Objective. Symptoms of psychological distress, including anxiety and depressive symptoms, and illness perceptions are important in determining outcome in patients with rheumatic disease. We aimed to compare psychological distress in psoriatic arthritis (PsA) and rheumatoid arthritis (RA) and to test whether the association between psychological variables and health-related quality of life (HRQOL) was similar in the 2 forms of arthritis. Methods. In 83 PsA patients and 199 RA patients, we used the Patient Health Questionnaire 9 (PHQ-9), the Symptom Checklist-90-Revised, and the Brief Illness Perception Questionnaire to assess psychological variables and the World Health Organization Quality of Life Instrument, Short Form to assess HRQOL. We used hierarchical regression analysis to determine the associations between psychological variables and HRQOL after adjusting for demographic variables and disease parameters. Results. The prevalence of moderate to severe levels of depressive symptoms (PHQ-9 score >10) was 21.7% in PsA patients, 25.1% in RA patients, and 36.7% in those PsA patients with polyarthritis. After adjustment for severity of disease and pain, anxiety (␤ ‫؍‬ ؊0.28) and concern about bodily symptoms attributed to the illness (␤ ‫؍‬ ؊0.33) were independent correlates of physical HRQOL in PsA. In RA, depressive symptoms (␤ ‫؍‬ ؊0.29) and concern about the consequences of the arthritis (␤ ‫؍‬ ؊0.27) were independent correlates of physical HRQOL. Conclusion. These findings suggest strongly that psychological factors are important correlates of HRQOL in PsA as well as in RA. Attention to patients' anxiety and their concern about numerous bodily symptoms attributed to the illness may enable rheumatologists to identify and manage treatable aspects of HRQOL in PsA.

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The estimated incidence and prevalence of pSS in this study were slightly higher in comparison with data from other studies based on physician-diagnosed cases. The prevalence was significantly lower when compared with the findings of studies based on the examination of a sample of the general population. Mortality rates did not differ significantly between pSS patients and the general population.

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Objective. The Patient Health Questionnaire 9 (PHQ-9) was developed to screen for depressive disorders in community, primary care, and medical settings. We aimed to estimate its diagnostic accuracy, internal consistency, reliability, and convergent validity in diagnosing major depressive disorder (MDD) in Greek patients with rheumatologic disorders. Methods. In a 2-phase sampling design study, we recruited 475 patients with established rheumatologic disorders. One of 2 of the high scorers (PHQ-9 score >9, n ‫؍‬ 85) and 1 of 3 of the low scorers (PHQ-9 score 0 -8, n ‫؍‬ 128) were interviewed using the Mini International Neuropsychiatric Interview to confirm MDD. A receiver operator characteristic curve analysis was performed to confirm the optimum threshold value. The scale's dimensional structure was tested with factor analysis, and internal consistency reliability was assessed with Cronbach's alpha. Psychological distress (Symptom Check List-90-Revised [SCL-90-R]), disability (Health Assessment Questionnaire disability index), and health-related quality of life (HRQOL; World Health Organization Quality of Life Instrument [WHOQOL-BREF]) were also assessed to test convergent validity with bivariate correlations.Results. At an optimum threshold of 10, the PHQ-9 showed a sensitivity of 81.2% and a specificity of 86.8%. The area under the curve was 0.91. The PHQ-9 presented unidimensional structure with good scale reliability (␣ ‫؍‬ 0.82). The PHQ-9 score presented the greatest correlations with SCL-90-R depression (r ‫؍‬ 0.736) and WHOQOL-BREF mental HRQOL scales (r ‫؍‬ ؊0.571), and all other correlations with disability and HRQOL were in the expected direction. Conclusion. At a cutoff of 10, the PHQ-9 is an accurate, reliable, and valid measure for screening for MDD among Greek rheumatologic patients.

Anxiety and depressive symptoms as well as cognitive variables are important in determining outcome in rheumatic diseases. We aimed to compare psychological distress symptoms and illness perceptions in ankylosing spondylitis (AS) and rheumatoid arthritis (RA) and to test whether their associations with health-related quality of life (HRQoL) were similar in these rheumatologic disorders. In 55 AS and 199 RA patients, we administered the Patient Health Questionnaire (PHQ-9), the Symptom Check-List and the Brief-Illness Perception Questionnaire to assess psychological variables and the World Health Organization Quality of Life Instrument, Short Form to assess HRQoL. We used hierarchical regression analyses to determine the associations between psychological variables and HRQoL after adjusting for demographic variables and disease parameters. The prevalence of clinically significant depressive symptoms (PHQ-9 ≥ 10) was 14.8 % in AS and 25.1 % in RA patients, but adjustment for demographics rendered these differences in depressive symptoms' severity non-significant. Psychological distress levels and HRQoL were similar in both disorders. Illness concern (b = -0.37) was the only significant independent correlate of physical HRQoL in AS. In RA, depression (b = -0.25), illness concern (b = -0.14) and worries about the consequences of the disease (b = -0.31) were the independent correlates of physical HRQoL. These findings suggest that cognitive variables are important correlates of HRQoL in AS, whereas in RA depressive symptoms and illness perceptions equally contribute to HRQoL. Our data encourage the design of psychotherapeutic trials targeting disease-related cognitions in AS in an attempt to improve patient's physical HRQoL.

Objectives-To describe the clinical and serological findings in male and paediatric Sjögren's syndrome (SS) patients. Patients and Methods-Using the European criteria for the diagnosis of SS 12 male and 13 paediatric patients were identified and compared with those of 30 consecutive unselected adult female SS patients. Results-The mean (SD) age of paediatric patients was 9.4 (2.2) years, ranging from 6 to 14 years. Recurrent parotid gland enlargement was the initial clinical manifestation in the majority of the children with a statistical significance compared with male (p<0.01) and with female patients (p<0.0001). Sicca manifestations were the most common clinical symptoms in male and female patients at disease onset. The systemic manifestations were similar among the three groups except that men showed lower frequency of arthritis (p<0.05) and Raynaud's phenomenon (p<0.05) compared with women. No diVerences were found among the immunological profile of children and female patients, while male patients had a lower frequency of antinuclear antibodies (p<0.025) and antibodies to Ro(SSA) nuclear antigens (p<0.025) compared with women. Conclusion-Primary SS is rare in children and men in Greece. Recurrent parotid gland enlargement is the most common clinical finding at disease onset in children. Male patients seem to have less systemic manifestations and lower frequency of autoantibodies. (Ann Rheum Dis 1997;56:333-335) Primary Sjögren's syndrome (SS) is a chronic autoimmune disorder aVecting the lacrimal and salivary glands, as well as other exocrine glands leading to functional impairment and mucosal dryness. It is often associated with systemic extraglandular manifestations, and laboratory tests show B cell polyclonal hyperactivity. It aVects predominantly women at middle age.