Symptoms of Depression Predict the Trajectory of Pain Among Patients with Early Inflammatory Arthritis: A Path Analysis Approach to Assessing Change

2009 ◽  
Vol 36 (2) ◽  
pp. 231-239 ◽  
Author(s):  
ORIT SCHIEIR ◽  
BRETT D. THOMBS ◽  
MARIE HUDSON ◽  
SUZANNE TAILLEFER ◽  
RUSSELL STEELE ◽  
...  
Keyword(s):  
Disease Activity ◽  
Path Analysis ◽  
Inflammatory Arthritis ◽  
Depression Scale ◽  
Mcgill Pain Questionnaire ◽  
Symptoms Of Depression ◽  
Early Inflammatory Arthritis ◽  
Pain Symptoms ◽  
Longitudinal Relationships ◽  
Over Time

Objective.To assess the longitudinal relationships, including directionality, among chronic pain, symptoms of depression, and disease activity in patients with early inflammatory arthritis (EIA).Methods.One hundred eighty patients with EIA completed an examination, including swollen joint count, and were administered the Center for Epidemiological Studies Depression Scale (CES-D) and the McGill Pain Questionnaire (MPQ) at 2 timepoints 6 months apart. Cross-lagged panel path analysis was used to simultaneously assess concurrent and longitudinal relationships among pain, symptoms of depression, and number of swollen joints.Results.Pain, symptoms of depression, and number of swollen joints decreased over time (p < 0.001) and were prospectively linked to pain, symptoms of depression, and number of swollen joints, respectively, at 6 months. Symptoms of depression and pain were correlated with each other at baseline (0.47) and at 6-month followup assessments (0.28). Baseline symptoms of depression significantly predicted pain symptoms at 6 months (standardized regression coefficient = 0.28, p = 0.001), whereas pain and disease activity did not predict the course of any other variable after controlling for baseline values.Conclusion.Symptoms of depression predicted the trajectory of pain from baseline to 6 months. In addition, there were reciprocal/bidirectional associations between pain and symptoms of depression over time. More research is needed to better understand the relationship between pain and depressive symptoms and how to best manage patients with EIA who have high levels of both.

scholarly journals The Relationship Between Symptoms of Depression and Anxiety and Disease Activity in IBD Over Time

2021 ◽  
Author(s):  
Ruth Ann Marrie ◽  
Lesley A Graff ◽  
John D Fisk ◽  
Scott B Patten ◽  
Charles N Bernstein
Keyword(s):  
Disease Activity ◽  
Activity Index ◽  
Depression Scale ◽  
Disease Activity Index ◽  
Depression And Anxiety ◽  
Symptoms Of Depression ◽  
Abdominal Examination ◽  
Inflammatory Bowel ◽  
The Relationship ◽  
Over Time

Abstract Brackground We aimed to examine associations between elevated symptoms of depression and anxiety and disease activity in inflammatory bowel disease (IBD). Previous findings have been inconsistent and have not accounted for variability in the courses of these conditions over time. Methods We followed 247 participants with IBD (153 Crohn’s disease [CD], 94 ulcerative colitis [UC]) for 3 years. Annually, participants underwent an abdominal examination, reported therapies used for IBD, and completed the Hospital Anxiety and Depression Scale (HADS) questionnaire. We evaluated associations of elevated symptoms (scores ≥11) of anxiety (HADS-A) and depression (HADS-D) with the presence of active IBD as measured using the Powell Tuck Index for UC and the Harvey-Bradshaw Disease Activity Index for CD. We employed logistic regression with generalized estimating equations, simultaneously estimating between-person and within-person effects. Results Of 247 participants, 15 (6.1%) had elevated symptoms of depression (HADS-D ≥11) at enrollment, 41 (16.6%) had elevated symptoms of anxiety (HADS-A ≥11), and 101 (40.9%) had active IBD. On average, individuals with elevated symptoms of depression (odds ratio [OR], 6.27; 95% CI, 1.39–28.2) and anxiety (OR, 2.17; 95% CI, 1.01–4.66) had increased odds of active IBD. Within individuals, elevations in symptoms of depression over time were associated with increased odds of active IBD (OR, 2.70; 95% CI, 1.15–6.34), but elevated symptoms of anxiety were not. After adjustment for covariates (including disease activity), elevated symptoms of depression were also associated with increased odds of biologic therapy use (OR, 2.02; 95% CI, 1.02–4.00). Conclusion Symptoms of depression and anxiety are associated with disease activity in IBD over time. Reducing these symptoms should be incorporated into the management of IBD.

