Depression as a Major Determinant of Pass (Patient’s Acceptable Symptoms State) in Rheumatoid Arthritis: A Cross Sectional Study in 116 Brazilian Patients

Abstract

BACKGROUNDSeveral instruments are used to evaluate rheumatoid arthritis (RA) patients' clinical condition aiming to tailor their treatment accordingly. The patient acceptable symptom state (PASS) is a simple question that measure the value beyond which patients consider themselves well. This work studied the RA patient's response to PASS and its association to disease activity, pain, functionality and mood conditions in a sample of Brazilian patients. METHODSRheumatoid arthritis patients were evaluated for PASS, simple disease activity index (SDAI) and clinical disease activity index (CDAI) to study disease activity; health assessment questionnaire (HAQ) to study functionality; visual analogic scale (VAS) for pain; and Center for Epidemiologic Studies depression scale (CES-D) and Beck anxiety inventory to analyze depression and anxiety, respectively. Patients that answered yes to PASS were compared to those who answered no. RESULTSOne hundred and sixteen patients (85.3% females; mean age of 56.5 years and median disease duration of 10 years) were included. About 82/116 (70.6%) answered yes to PASS. Comparison of groups showed that those not in PASS had more disease activity (CDAI with p = 0.03), lower functionality (p = 0.001), more depression (p = 0.001), pain (p = 0.03) and anxiety (p = 0.05). Linear logistic regression showed that depression was the only independent variable associated with negative answer to PASS (p = 0.003; OR = 1.06; 95% CI = 1.02 to 1.1). CONCLUSIONRheumatoid arthritis not in PASS have more disease activity, pain, depression, anxiety and lower function. Depression was associated independently with a negative answer.