Psychological distress over time in early rheumatoid arthritis: results from a longitudinal study in an early arthritis cohort

Rheumatology (Oxford). 2015 Mar;54(3):520-7. doi: 10.1093/rheumatology/keu371. Epub 2014 Sep 14.


Objective: RA is a chronic disease with frequent psychological co-morbidities, of which depression and anxiety are two common manifestations. We aimed to identify predictive factors of psychological distress in a large prospective cohort of very early RA patients.

Methods: ESPOIR (Etude et Suivi des Polyarthrites Indifférenciées Récentes) is a multicentre, longitudinal and prospective cohort study of patients with early arthritis (<6 months disease duration). The study sample comprised 641 patients with very early RA according to the 2010 ACR/European League Against Rheumatism RA criteria from the ESPOIR cohort. Psychological distress was assessed over 3 years by the five-item Mental Health Inventory questionnaire at various time points (baseline, 6, 12, 18, 24 and 36 months). Logistic regression with a generalized estimating equation model was used to analyse the association of disease variables and risk of psychological distress.

Results: At baseline, 46.9% of RA patients were screened as positive for psychological distress. Over 3 years, psychological distress decreased significantly, with a prevalence of 25.8% at 36 months. The HAQ Disability Index (HAQ-DI) score was the most important factor predicting psychological distress over 3 years [odds ratio 2.10 (95% CI 1.41, 3.14)-3.59 (2.29, 5.63)]. Baseline biological and radiological variables and treatment regimens were not associated with distress.

Conclusion: Psychological distress in very early RA is frequent and the HAQ-DI score is a predictor of depression and anxiety in these patients. A psychological evaluation in patients with early RA is important for further individual psychiatric diagnosis and management.

Keywords: HAQ; depression; early rheumatoid arthritis; psychological distress.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anxiety / epidemiology
  • Arthritis, Rheumatoid / diagnosis*
  • Arthritis, Rheumatoid / epidemiology
  • Arthritis, Rheumatoid / psychology*
  • Cohort Studies
  • Comorbidity
  • Depression / epidemiology
  • Disability Evaluation*
  • Early Diagnosis*
  • Female
  • France / epidemiology
  • Humans
  • Logistic Models
  • Longitudinal Studies
  • Middle Aged
  • Prevalence
  • Prospective Studies
  • Stress, Psychological / complications*
  • Surveys and Questionnaires
  • Time Factors