Pain coping strategies and depression in rheumatoid arthritis.

A study was conducted to examine the role of pain episodes and the role of active and passive pain coping strategies in depicting depression in 287 patients with rheumatoid arthritis (RA). The independent effects of pain and pain coping strategies, as well as the interaction effects between pain and pain coping strategies on depression, were evaluated cross-sectionally and prospectively over a 6-month interval. The cross-sectional findings revealed that pain, passive coping, and the interaction between pain and passive coping contributed independent variance, all accounting for higher depression. Of principal interest was the finding that the frequent use of passive pain coping strategies in the face of high pain contributed to the most severe level of depression over time. These results were obtained after controlling for the potentially confounding effects of prior depression, functional disability, and medication status. These data imply that there may be a potential benefit of developing techniques to reduce the use of passive pain coping strategies to deal with chronic arthritis pain in cognitive–behavioral pain management programs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Helplessness and depression in end-stage renal disease.

45 dialysis and 25 posttransplant patients (mean age 40.6 yrs) participated in interviews and were administered a battery of tests, including the Beck Depression Inventory, Health Locus of Control Scale, Rotter's Internal–External Locus of Control Scale, and Self-Esteem Inventory. Separate ratings made by hospital staff and family were also obtained. Analyses revealed that perceived control over nontreatment life dimensions was importantly related to depression, although data failed to provide strong support for a reformulated helplessness theory. (58 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive distortion in rheumatoid arthritis: Relation to depression and disability.

Rheumatoid arthritis (RA) is often accompanied by significant levels of depression and disability. Previous research has demonstrated that cognitive distortions are related to depression and disability in other chronic pain conditions. Our study tested the relevance of Beck's model to RA by examining the relation between cognitive distortion, as measured by the Cognitive Error Questionnaire, and both self-reported and interview-rated depression and disability in 92 RA patients. Even when disease severity was controlled, cognitive distortion was significantly associated with depression. Although cognitive distortion was also related to physical disability, this relation was smaller. The results are discussed in terms of the potential relevance of Beck's model to the treatment of depression and disability in RA patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prevalence and depression degree in patients with rheumatoid arthritis

BACKGROUND: Study goals were: a) to know the existence and depressive level among a series of rheumatoid arthritis (RA) patients; b) to assess differences in depression levels of individuals with and without RA, and c) to identify the association of depression level with socioepidemiological, clinical, and prognostic characteristics in these patients. MATERIAL AND METHODS: Cross-sectional study that undertakes a 3 years period (July 1992-March 1995) and includes 221 patients diagnosed of RA according to the 1988 criteria of the American College of Rheumatology (ACR). Association of depression levels, assessed with the Self-Rating Depression Scale of Zung-Conde, with each one of the variables was evaluated using chi 2 tests (p < 0.05). A multivariate analysis type Automatic Interaction Detection (AID), based on the statistic r2, was applied to determine patient's profile with RA and depression. RESULTS: Depressive level was identified in 33.48% of patients. Odds ratio (OR) between "not depressive" and "depressive" levels was from 20.35 with 95% CI: 8.87-47.88 (p < 0.00001). Association was found with the variables sex (p < 0.0001), profession (p = 0.02), weight and height (p < 0.0001 in both variables), Ritchie index (p < 0.004), number of painful joints (p = 0.002), morning stiffness (p = 0.049) and secondary effects of the treatment (p = 0.034). Sex was the variable that most influenced in depressive level (p < 0.00001). In females group, the factor mainly related with depression was the number of painful joints (p < 0.0002) while in males, it was the self-rating pain valuation with a Likert scale (p < 0.0001). CONCLUSIONS: RA could causes depression in the patients. The factor with highest influence in the depression of these patients was the sex. The most influential factor in the females was the number of painful joints, while in the males was the self-rating of pain.     

Naturalistically observed sighing and depression in rheumatoid arthritis patients: A preliminary study.

Objective: This study tested the degree to which naturalistically observed sighing in daily life is a behavioral indicator of depression and reported physical symptoms (i.e., experienced pain and flare days) in rheumatoid arthritis (RA) patients. Design: Thirteen RA patients wore the Electronically Activated Recorder (EAR), an observational ambulatory assessment tool, for two weekends (Friday through Sunday) approximately one month apart. The EAR periodically recorded snippets of ambient sounds from participants' momentary environments (50 s every 18 min). Sighs were coded from the sampled ambient sounds. Main Outcome Measures: Depression was assessed with the Center for Epidemiological Studies Depression Scale and the Beck Depression Inventory. Pain during the past month was assessed with a 10-cm visual-analog scale, and number of flare days during the prior 6 months was reported. Results: Sighing was significantly and strongly related to patients' levels of depression and nonsignificantly and less strongly related to their reported pain and number of flare days. Conclusion: The findings suggest that sighing can serve as an observable marker of depression in RA patients. Because the sample size was small, the findings should be considered preliminary. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Longitudinal relationships among pain, sleep problems, and depression in rheumatoid arthritis.

