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Aim. To assess the influence of anxiety and depressive disorders on joint destruction in patients with rheumatoid arthritis (RA). Materials and methods. 128 RA-patients were included, 87% were women with a mean age of 47.411.3 years and a median of RA duration 96 [48; 228] months. At the inclusion most patients had moderate (n=56, 43.7%) and severe (n=48, 37.5%) disease activity according to DAS28. Joint destruction was classified as maximal in patients with radiographic stage III, IV and/or osteonecrosis) and minimal in patients with stage I, II and no osteonecrosis. Pain intensity was measured with the BPI (Brief Pain Inventory) scale, severity of fatigue with fatigue severity scale (FSS), clinically important fatigue was diagnosed in patients with FSS4. Anxiety and depressive disorders (ADD) were diagnosed by a licensed psychiatrist in 123 (96.1%) of RA-patients in accordance with ICD-10 in semi-structured interview. Severity of depression and anxiety was evaluated with Montgomery-Asberg Depression Rating Scale (MADRS) and Hamilton Anxiety Rating Scale (HAM-A). RA-patients with ADD were divided into the following treatment groups: 1 сDMARDs (n=39), 2 сDMARDs+PPT (sertraline or mianserine), n=43, 3 сDMARDs+bDMARDs (n=32), 4 сDMARDs+bDMARDs+PPT (sertraline or mianserine), n=9. Biologics treatment duration varied from 1 to 6 years, antidepressants from 6 to 96 weeks. 83 (67.5%) RA patients were assessed at five-years follow-up. Linear regression analysis was conducted to determine factors associated with maximal join destruction. Results. According to linear regression analysis, maximal joint destruction at 5 years follow-up was associated with higher baseline BPImax, longer RA and ADD duration, clinically important fatigue at baseline, baseline extraarticular RA manifestations, recurrent depressive disorder at 5-years follow-up and treatment with cDMARDs only. Conclusion. Recurrent depressive disorder without antidepressant treatment is an important predictor of progression of joint destruction in patients with rheumatoid arthritis.

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Backgroundmental disorders (MD) (anxiety/depressive (ADD) and cognitive (CD)) occur in rheumatoid arthritis (RA) patients (pts) very often, they are usually stress-related and, probably, have common pathogenesis chains with RA. In this connection the disease-modifying anti-rheumatic drugs (DMARDs) and biologics drugs treatment may be effective in ADD in RA-pts.Objectivesto determine the frequency of MD dynamics during DMARDs, biologics and antidepressants treatment of RA-pts in prospective 5yrs study.Methods128 RA-pts were enrolled in this study. All of them met the full ACR criteria. 86% RA-pts were women with a mean age of 47,4±1,0 (M±m) yrs. RA activity was assessed by DAS28 and was high (5,25±0,17 (M±m)) in the beginning of the study. 67% RA-pts were taking prednisone (5±2,7 mg/day),80% RA-pts - DMARDs, 26% - biologics (rituximab – 11%, anti-TNF-α – 10%, anti-IL6 – 5%). MD were diagnosed by psychiatrist in accordance with the ICD-10 in semi-structured interview. The severity of depression and anxiety was evaluated by Montgomery–Asberg Depression Rating Scale (MADRS) and Hamilton Anxiety Rating Scale (HAM-A). CD were diagnosed with psychology and neuropsychology methods. ADD were diagnosed in 121 (94,5%) and CD – in 87 (67,9%) of RA-pts. Major depressive disorder (MDD) was found in 41 (32%), minor depressive disorder (MinDD) – in 50 (39%) and anxiety disorders (AD) – in 30 (23,4%) of RA-pts. The occurrences of MD were evaluated in one and five yrs in 105 from 121 (87%) RA-pts divided into the following treatment groups: 1 – DMARDS (n=32), 2 - DMARDs + antidepressants (sertraline or mianserine) (n=37), 3 – DMARDs + biologics (n=27), 4 - DMARDs + biologics + antidepressants (sertraline or mianserine) (n=9).Results Group 1: the frequency of MDD was increased from 24,6% to 34,8% in a year and to 42,8% in 5 yrs (p=0,09); MinDD – from 47,8% to 60,8% (p=0,19) and 50% in 5 yrs; the number of pts with AD decreased from 27,5% to 4,3% (p=0,014) and 4,8% (p=0,021) accordingly. The frequency of CD was increased from 64,3% to 78,3% (p=0,16) in 5 yrs. Group 2: the frequency of MDD was decreased from 47,4% to 15,7% (p=0,049) in a year and to disappearance of depressive symptoms (p<0,001) in 5 yrs; MinDD – from 26,3% to 15,8% and to disappearance (p<0,001) in 5 yrs; AD – from 26,3% to 10,5% and to disappearance (p<0,001) in 5 yrs. The frequency of CD was decreased from 78,9% to 60% (p=0,25). Group 3: the frequency of MDD was unchanged (40,7%, 45,4% and 42,8% accordingly); the frequency of MinDD was increased not significantly – 40,7%, 40,9% and 52,4%; but AD – was significantly decreased (from 18,5% - to disappearance in a year (p=0,042) and 5 yrs (p=0,047)). The frequency of CD was increased from 77,8% to 85%. Group 4: the frequency of MDD was decreased significantly from 66,7% to 16,7% in a year and to disappearance in 5 yrs (p=0,03); MinDD and AD were decreased from 16,7% both to disappearance. The occurrence of CD was decreased from 71,4% to 57,1%.Conclusionsthe results demonstrated the best positive dynamics of MD (ADD and...