scholarly journals The Relationship Between Function and Disease Activity as Measured by the HAQ and DAS28 Varies Over Time and by Rheumatoid Factor Status in Early Inflammatory Arthritis (EIA). Results from the CATCH Cohort§

2013 ◽  
Vol 7 (1) ◽  
pp. 58-63 ◽  
Author(s):  
Tristan A Boyd ◽  
A Bonner ◽  
C Thorne ◽  
G Boire ◽  
C Hitchon ◽  
...  
Keyword(s):  
Disease Activity ◽  
Inflammatory Arthritis ◽  
Health Assessment ◽  
First Year ◽  
Initial Visit ◽  
Time Points ◽  
Early Inflammatory Arthritis ◽  
The Relationship ◽  
Over Time ◽  
Questionnaire Disability

Objective: To investigate the relationship between function and disease activity in early inflammatory arthritis (EIA). Methods: Canadian Early Arthritis Cohort (CATCH) (n=1143) is a multi-site EIA cohort. Correlations between the Health Assessment Questionnaire Disability Index (HAQ) and DAS28 were done at every 3 months for the first year and then at 18 and 24 months. We also investigated the relationship between HAQ and DAS28 by age (<65 versus ≥65) and RF (positive vs negative). Results: Mean HAQ and DAS28 scores were highest at the initial visit with HAQ decreasing over 24 months from a baseline of 0.94 to 0.40 and DAS28 scores decreasing from 4.54 to 2.29. All correlations between HAQ and DAS28 were significant at all time points (p<0.01). The correlations between HAQ and DAS28 were variable over time. The strongest correlation between HAQ and DAS28 occurred at initial visit (most DMARD naive) (n=1,143) and 18 months (r=0.57, n=321) and 24 months (r=0.59, n=214). The baseline correlation between HAQ and DAS28 was significantly different than correlations obtained at 3, 6, and 12 months (p=0.02, 0.01, and 0.01, respectively). Age did not change the association between HAQ and DAS28 {<65 years old (r=0.50, n=868) versus ≥65 (r=0.48, n=254), p=0.49}. The correlation between HAQ and DAS28 was stronger with RF+ patients (r=0.63, n=636) vs RF negative (r=0.47, n=477), p=0.0043 Conclusion: Over 2 years in EIA, HAQ and DAS both improved; correlations at time points were different over 2 years and RF status affected the correlations.

Caregiving appraisal and disease activity in early inflammatory arthritis

2012 ◽  
Vol 27 (1) ◽  
pp. 156-164 ◽  
Author(s):  
Margaret Purden ◽  
Sally S. Mustafa ◽  
Karl J. Looper ◽  
Phyllis Zelkowitz ◽  
Murray Baron ◽  
...  
Keyword(s):  
Disease Activity ◽  
Inflammatory Arthritis ◽  
Early Inflammatory Arthritis

Prognosis of Seronegative Patients in a Large Prospective Cohort of Patients with Early Inflammatory Arthritis

2014 ◽  
Vol 41 (12) ◽  
pp. 2361-2369 ◽  
Author(s):  
Lillian Barra ◽  
Janet E. Pope ◽  
John E. Orav ◽  
Gilles Boire ◽  
Boulos Haraoui ◽  
...  
Keyword(s):  
Disease Activity ◽  
Inflammatory Arthritis ◽  
Disease Activity Score ◽  
Response To Treatment ◽  
Erosive Disease ◽  
Reactive Protein ◽  
Activity Measures ◽  
Early Inflammatory Arthritis ◽  
Large Prospective Cohort ◽  
Citrullinated Peptide

