THE RELATIONSHIP BETWEEN CLINICAL ACTIVITY AND DEPRESSION IN RHEUMATOID-ARTHRITIS

Objective. To determine the extent to which clinical variables and cha nges in clinical variables explain depression and depression changes i n patients with rheumatoid arthritis (RA). Methods. 713 patients with RA attending an outpatient rheumatology clinic were studied at their 2 most recent clinic visits as part of their ordinary rheumatic disease care. Six demographic variables and 7 clinical variables were assesse d including the Arthritis Impact Measurement Scale depression score, S tanford Health Assessment Questionnaire Functional Disability Index (H AQ-DI), visual analog scale (VAS) pain scales, joint count, grip stren gth, am stiffness, and erythrocyte sedimentation rate. Change scores r epresenting the difference between the scores at the last and the next to last visit were calculated for all clinical variables. Results. Ab out 20% of the variance in depression change scores was explained by c hanges in clinical variables. The amount of variance explained appeare d to be inversely related to the time between visits. Thirty-four perc ent of the variance in current levels of depression scores was explain ed by current clinical and demographic variables. The most important p redictors of depression score and depression change were VAS Pain and HAQ-DI. At the last clinic visit between 11 and 16% of the depression score was explained by changes in depression scores since the previous clinic visit. Conclusion. Clinical changes explain 20% of depressive changes between visits, while 34% of current depression scores are exp lained by current clinical status. Changes in pain and HAQ-DI predict changes in depression.