Anxiety and depressive symptoms and illness perceptions in psoriatic arthritis and associations with physical health‐related quality of life

Abstract

Objective. Symptoms of psychological distress, including anxiety and depressive symptoms, and illness perceptions are important in determining outcome in patients with rheumatic disease. We aimed to compare psychological distress in psoriatic arthritis (PsA) and rheumatoid arthritis (RA) and to test whether the association between psychological variables and health-related quality of life (HRQOL) was similar in the 2 forms of arthritis. Methods. In 83 PsA patients and 199 RA patients, we used the Patient Health Questionnaire 9 (PHQ-9), the Symptom Checklist-90-Revised, and the Brief Illness Perception Questionnaire to assess psychological variables and the World Health Organization Quality of Life Instrument, Short Form to assess HRQOL. We used hierarchical regression analysis to determine the associations between psychological variables and HRQOL after adjusting for demographic variables and disease parameters. Results. The prevalence of moderate to severe levels of depressive symptoms (PHQ-9 score >10) was 21.7% in PsA patients, 25.1% in RA patients, and 36.7% in those PsA patients with polyarthritis. After adjustment for severity of disease and pain, anxiety (␤ ‫؍‬ ؊0.28) and concern about bodily symptoms attributed to the illness (␤ ‫؍‬ ؊0.33) were independent correlates of physical HRQOL in PsA. In RA, depressive symptoms (␤ ‫؍‬ ؊0.29) and concern about the consequences of the arthritis (␤ ‫؍‬ ؊0.27) were independent correlates of physical HRQOL. Conclusion. These findings suggest strongly that psychological factors are important correlates of HRQOL in PsA as well as in RA. Attention to patients' anxiety and their concern about numerous bodily symptoms attributed to the illness may enable rheumatologists to identify and manage treatable aspects of HRQOL in PsA.

Promoting patient‐centred care in psoriatic arthritis: a multidisciplinary European perspective on improving the patient experience

“…Lack of sleep and unwanted effects of medication may cause irritability, and with low energy levels patients may withdraw from favoured activities. A cross‐sectional study that included 83 patients with PsA showed an incidence of moderate to severe levels of depressive symptoms in 22% of the cohort 5. Anxiety and concern about bodily symptoms were also seen to affect HRQoL 5.…”

“…A cross‐sectional study that included 83 patients with PsA showed an incidence of moderate to severe levels of depressive symptoms in 22% of the cohort 5. Anxiety and concern about bodily symptoms were also seen to affect HRQoL 5. Taken together, these factors will negatively influence interpersonal and family relationships, and can contribute to work absenteeism and hence affect career prospects; however, further high quality research is needed to determine the extent of this effect.…”

“…Whether PsA is diagnosed depends, in part, on whether a general practitioner (GP) or dermatologist has the specific knowledge and skill to recognize the symptoms and promptly refer the patient to a rheumatologist. A delay in treatment of PsA after diagnosis can result in an increased rate of progression of clinical damage,2 and quality of life (QoL) can be negatively affected, with patients experiencing pain,3 fatigue4 and depression 5. The impact of PsA beyond joint and skin symptoms strongly indicates that a patient‐focused approach should be emphasized in the management of PsA 6…”

The role of psychological factors in inflammatory rheumatic diseases: From burden to tailored treatment

“…Although this review aims to capture various inflammatory rheumatic diseases, it is relevant to mention that most of the studies have been performed in patients with rheumatoid arthritis. Therefore, although studies have shown that quality-of-life impairment and biopsychosocial risk and resilience factors are mostly comparable between diseases [9,10], generalizing the findings to all inflammatory rheumatic conditions should be performed with caution. In addition, we use evidence from healthy controls and patients with other chronic somatic conditions in the case of a lack of studies for inflammatory rheumatic diseases.…”

Fears and beliefs of people living with rheumatoid arthritis: a systematic literature review

“…Fears about the consequences of the RA were independently correlated to physical HRQOL, i.e., patients who believe in worse consequences of RA had worse scores in the physical component of quality of life measures; patient global assessment of disease activity was also a significant predictor of poor mental and physical HRQOL [6,[33][34][35][36].…”