Objective.Rheumatoid factor (RF) and anticitrullinated protein antibodies (ACPA) are believed to be associated with more severe rheumatoid arthritis; however, studies in early inflammatory arthritis (EIA) have yielded conflicting results. Our study determined the prognosis of baseline ACPA-negative and RF-negative patients.Methods.Patients enrolled in the Canadian Early Arthritis Cohort had IgM RF and IgG anticyclic citrullinated peptide antibodies 2 (anti-CCP2) measured at baseline. Remission was defined as a Disease Activity Score of 28 joints (DAS28) < 2.6 using logistic regression accounting for confounders at 12-month and 24-month followup.Results.Of the 841 patients, 216 (26%) were negative for both RF and anti-CCP2. Compared to seropositive subjects, seronegative subjects were older (57 ± 15 vs 51 ± 14 yrs), more males proportionately (31% vs 23%), and had shorter length of symptoms (166 ± 87 vs 192 ± 98 days), and at baseline had higher mean swollen joint count (SJC; 8.8 ± 6.8 vs 6.5 ± 5.6), DAS28 (5.0 ± 1.6 vs 4.8 ± 1.5), and erosive disease (32% vs 24%, p < 0.05). Treatment was similar between the 2 groups. At 24-month followup, seronegative compared to seropositive subjects had greater mean change (Δ ± SD) in disease activity measures: ΔSJC counts (−6.9 ± 7.0 vs −5.1 ± 5.9), ΔDAS28 (−2.4 ± 2.0 vs −1.8 ± 1.8), and ΔC-reactive protein (−11.0 ± 17.9 vs −6.4 ± 17.5, p < 0.05). Accounting for confounders, antibody status was not significantly associated with remission. However, at 12-month followup, ACPA-positive subjects were independently more likely to have new erosive disease (OR 2.94, 95% CI 1.45–5.94).Conclusion.Although seronegative subjects with EIA have higher baseline DAS28 compared to seropositive subjects, they have a good response to treatment and are less likely to develop erosive disease during followup.

scholarly journals P104 Longitudinal patient reported outcome data collected from a smartphone app can map group level trajectories of disease activity over time

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
Philip D. H Hamann ◽  
Nicola Minaur ◽  
Jon H Tobias ◽  
Emma M Clark
Keyword(s):  
Disease Activity ◽  
Inflammatory Arthritis ◽  
Patient Reported Outcome ◽  
Outcome Data ◽  
Smartphone App ◽  
Group Level ◽  
Moderate Disease ◽  
Patient Reported ◽  
Over Time ◽  
Moderate Disease Activity

Abstract Background Patient-reported outcome measures are a cornerstone of the current early inflammatory arthritis audit and part of the best practice tariff. However, outcome data are collected infrequently meaning longitudinal changes in disease activity cannot be accurately examined. We report results of a twelve-month clinical pilot of a cloud-enabled commercial smartphone app to record patient self-reported disease activity outcome measures to evaluate trends of disease activity in a routine rheumatology setting. Methods Patients with a clinical diagnosis of inflammatory arthritis attending routine rheumatology clinic were offered the opportunity to use a smartphone app to record their disease activity between hospital appointments using the RAPID3. Data from the first twelve months (July 2018 - July 2019) was extracted and latent class modelling using aggregate data was undertaken to explore the trends of disease activity experienced by our patients at a group level. Standard analysis recommendations were followed. Results Over the course of twelve-months, 58 patients used the app to record their disease activity using the RAPID3. These patients had a mean age of 53 and were 76% female. 35 patients had rheumatoid arthritis, 15 patients had psoriatic arthritis and 8 had another inflammatory arthritis. The median number of RAPID3 scores completed per patient was 8 (interquartile range 14), and a total of 706 RAPID3 scores were submitted over the 12 months. Three different trajectories of disease activity were identified among our cohort of patients. The first trajectory showed a low stable plateau of disease activity for six months before further improvement (27 patients:47%) over six months. The second trajectory (23 patients; 40%) showed an initial moderate disease activity which gradually declined over six months before improving markedly in the last three months, returning to moderate disease activity. The final trajectory (8 patients; 14%) identified patients with the highest disease activity which showed a gradual but slow improvement of disease activity over twelve months. These different trajectories show the changing burden of inflammatory arthritis over time. Conclusion Regular longitudinal data collection of patient-reported outcomes via a smartphone app can be used to show distinct group level trajectories of disease activity and could be used to examine changes in outcomes of patients over time. Data such as these could be used at a departmental level to examine the burden of inflammatory arthritis experienced by patients, assist planning future service requirements, and help anticipate the timings of future appointments more accurately for patients. Disclosures P.D.H. Hamann Consultancies; Living With Ltd. Royalties; PH has provided consultancy for and has an options and limited royalty agreement with, Living With Ltd. software company for the development of the smartphone application described in this abstract. N. Minaur None. J.H. Tobias None. E.M. Clark None.