Evaluated the relationship between pain and sleep problems, and the role of pain and sleep problems in depression, in a sample of 242 patients who had been diagnosed with definite or classical rheumatoid arthritis (RA). Patients completed the Pain scale of the Arthritis Impact Measurement Scales, the Center for Epidemiological Studies Depression Scale, and self-reports of sleep disturbance at 2 data waves over a 2-yr interval. Cross-sectional multiple regression analysis revealed that the sleep problems variable was independently associated with depression at Time 1. Longitudinal multiple regression analyses demonstrated that prior pain predicted subsequent adverse changes in sleep problems, whereas sleep problems did not affect pain over time, and prior pain and the interaction of high pain and high sleep problems were independently associated with depression from Time 1 to Time 2. These data suggest that pain may exacerbate sleeping difficulty in RA patients and that both may contribute to depression over time. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Development of a shortened center for epidemiological studies depression scale for assessment of depression in rheumatoid arthritis.

Objective: The purpose was to develop a short-form version of the Center for Epidemiologic Studies Depression Scale (CES-D) for the identification of persons with major depressive disorder (MDD) within a population with rheumatoid arthritis (RA). Study Design: Data were analyzed from 337 persons with RA. Forty-six participants met the diagnostic criteria for MDD; 291 participants were classified in the non-MDD category (including 21 participants with dysthymia and 18 participants with minor depressive disorder). A short-form version of the CES-D was developed, and multiple cutoff scores were examined. Results: A cutoff score of ≥5 from a 9-item, short-form CES-D was found to be generally as efficient as the more commonly used full-scale cutoff score of ≥16 for classifying participants with MDD within an RA population. Although the shortened CES-D scale (cutoff score ≥5) was slightly more sensitive, it also exhibited slightly less specificity than the full-scale cutoff score of ≥16. Conclusion: The results suggest that a short-form CES-D can be used to screen for MDD within an RA sample with a degree of efficiency that is generally comparable to that of the full-scale instrument. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attributional style and depression in rheumatoid arthritis: The moderating role of perceived illness control.

Examined the moderating influence of perceived daily illness control on the relationship between disease-unrelated causal attributions and Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) depressive symptomatology in a sample of 58 patients (aged 25–75 yrs) with rheumatoid arthritis (RA). Eight of the Ss met DSM-IV criteria for major depression. All Ss completed paper-and-pencil instruments measuring depression, attributional style, arthritis-specific helplessness, disease severity and pain and disability. As predicted, attribution?×? perceived control interactions contributed significant variance to depression, after controlling for disease variables and arthritis helplessness. Specifically, internal and global attributions for negative events were associated with increased levels of depression under conditions of decreased perceived illness control. The findings provide support for examining general attributional style in studies of depression in RA and for cognitive diathesis-stress conceptualizations of adjustment to chronic illness. Clinical implications of the results for cognitive-behavioral treatment approaches in RA are also discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coping with rheumatoid arthritis.

Argues that despite the widespread assumption that psychological processes play an important role in rheumatoid arthritis (RA), and despite the recent intense activity in health psychology, RA has been ignored by psychological researchers. Questions concerning the extent and variability of dysfunction resulting from RA and the coping mechanisms that may mediate functional capacity are raised. The background literature to address these questions is reviewed, including information concerning diagnostic problems and approaches, adjustment to RA, and methodological problems in studies to date. It is suggested that the literature is clouded by diagnostic inconsistencies and neglect of the variety of areas of adjustment that may be affected by the disease, including employment and financial, physical (including pain), social, self-concept, and emotional. A project underway at the University of Saskatchewan, in which RA patients are being studied for coping behaviors that may contribute to their adaptation and functional capacity, is introduced as one means of addressing some of the outstanding issues in the area. (French abstract) (63 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interpersonal stress, depression, and disease activity in rheumatoid arthritis and osteoarthritis patients

The relationships among interpersonal stressors, depression, coping inefficiency, hormones (prolactin, cortisol, and estradiol), and disease activity were examined. The sample comprised 33 women with rheumatoid arthritis (RAs; age 37-78) and 37 women with osteoarthritis (OAs; age 47-91), who served as controls. In a regression analysis, interpersonal conflict events accounted for more than twice as much variance in depression in RAs than in OAs. In the RA patients, the immune-stimulating hormones prolactin and estradiol were significantly positively correlated with interpersonal conflicts, depression, coping inefficacy, and clinician ratings of disease activity, suggesting that RAs are more reactive to interpersonal stressors than are OAs, both psychologically and physiologically.     

