RA patients’ mood, anxiety, and physical disability improved over past 20 years

Psychological distress and physical disability have decreased in patients with rheumatoid arthritis over the past 2 decades, at least partly because of reduced disease activity with earlier and more intensive treatment and shifting recommendations for physical activity, according to an analysis of 1,151 Dutch patients who were monitored at diagnosis and after 3-5 years of treatment during 1990-2011.

Although prior studies have found this trend for improvement for shorter time periods, they had few cross-sectional cohorts and did not examine recent years, said Cécile L. Overman and colleagues at Utrecht (the Netherlands) University and Utrecht University Medical Center.

The investigators assembled the study cohort from a median of 47 patients older than 16 years with a duration of rheumatoid arthritis of less than 1 year who presented each year during 1990-2001 to rheumatology departments across the Netherlands. The patients originally had consented to participate in one of several prospective trials comparing the effectiveness of different drug treatment strategies, including strategies that were conventional at the time.

The rate of depressed mood among patients at the time of diagnosis declined from 43% in 1990-1994 to 32% in 2004-2008, and the corresponding rate at follow-up declined from 25% to 14%. For anxiety, the rate at the time of diagnosis shifted from 34% to 21% and at follow-up changed from 23% to 12%. Physical disability rates at diagnosis decreased from 64% to 60% and at follow-up from 53% to 31% (Arthritis Care Res. 2013 Dec. 3 [doi:10.1002/acr.22211]).

Across the 21 years of the study, there were small, but statistically significant decreases in depressed mood and physical disability and a moderate decline in anxiety. During treatment, these changes were not significant for depressed mood but were significant, yet small for anxiety and moderate to large for physical disability. After time trends were accounted for, measurements associated with decreased disease activity at the time of diagnosis and at follow-up declined over the course of the study, and partly mediated declines in depressed mood, anxiety, and physical disability. Changes in patient composition over time, such as earlier diagnosis over the years as reflected by a decreasing age at the time of diagnosis, increases in education level, and increases in socioeconomic status and life expectancy, were not consistently associated with depressed mood or anxiety or physical disability at diagnosis or follow-up.

"Across the decades, especially the trend of progressively decreasing physical disability after the first years of treatment was noteworthy, and this favorable trend remained significant after having taken account of the reduction of disease activity and change in the composition of patient influx," wrote Ms. Overman, a PhD candidate in the department of clinical and health psychology at the university, and her associates.

The investigators noted that it is impossible to know whether the changes in patient composition played a causal role in affecting psychological distress and physical disability or "only reflect a historic change occurring simultaneously, affecting the improvements statistically but not in real life."

They also suggested that improvements in psychological distress and physical disability might be related not only to pharmacologic reduction of disease activity but also targeted nonpharmacologic therapies such as exercise therapy and cognitive-behavioral therapy as well as "the changed education by rheumatologists and health professionals enhancing physical activity and encouraging patients to live a valued life."

Biologic agents’ inhibition of proinflammatory cytokines and their potential effects on behavior also could have contributed to a reduction in psychological distress and physical disability "not fully explained by reduced disease activity," according to the investigators.

The study was funded by a grant from the Faculty of Social and Behavioral Sciences of Utrecht University and by unrestricted grants from the Dutch Arthritis Foundation. The authors reported no relevant financial conflicts.

[email protected]

Psychological distress and physical disability have decreased in patients with rheumatoid arthritis over the past 2 decades, at least partly because of reduced disease activity with earlier and more intensive treatment and shifting recommendations for physical activity, according to an analysis of 1,151 Dutch patients who were monitored at diagnosis and after 3-5 years of treatment during 1990-2011.

Although prior studies have found this trend for improvement for shorter time periods, they had few cross-sectional cohorts and did not examine recent years, said Cécile L. Overman and colleagues at Utrecht (the Netherlands) University and Utrecht University Medical Center.

The investigators assembled the study cohort from a median of 47 patients older than 16 years with a duration of rheumatoid arthritis of less than 1 year who presented each year during 1990-2001 to rheumatology departments across the Netherlands. The patients originally had consented to participate in one of several prospective trials comparing the effectiveness of different drug treatment strategies, including strategies that were conventional at the time.

The rate of depressed mood among patients at the time of diagnosis declined from 43% in 1990-1994 to 32% in 2004-2008, and the corresponding rate at follow-up declined from 25% to 14%. For anxiety, the rate at the time of diagnosis shifted from 34% to 21% and at follow-up changed from 23% to 12%. Physical disability rates at diagnosis decreased from 64% to 60% and at follow-up from 53% to 31% (Arthritis Care Res. 2013 Dec. 3 [doi:10.1002/acr.22211]).