Does Socioeconomic Status Affect Outcomes in Early Inflammatory Arthritis? Data from a Canadian Multisite Suspected Rheumatoid Arthritis Inception Cohort

2014 ◽  
Vol 42 (1) ◽  
pp. 46-54 ◽  
Author(s):  
Grace Yang ◽  
Vivian P. Bykerk ◽  
Gilles Boire ◽  
Carol A. Hitchon ◽  
J. Carter Thorne ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Disease Activity ◽  
Low Income ◽  
Inflammatory Arthritis ◽  
Activity Index ◽  
Income Group ◽  
Joint Disease ◽  
Physical Component Score ◽  
Low Ses ◽  
Early Inflammatory Arthritis

Objective.To assess the effect of socioeconomic status (SES) on outcomes in patients with early inflammatory arthritis, using data from the Canadian Early Arthritis Cohort (CATCH) study.Methods.In an incident cohort, 2023 patients were recruited, and allocated to low SES or high SES groups based on education and income. Outcomes at baseline and 12 months were analyzed in relation to SES including the 28-joint Disease Activity Score (DAS28), Simplified Disease Activity Index (SDAI), pain, patient’s global assessment scale (PtGA), the Health Assessment Questionnaire–Disability Index (HAQ-DI), and the SF12-v2 Health Survey, using the ANOVA, chi-squared test, and regression analyses.Results.The CATCH population had 43% with high school education or less and 37% in the low-income group (< 50,000 Can$ per annum household income). The low-education group had higher DAS28 at baseline (p = 0.045), becoming nonsignificant at 12 months and lower physical component score on SF12-v2 at baseline (p = 0.022). Patients in the low-income group presented with higher HAQ-DI (p = 0.017), pain (p = 0.035), PtGA (p = 0.004), and SDAI (p = 0.022). Low-income versus high-income groups were associated with an OR above the median for HAQ-DI (1.20; 95% CI 1.00–1.45), PtGA (1.27; 95% CI 1.06–1.53), and SDAI (1.25; 95% CI 1.02–1.52) at baseline. The association with low income persisted at 12 months for HAQ-DI (OR 1.30; 95% CI 1.02–1.67), but not for other variables.Conclusion.Low SES was initially associated with higher disease activity, pain, and PtGA, and poorer function. At 1 year, outcomes were similar to those with high SES, with the exception of HAQ-DI.

scholarly journals A Pragmatic Application of Ultrasonography for the Assessment of Disease Activity in Patients with Early Inflammatory Arthritis

2021 ◽  
Vol 10 (2) ◽  
pp. 283
Author(s):  
Seoung Wan Nam ◽  
Taeyoung Kang
Keyword(s):  
Disease Activity ◽  
Inflammatory Arthritis ◽  
Power Doppler ◽  
Correlation Coefficients ◽  
Clinical Parameter ◽  
Study Data ◽  
Joint Disease ◽  
Study Population ◽  
Early Inflammatory Arthritis ◽  
Musculoskeletal Ultrasonography

The aim of the study was to examine the usefulness of targeted musculoskeletal ultrasonography (MSUS) in assessing the disease activity of patients with early inflammatory arthritis (EIA). Twenty-eight patients with EIA were enrolled. The MSUS examination of joints with arthritic signs (tenderness or swelling), measurement of 28-joint Disease Activity Score (DAS28), and its components were performed at four-week interval visits until power doppler (PD) US remission was achieved. Various MSUS parameters of grey scale (GS) and PD synovitis were measured. Pearson or Spearman correlation coefficients were determined for the purpose of the study. Data were gathered from a total of 85 visits. The Sum of GS grade correlated better with physical examination findings, while the Sum of PD grade correlated better with serum inflammatory markers and patient global health. However, Global OMERACT-EULAR Synovitis Score (GLOESS), which reflected both PD and GS grades, correlated evenly well with each clinical parameter. In addition, GLOESS correlated best with DAS28 in the overall study population (p < 0.01). Conclusively, our targeted MSUS parameters of arthritic joints, especially sums of semi-quantitative grades of synovitis, could be useful in monitoring patients with EIA.

