THE RELATIONSHIP BETWEEN PSYCHOLOGICAL DISTRESS AND TRADITIONAL CLINICAL-VARIABLES - A 2-YEAR PROSPECTIVE-STUDY OF 216 PATIENTS WITH EARLY RHEUMATOID-ARTHRITIS

In this longitudinal study (12 and 24 months follow-up) of 216 patient s with early rheumatoid arthritis (RA) (less than or equal to 4 yr dur ation:), we assessed the strength and stability of the relationship be tween psychological distress and traditional clinical variables, exami ned the ability of these clinical variables to predict changes in ment al distress, and explored the directionality between mental distress a nd the other clinical variables. Study variables were symptoms of anxi ety and depression measured by the Arthritis Impact Measurement Scales , tender joint counts, erythrocyte sedimentation rate (ESR), and self- reported pain and disability. Psychological distress showed high level s of stability over time. Pain and disability were the two variables m ost strongly and consistently related to mental distress. High levels of disability predicted an increase in depression during the next year , otherwise, changes in psychological distress were not predicted by d isease-related variables. Attempts at causal modelling of the temporal relationship between mental distress, pain and disability failed to y ield consistent results.