Corticosteroid prescribing in rheumatoid arthritis and psoriatic arthritis

Embryos from certain mouse strains are arrested at the 2-cell stage in cell culture ('2-cell block'), whereas those from other strains develop to the blastocyst stage under the same conditions. It was previously shown that blocking embryos can be rescued in culture by aggregation with an excess of 2-cell stages of a non-blocking strain such as CBA x C57BL/6 F2. Here we have employed a LacZ transgene in a blocking strain (NMRI) to follow the fate of rescued blastomeres up to the blastocyst stage. We found that rescued blastomeres can participate in both inner cell mass and trophoblast formation, thus completely overcoming the 2-cell block.     

Tumors in rheumatoid arthritis

Benign (bTu) and malignant tumours (mTu) were studied in a randomised autopsy material of 161 patients with rheumatoid arthritis (RA). The tissue specimens were fixed in 8% formaldehyde solution at pH 7.6 and embedded in paraffin. The tumours were diagnosed histologically and confirmed by immunohistochemical methods. Five benign (3.1%), and thirteen malignant tumours (8.1%) found observed in 18 (11.2%) of 161 cases. There was no significant difference between laboratory parameters of patients with malignant tumours and without tumours. One benign (0.62%) and seven malignant (4.35%) tumours led to death in 8 (4.97%) of 18 cases altogether. Neoplasms were detected clinically in 8 of 18 cases (44.4 rel%). None of tumorous patients received immunosuppressive treatment and only five had gold (Tauredon) therapy. Paraneoplastic syndromes with rheumatoid complaints may be excluded by the onset and duration of RA and tumours. Benign neurogenic tumours and malignant bronchioloalveolar carcinoma were frequently associated with RA not treated by immunosuppressive drugs. Our data do not support the assumption of a high risk of malignant lymphomas associated with RA treated with immunosuppressive therapy.     

Osteoporosis in rheumatoid arthritis

Patients with rheumatoid arthritis (RA) develop both periarticular and generalized osteoporosis. Periarticular osteopenia in appendicular bones occurs early in the course of RA and is one of the earliest radiological signs of RA. An uncoupled state in bone resorption-formation linkage, contributes to the development of periarticular osteopenia and it might be mediated through an increased productions of cytokines and prostaglandins by synovium and bone marrow. Accordingly, early suppression of rheumatoid synovitis is necessary for the prevention of periarticular osteopenia. Generalized osteoporosis is also common in RA and leads to increased risk of fractures. Generalized osteoporosis considered to be multifactorial and factors contributing to lumbar osteoporosis might be different from those to loss of appendicular bones, such as femur and radius. Corticosteroids and menopausal state are important risk factors for lumbar osteoporosis. Rheumatoid activity and reduced physical activity are also important determinants. According to the previous studies, however, the influence of functional impairment is more prominent in the femoral BMD compared to spinal BMD. In addition to control of RA and maintenance of physical activity, hormone replacement therapy (HRT) and bisphosphonate are possible agents for the treatment of osteoporosis in RA patients, especially postmenopausal women.     

Infection in rheumatoid arthritis

Sepsis is an unusually common cause of illness and death in RA. All sorts of infections occur, but pyarthrosis produces exceptional problems. Clinically, pyarthrosis, empyema, and purulent pericarditis mimic bland rheumatoid effusions. Aspiration of the attendant effusions is the only reliable diagnostic procedure. Subcutaneous nodules on the sacrum and back are easily overlooked. Necrosis and ulceration of these nodules may provoke septicemia. Those with Felty's syndrome do not uniformly have problems with recurrent infection. Splenectomy may not benefit such patients. The belief that corticosteroids cause increased infections in rheumatoid patients is not totally justifiable at present. Steroids can, however, disguise underlying sepsis and hamper proper diagnosis.     

Learned helplessness and its correlation to impairment, pain, anxiety and depression in rheumatoid arthritis

A Swedish version of the self-report instrument Arthritis Helplessness Index (AHI) is presented. Validity and reliability of the translation has been analyzed. 100 consecutive patients with rheumatoid arthritis (RA) were studied, 78 of which completed 2 self-administered questionnaires with AHI, impairment, pain, anxiety and depression. Furthermore 20 of the patients were interviewed with regard to AHI. Forty-two other patients with RA were analyzed for correlation between AHI and biochemical activity and Signals of Functional Impairment (SOFI). We conclude that the Swedish version of AHI has satisfactory validity and reliability. It correlates with age, physical impairment, pain, anxiety and depression but not with sex or disease activity. Five of the original 15 items could for various reasons be omitted, leaving a 10 statement instrument. AHI is promising as a variable in future outcome studies of RA.