Longitudinal study of the bidirectional association between pain and depressive symptoms in patients with psoriatic arthritis

Abstract

Objective. To test the bidirectional hypothesis that depressive symptoms influence changes in pain over time, and pain influences changes in depressive symptoms. Methods. A total of 394 patients attending the University of Toronto Psoriatic Arthritis clinic were followed over a mean period of 7.5 years with annual assessments, including number of swollen joints (SJC), Health Assessment Questionnaire (HAQ), and the Medical Outcomes Survey Short Form 36 (SF-36). Linear mixed-effects models were used to examine the cross-and lagged associations between the changes in HAQ pain and in the SF-36 mental component summary (MCS) score, adjusting for SJC and other covariates. Results. The strongest predictors of changes in pain, SJC, and depressive symptoms between visits were scores of the corresponding variables at the previous visit, with standardized regression coefficients exceeding 0.75 in absolute value. There was, however, evidence of a small, but consequential, bidirectional relationship (i.e., standardized regression coefficients <0.3) between depressive symptoms and pain. Both previous MCS scores and change in MCS scores were associated with change in pain between visits; conversely, previous pain scores and change in pain scores were associated with change in depressive symptoms between visits. Conclusion. Even though cross-variable associations between pain and depressive symptoms exist, changes in pain and depressive symptoms appear to be strongly driven by their measurements at the previous visit. To optimize patient outcomes, a clinical approach that assesses and treats clinically significant depressive symptoms, as well as pain, is required.

Temporal Effect of Depressive Symptoms on the Longitudinal Evolution of Rheumatoid Arthritis Disease Activity

“…Studies have consistently demonstrated temporal associations between depression and pain among RA, PsA, and EIA patients (12,13,18,20). Research also indicates that depression moderates stress-associated changes in pain, EGA, and TJC, but these associations were not linked to immune activation (19).…”

“…Studies of psoriatic (PsA) and early undifferentiated inflammatory arthritis (EIA) patients have demonstrated significant temporal bidirectional effects between depression and disease activity, and possible causal mechanisms include biological, psychological, and behavioral factors, as well as the interaction of these different domains (11–13). Cross-sectional research has consistently demonstrated strong positive associations between depression and composite disease activity, pain, function, global assessments, and acute-phase reactants (14–17).…”

Evaluation of Self-reported Patient Experiences: Insights from Digital Patient Communities in Psoriatic Arthritis

“…We also determined what challenges patients were experiencing in receiving treatment with biologic therapies and found that about one-third of patients with PsA reported 6 The …”

“…PsA may present with ≥ 1 clinical subtype, including peripheral joint inflammation, enthesitis, dactylitis, axial spondylitis, and varying severity of nail and skin changes; the heterogeneous aspect of this disease makes diagnosis and treatment challenging 4,5 . Some patients with PsA may experience destruction of the joints, and functional and psychosocial impairments are common 6,7,8 . Additionally, PsA is associated with an increased prevalence of comorbidities such as metabolic and cardiovascular disease, further complicating management of the disease 9 .…”

Psoriasis, Depression, and Inflammatory Overlap: A Review

“…Comorbid psoriasis and psoriatic arthritis increase the risk of depression beyond that of psoriasis alone. Psoriatic arthritis adversely impacts sleep, work, and socialization [4,5].…”