Mental disorders (MDs) of the anxiety-depressive spectrum (ADS) and cognitive impairment (CI) are characteristic of the majority of patients with rheumatoid arthritis (RA); however, the effects of disease-modifying antirheumatic drugs (DMARDs), biological agents (BAs), and their combinations with psychopharmacological drugs (PPDs) on these abnormalities have been insufficiently studied. Objective: to investigate trends in the incidence of MDs in RA patients receiving different treatment regimens.Subjects and methods. The investigation included 128 RA patients (13% men and 87% women) who fulfilled the 1987 American College of Rheumatology criteria; their mean age was 47.4±0.9 years; the median duration of RA was 96 [48; 228] months. RA activity was found to be high, moderate, and low in 48, 56, and 24 patients, respectively. DAS28 averaged 5.34±0.17. 80% of the patients received DMARDs. MDs were diagnosed based on ICD-10 coding, by using a semi-structured interview and scales, such as the Hospital Anxiety and Depression Scale, the Hamilton Anxiety Scale, and the Montgomery-Asberg Depression Rating Scale. Clinical and psychological procedures were used to diagnose CI. At the study inclusion stage, ADS disorders were detected in 123 (96.1%) patients; CI was found in 88 (68.7%). Forty-one (32.1%) patients were diagnosed with major depression (an obvious or moderate depressive episode), 53 (41.4%) patients had minor depression (a mild depressive episode and dysthymia), and 29 (22.6%) had anxiety disorders (ADs) (adjustment disorders with anxiety symptoms, as well as generalized anxiety disorder). The dynamics of MDs was estimated in 112 (87.5%) of the 128 patients and in 83 (64.8%) at one- and five-year follow-ups, respectively. The following groups were identified according to the performed therapy: 1) synthetic DMARDs (n = 39); 2) synthetic DMARDs + PPDs (n = 43); 3) BAs + DMARDs (n = 32); 4) BAs + DMARDs + PPDs (n = 9).Results and discussion. In Group 1, the frequency of major depression increased insignificantly from 25% to 32.2 and 33.3% (p = 0.36) at one- and five-year follow-ups, respectively; that of minor depression decreased from 51% to 48.4 (p = 0.5) and 50% (p = 0.6) respectively; the number of patients with ADs declined significantly from 24% to 3.2 (p = 0.018) and 4.2% (p = 0.021), respectively. The frequency of CI rose from 63.5% to 64.5 and 81.8%, respectively (p = 0.12). In Group 2, the frequency of major depression decreased from 43 to 19% (p = 0.049) at one-year follow-up; and none of the patients was found to have ADS disorders at five-year follow-up (p < 0.001); the frequency of minor depression dropped from 38% to 23.8 and 7.1% at one-year (p = 0.35) and five-year (p = 0.002) follow-ups, respectively; the frequency of ADs fell from 19% to 4.8 (p = 0.044) and 0% (p = 0.012), respectively. The frequency of CI decreased insignificantly from 80.9% to 76.2 (p = 0.39) and 61.5% (p = 0.061), respectively. In Group 3 treated with BAs, the frequency of major depression increased statistically insignificantly from 31.2% to 37.9 (p = 0.39) and 42.8% (p = 0.28) at oneand five-year follow-ups, respectively; the frequency of minor depression rose insignificantly from 37.5% to 48.3 (p = 0.28) and 52.4% (p = 0.21), respectively; and that of ADs dropped from 25 to 0% at one-year (p = 0.003) and five-year (p = 0.011) follow-ups. Moreover, the frequency of CI increased from 75% up to 79.3 (p = 0.46) and 90% (p = 0.16) at one- and five-year follow-ups respectively. In Group 4, the frequency of major depression decreased significantly from 66.7 to 22.2% (p = 0.076) and complete regression (p = 0.004) at one- and five-year follow-ups, respectively; that of minor depression increased slightly from 11.1 to 33.3% (p = 0.28) due to the transformation of major depression into minor one at one- and five-year follow-ups, respectively; the frequency of ADs fell from 22.2% to zero at 5 years; and the incidence of CI declined 66.7 to 57.1% (p = 0.54).Conclusion. Synthetic DMARDs had no effect on the ADS disorders and CI in patients with RA; BAs promoted the regression of ADs and did not affect the progression of depression and CI. A combination of DMARDs and BAs used at the adequate dose of PPDs for the same period led to the regression of ADS disorders and the reduction in the frequency of CI.