Care Gap in Patients with Early Inflammatory Arthritis with a High Fracture Risk Identified Using FRAX®

2010 ◽  
Vol 37 (11) ◽  
pp. 2221-2225 ◽  
Author(s):  
CARLY K. CHENG ◽  
HEATHER McDONALD-BLUMER ◽  
GILLES BOIRE ◽  
JANET E. POPE ◽  
BOULOS HARAOUI ◽  
...  
Keyword(s):  
Vitamin D ◽  
High Risk ◽  
Fracture Risk ◽  
Disease Activity ◽  
Inflammatory Arthritis ◽  
Risk Group ◽  
Risk Groups ◽  
Low Risk ◽  
Care Gap ◽  
Early Inflammatory Arthritis

Objective.To determine the proportion of patients with early inflammatory arthritis in a Canadian cohort who are at high risk for a major osteoporotic fracture using the Fracture Risk Assessment Tool (FRAX®), and to determine if a care gap exists in high-risk patients.Methods.FRAX was applied to 238 patients enrolled in the Canadian Early Arthritis Cohort (CATCH) study based on norms from the United States and the United Kingdom, without the use of bone mineral density measurements.Results.FRAX identified 5%–13% of patients at high risk for fracture, using a conservative analysis. Based on US norms, there was a significant correlation between increasing fracture risk groups and oral glucocorticoid use (p = 0.012) and baseline erosions (p = 0.040). Calcium or vitamin D use did not vary among the different fracture risk groups (p = NS), nor did bisphosphonate use (p = NS). The Disease Activity Score with 28 joint count in the high-risk group was significantly higher compared to the low-risk group (p = 0.048).Conclusion.Patients at increased risk had higher disease activity, more frequent glucocorticoid use, and more baseline erosions compared to patients at low risk. A care gap exists, in that a very low proportion of patients at high risk are being treated with calcium, vitamin D, and/or bisphosphonates. A higher fracture risk was calculated in our cohort using the US FRAX calculation tool compared to the UK calculation tool. These data highlight the need to identify and modify fracture risk in patients with early inflammatory arthritis.

Missing Anticitrullinated Protein Antibody Does Not Affect Short-term Outcomes in Early Inflammatory Arthritis: From the Canadian Early Arthritis Cohort

2015 ◽  
Vol 42 (11) ◽  
pp. 2023-2028 ◽  
Author(s):  
Jenny Shu ◽  
Vivian P. Bykerk ◽  
Gilles Boire ◽  
Boulos Haraoui ◽  
Carol Hitchon ◽  
...  
Keyword(s):  
Disease Activity ◽  
Inflammatory Arthritis ◽  
Smoking Status ◽  
Health Assessment ◽  
Symptom Duration ◽  
Care Gap ◽  
American College Of Rheumatology ◽  
European League Against Rheumatism ◽  
Early Inflammatory Arthritis ◽  
Group 3

Objective.Anticitrullinated protein antibody (ACPA) is as sensitive as, but more specific than, rheumatoid factor (RF) and is detected earlier in rheumatoid arthritis (RA). Although part of the RA classification criteria, ACPA testing is not routinely paid for/accessible in all jurisdictions. The effect of missing ACPA testing was studied to determine whether failure to perform ACPA testing could cause a care gap in early inflammatory arthritis.Methods.Nearly 2000 patients (n = 1998) recruited to an early inflammatory arthritis cohort were allocated into 3 groups: (1) seropositive (either RF+ or ACPA+), (2) seronegative (RF− and ACPA−), and (3) missing ACPA and RF−. Analyses were adjusted for age, sex, symptom duration, and smoking status if p < 0.1. Disease Activity Score at 28 joints (DAS28) at 3 months was studied, because beyond then, disease activity is expected to determine ongoing treatment.Results.More seropositive patients fulfilled the 2010 American College of Rheumatology/European League Against Rheumatism RA criteria than seronegative patients. Group 3 was slightly older and had a smaller percentage of females, as well as shorter symptom duration and less smoking. At 3 months, group 3 was treated with fewer disease-modifying antirheumatic drugs and methotrexate (p < 0.00002) than groups 1 and 2, but there were no significant differences in DAS28, Health Assessment Questionnaire-Disability Index (HAQ-DI), proportion receiving corticosteroids, or physician’s/patient’s global assessments.Conclusion.There was no care gap in the RF-negative, unknown ACPA group because there were no significant differences in the DAS28, 3-month change in DAS28, or HAQ-DI, despite less treatment. Cost-effectiveness of ensuring ACPA testing availability in suspected RA is unknown because early outcomes did not differ, whether or not ACPA was available.

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