Across the 21 years of the study, there were small, but statistically significant decreases in depressed mood and physical disability and a moderate decline in anxiety. During treatment, these changes were not significant for depressed mood but were significant, yet small for anxiety and moderate to large for physical disability. After time trends were accounted for, measurements associated with decreased disease activity at the time of diagnosis and at follow-up declined over the course of the study, and partly mediated declines in depressed mood, anxiety, and physical disability. Changes in patient composition over time, such as earlier diagnosis over the years as reflected by a decreasing age at the time of diagnosis, increases in education level, and increases in socioeconomic status and life expectancy, were not consistently associated with depressed mood or anxiety or physical disability at diagnosis or follow-up.

"Across the decades, especially the trend of progressively decreasing physical disability after the first years of treatment was noteworthy, and this favorable trend remained significant after having taken account of the reduction of disease activity and change in the composition of patient influx," wrote Ms. Overman, a PhD candidate in the department of clinical and health psychology at the university, and her associates.

The investigators noted that it is impossible to know whether the changes in patient composition played a causal role in affecting psychological distress and physical disability or "only reflect a historic change occurring simultaneously, affecting the improvements statistically but not in real life."

They also suggested that improvements in psychological distress and physical disability might be related not only to pharmacologic reduction of disease activity but also targeted nonpharmacologic therapies such as exercise therapy and cognitive-behavioral therapy as well as "the changed education by rheumatologists and health professionals enhancing physical activity and encouraging patients to live a valued life."

Biologic agents’ inhibition of proinflammatory cytokines and their potential effects on behavior also could have contributed to a reduction in psychological distress and physical disability "not fully explained by reduced disease activity," according to the investigators.

The study was funded by a grant from the Faculty of Social and Behavioral Sciences of Utrecht University and by unrestricted grants from the Dutch Arthritis Foundation. The authors reported no relevant financial conflicts.

[email protected]

Psychological distress and physical disability have decreased in patients with rheumatoid arthritis over the past 2 decades, at least partly because of reduced disease activity with earlier and more intensive treatment and shifting recommendations for physical activity, according to an analysis of 1,151 Dutch patients who were monitored at diagnosis and after 3-5 years of treatment during 1990-2011.

Although prior studies have found this trend for improvement for shorter time periods, they had few cross-sectional cohorts and did not examine recent years, said Cécile L. Overman and colleagues at Utrecht (the Netherlands) University and Utrecht University Medical Center.

The investigators assembled the study cohort from a median of 47 patients older than 16 years with a duration of rheumatoid arthritis of less than 1 year who presented each year during 1990-2001 to rheumatology departments across the Netherlands. The patients originally had consented to participate in one of several prospective trials comparing the effectiveness of different drug treatment strategies, including strategies that were conventional at the time.

The rate of depressed mood among patients at the time of diagnosis declined from 43% in 1990-1994 to 32% in 2004-2008, and the corresponding rate at follow-up declined from 25% to 14%. For anxiety, the rate at the time of diagnosis shifted from 34% to 21% and at follow-up changed from 23% to 12%. Physical disability rates at diagnosis decreased from 64% to 60% and at follow-up from 53% to 31% (Arthritis Care Res. 2013 Dec. 3 [doi:10.1002/acr.22211]).

Across the 21 years of the study, there were small, but statistically significant decreases in depressed mood and physical disability and a moderate decline in anxiety. During treatment, these changes were not significant for depressed mood but were significant, yet small for anxiety and moderate to large for physical disability. After time trends were accounted for, measurements associated with decreased disease activity at the time of diagnosis and at follow-up declined over the course of the study, and partly mediated declines in depressed mood, anxiety, and physical disability. Changes in patient composition over time, such as earlier diagnosis over the years as reflected by a decreasing age at the time of diagnosis, increases in education level, and increases in socioeconomic status and life expectancy, were not consistently associated with depressed mood or anxiety or physical disability at diagnosis or follow-up.

"Across the decades, especially the trend of progressively decreasing physical disability after the first years of treatment was noteworthy, and this favorable trend remained significant after having taken account of the reduction of disease activity and change in the composition of patient influx," wrote Ms. Overman, a PhD candidate in the department of clinical and health psychology at the university, and her associates.

The investigators noted that it is impossible to know whether the changes in patient composition played a causal role in affecting psychological distress and physical disability or "only reflect a historic change occurring simultaneously, affecting the improvements statistically but not in real life."

They also suggested that improvements in psychological distress and physical disability might be related not only to pharmacologic reduction of disease activity but also targeted nonpharmacologic therapies such as exercise therapy and cognitive-behavioral therapy as well as "the changed education by rheumatologists and health professionals enhancing physical activity and encouraging patients to live a valued life."

Biologic agents’ inhibition of proinflammatory cytokines and their potential effects on behavior also could have contributed to a reduction in psychological distress and physical disability "not fully explained by reduced disease activity," according to the investigators.

The study was funded by a grant from the Faculty of Social and Behavioral Sciences of Utrecht University and by unrestricted grants from the Dutch Arthritis Foundation. The authors reported no relevant financial conflicts.

[email protected]