A study recently published in Arthritis & Rheumatism found that a cohort of patients from multiethnic backgrounds who all had rheumatoid arthritis (RA) had nearly double the rate of depressive symptoms compared with middle-class white patients with RA.1 The study also examined predictors of depression, and concluded that physical disability—not acute disease activity—is the principal predictor of depression in patients with RA.
RA is a chronic disease that causes pain, stiffness, swelling, and limitation in the motion and function of multiple joints. Disability occurs when a patient can no longer perform a task they once could, while acute RA disease activity is measured by swollen joints, tender joints, and inflammatory markers in patient assessments.
The study followed 172 patients at San Francisco General Hospital’s outpatient rheumatology clinic and found that 40% of this multiethnic, low-income cohort had symptoms of at least moderate depression. However, Asian patients had lower scores compared with other patients in the cohort.
The research also shows that patients can tolerate symptoms such as swelling and tenderness without becoming depressed. However, when patients can no longer perform certain tasks because of disability, many develop depressive symptoms. Based on these findings, the researchers concluded that rheumatologists should continue to make disability prevention a priority through their treatment choices and should encourage additional screening for depression, especially in at-risk populations.
Among the researchers on this project were Edward Yelin, PhD, professor in residence of medicine and health policy in the Division of Rheumatology, and Mary Margaretten, MD, assistant adjunct professor of medicine, both of whom are at the University of California, San Francisco.
Dr. Yelin, a recent recipient of an ACR Research and Education Foundation’s (REF’s) Within Our Reach: Finding a Cure for Rheumatoid Arthritis RA research grant, says, “I think what was shocking is that the rate is twice as high in one group versus another. When that happens, you would think that it would be driven by different factors, but it seems to be driven by the same ones, including disability and age.”
Dr. Margaretten believes the study’s findings demonstrate why it’s important for practicing rheumatologists to screen for depression—especially in patients from diverse ethnic backgrounds and with lower socioeconomic status. The study also provides further evidence of the benefit of staving off disability as long as possible. “Disability certainly has psychological consequences,” she says. Dr. Yelin notes that future research might seek to understand why Asian patients, despite severe disease and low socioeconomic status, report less depression. “Is it because they are more stoic?” he asks. “Do the measures we use not work as well for them? Do they have more cultural support?”