
Statistical tests and variables were not adjusted for age, sex, or demographic status due to the relatively low number of RA patients
Could not evaluate the role of fibromyalgia as a differential diagnosis

Abstract

OBJECTIVE: To investigate the prevalence of depressive symptoms and its association with clinical and psychological factors in patients with rheumatoid arthritis (RA) in Germany and in Brazil. METHOD: A convenience sample of 267 RA patients, 176 from Germany (age 62.4 ± 12.3 years) and 91 from Brazil (age 56.3 ± 12.6 years), was used in this cross-sectional study. The following questionnaires were used: Beck Depression Inventory (BDI), painDETECT test, Perceived Stress Questionnaire, fatigue questionnaire (FACIT), Health Assessment Questionnaire Disability Index (HAQ-DI), and the SF-36 questionnaires (Short-Form 36 Health Survey). Disease activity score (DAS 28-CRP) and visual analogue scale (VAS) for pain were also evaluated. Statistical analysis is based on comparison of means and proportions. Statistical significance for non-normal data was evaluated by non-parametrical tests. RESULTS: Depressive symptoms were more prevalent in the Brazilian sample (44% vs 22.9%, p = 0.025). Compared to German patients, the Brazilian ones also experienced more pain (current pain status on VAS: 4.67 ± 3.4 vs 3.67 ± 2.31 respectively, p < 0.01), were physically more limited (1.89 ± 1.85 vs 1.01 ± 0.75, p = 0.012), and had higher C-reactive protein levels (7.78 ± 18.3 vs 5.82 ± 10.45, p = 0.028). Despite receiving a more intensive treatment, German patients presented similar disease activity when compared to Brazilian patients (DAS28-CRP: Brazil 3.4 ± 1.5 vs Germany 3.3 ± 1.3, p = 0.307). CONCLUSION: Depressive symptoms are frequent in RA patients from different countries and interact with psychological disorders and the experience of pain. They contribute negatively to their well-being suggesting the need for psychoeducational strategies. Key Points • New psychoeducational strategies for RA management.• Higher inflammation marker in rheumatoid arthritis patients is associated with depression.• Medical treatment in RA influences depressive symptoms.• Depressive symptoms are dependent on population group.• High disease activity is related to depression.

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