Depression in arthritis patients

Patients with rheumatoid arthritis are twice as likely to experience depression but are unlikely to talk to a doctor about it, according to researchers at the University of North Carolina at Chapel Hill.

Rheumatoid arthritis (RA) – the most common form of chronic inflammatory arthritis – is a debilitating disease characterized by inflammation of joint tissues, persistent pain, functional disability, stiffness and fatigue.

Betsy Sleath, PhD, a professor at the UNC School of Pharmacy, said that although depression in primary care settings has been well examined, no previous studies have looked at whether rheumatologists and RA patients discuss depression during medical visits.

In a new study lead by Sleath and published in this month's issue of Arthritis Care & Research, researchers found that almost 11 percent of RA patients had moderately severe to severe symptoms of depression. Those who were rated as being more restricted in their normal activities were significantly more likely to have these symptoms.

The study also found that only one in five of the patients who showed symptoms of depression discussed it with their rheumatologists. Those who did were always the ones to bring up the topic, not the physician. When depression was brought up, it was often not discussed at any length.

Sleath said when patients visit their specialist, their arthritis is understandably their main focus – but rheumatologists should consider addressing both RA and depression when they see their patients.

“Chronic diseases can greatly affect a patient's psychosocial well-being, and depression can also affect a patient's adherence to treatment regimens,” Sleath said. “Since many arthritis patients see their rheumatologist more often then their primary-care physician, we recommend that rheumatologists take steps to screen patients for signs of depression.”

Sleath said if physicians are uncomfortable discussing depression with their patients, they should consider having their office staff administer a brief depression screening before the patients' visits in order to identify problems early on.

In addition to screening for depression, Sleath said it is important for patients to have access to appropriate treatment. Rheumatologists can treat the depression themselves, refer patients to a mental health professional or communicate with the patient's primary-care physician to coordinate a treatment plan. Also, given how common depression is in these patients, rheumatology training programs should educate physicians about the importance of screening for and treating depression, she said.

The study included 200 arthritis patients from four rheumatology clinics with eight participating doctors. Patient visits were audiotaped, and patients were interviewed after their medical visits using a questionnaire to assess depressive symptoms.