The Association between Depression and vitamin D level with disease activity in patient with rheumatoid arthritis

Abstract

Introduction: Rheumatoid arthritis (RA) is a chronic rheumatologic disease, affecting different aspects of patient life. Although several studies have reported a higher rate of depression among patients with RA, there is still controversy over the underlying risk factors and probable covariates of depression in these individuals. The present study investigated the relationship between disease activity, serum levels of vitamin D, and depression in patients with RA. Methods: In this cross sectional study patients with confirmed RA based on the American College of Rheumatology guidelines entered the study. Disease activity was measured using the Disease Activity Score (DAS). The Hospital Anxiety and Depression Scale (HADS) was also administered to determine the subjects' level of depression. The Health Assessment Questionnaire (HAQ) was applied for evaluating the subjective disability of the patients in their daily activities. Serum levels of vitamin D, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) were also measured. Results: 62 patients were enrolled in the study. Depression was present and possibly present in 12 (19.4%) and 15 (24.2%) cases, respectively. According to the results the DAS was inversely associated with vitamin D3 levels (P<0.001). There were also significant relations between the DAS and scores on both the HAQ and HADS. Moreover, higher levels of vitamin D3 were related with lower scores on the HAQ and HADS (P=0.018). Conclusion: Higher scores on the HADS were directly associated with lower levels of vitamin D, HAQ score anddisease activity. Nevertheless, no significant association was found with HADS and patients' sociodemographic characteristics.Targeted approach to psychological aspects and vitamin D levels among patients with RA may have considerable implication for the optimal management of RA.