MANIFESTATIONS OF NEUROPSYCHIATRIC DISEASE IN PATIENTS WITH OSTEOARTHRITIS AND INFLAMMATORY JOINT DISEASE
Keywords:
Rheumatology, Anxiety, Depression, Rheumatoid arthritis, PsychiatryAbstract
Inflammatory joint diseases, such as rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing
spondilitis (AS), and osteoarthritis are conditions of great social importance, due to their relatively high prevalence.
The forementioned conditions usually show progressive development and tend to be disabling in nature. They put a
great strain on patients’ quality of life physically as well as mentally. Numerous randomized trials, retrospective
analyses and cohort studies show statistically significant association between these rheumatological conditions and
certain psychiatric manifestations (mainly anxiety and depression, but not only). Data regarding the most common
autoimmune joint disease – RA shows that 15% of those patients develop some sort of depressive disorder. Low
self-esteem and anxiety as more common as well. A longer lasting and more active RA is more likely to cause some
sort of mental disorder. Elevated levels of CRP (biochemical marker of disease activity) have been found to be
associated with higher likelihood for the development of anxiety and depression. Psoriatic arthritis and the psoriatic
disease in general lead to a higher prevalence of depression, anxiety and sleep disorders, sexual disturbances and
low self-esteem. Approximately half of the patients with PsA have some sort of sleep disorder, nearly 70% have
sexual problems. The percentages for depression and anxiety are between 22% and 36%. A lot of attention has been
drawn to the underlying mechanisms causing this link between the rheumatological condition and the mental
disorder. The consistently high levels of psychological stress in patients with PsA lead to a pathological overactivation
of the hypothalamic-pituitary-adrenal axis. This over-activation produces to higher quantities of CRH and
cortisol which lead to subsequent physiological changes. Research has shown that mediators of greater importance
for the development of neuropsychiatric manifestations are TNF-alfa, IL-6, IL17. The prevalence of depression and
anxiety in patients with AS is far lower than in those with RA and PsA, however higher than the one in the
otherwise healthy population. Prospective trials show that on average one in every ten patients with AS develops
some form of depression. This is markedly higher that in the general population – 6%. OA being the most common
joint disease of them all shows similar results when being investigated from mental stand point. OA elevates the risk
for developing depression, anxiety or any other psychiatric disorder. The most common factors associated with
higher likelihood ratio are obesity, impaired joint mobility, general disability. The current state of knowledge leaves
little room for doubt about the correlation between the described joint diseases and the most common psychiatric
conditions. However, we are lacking data explaining the intimate mechanisms of this correlation. The discovery of
these mechanisms and the possible ways of interfering with them are one of the main challenges in the field of
today’s rheumatology. Any breakthrough in this direction would definitely give new hope for treatment and
prevention
References
Ang, D. C., Choi, H., Kroenke, K., & Wolfe, F. (2005). Comorbid depression is an independent risk factor for mortality in patients with rheumatoid arthritis. The Journal of Rheumatology, 32(6), 1013–1019.
Brihan, I., Ianoși, S. L., Boda, D., Hălmăjan, A., Zdrîncă, M., & Fekete, L. G. (2020). Implications of self-esteem in the quality of life in patients with psoriasis. Experimental and Therapeutic Medicine, 20(6), 202. https://doi.org/10.3892/etm.2020.9332
Durmus, D., Sarisoy, G., Alayli, G., Kesmen, H., Çetin, E., Bilgici, A., Kuru, O., & Ünal, M. (2021). Psychiatric symptoms in ankylosing spondylitis: their relationship with disease activity, functional capacity, pain and fatigue. Comprehensive Psychiatry, 62, 170–177. https://doi.org/10.1016/j.comppsych.2015.07.016
Ferreira, B. I. R. C., Abreu, J. L. P. D. C., Reis, J. P. G. Dos, & Figueiredo, A. M. D. C. (2016). Psoriasis and Associated Psychiatric Disorders: A Systematic Review on Etiopathogenesis and Clinical Correlation. The Journal of Clinical and Aesthetic Dermatology, 9(6), 36–43.
Guenther, V., Locher, E., Falkenbach, A., Gutweniger, S., Kopp, M., Pfaffenberger, N., Stuerz, K., & Mur, E. (2010). Body image in patients with ankylosing spondylitis. Clinical and Experimental Rheumatology, 28(3), 341–347.
Husni, M. E., Merola, J. F., & Davin, S. (2023). The psychosocial burden of psoriatic arthritis. Seminars in Arthritis and Rheumatism, 47(3), 351–360. https://doi.org/10.1016/j.semarthrit.2017.05.010
Isik, A., Koca, S. S., Ozturk, A., & Mermi, O. (2007). Anxiety and depression in patients with rheumatoid arthritis. Clinical Rheumatology, 26(6), 872–878. https://doi.org/10.1007/s10067-006-0407-y
Jankowiak, B., Kowalewska, B., Krajewska-Kułak, E., Khvorik, D. F., & Niczyporuk, W. (2020). Relationship between self-esteem and stigmatization in psoriasis patients. Postepy Dermatologii i Alergologii, 37(4), 597–602. https://doi.org/10.5114/ada.2020.93242
Krol, B., Sanderman, R., Suurmeijer, T., Doeglas, D., van Rijswijk, M., & van Leeuwen, M. (1994). Disease characteristics, level of self-esteem and psychological well-being in rheumatoid arthritis patients. Scandinavian Journal of Rheumatology, 23(1), 8–12. https://doi.org/10.3109/03009749409102127
Kurt, E., Özdilli, K., & Yorulmaz, H. (2013). Body Image and Self-Esteem in Patients with Rheumatoid Arthritis. Noro Psikiyatri Arsivi, 50(3), 202–208. https://doi.org/10.4274/npa.y6195
Lok, E. Y. C., Mok, C. C., Cheng, C. W., & Cheung, E. F. C. (2010). Prevalence and determinants of psychiatric disorders in patients with rheumatoid arthritis. Psychosomatics, 51(4), 338-338.e8. https://doi.org/10.1176/appi.psy.51.4.338
Lwin, M. N., Serhal, L., Holroyd, C., & Edwards, C. J. (2022). Rheumatoid Arthritis: The Impact of Mental Health on Disease: A Narrative Review. Rheumatology and Therapy, 7(3), 457–471. https://doi.org/10.1007/s40744-020-00217-4
Matcham, F., Rayner, L., Steer, S., & Hotopf, M. (2013). The prevalence of depression in rheumatoid arthritis: a systematic review and meta-analysis. Rheumatology (Oxford, England), 52(12), 2136–2148. https://doi.org/10.1093/rheumatology/ket169
McDonough, E., Ayearst, R., Eder, L., Chandran, V., Rosen, C. F., Thavaneswaran, A., & Gladman, D. D. (2024). Depression and anxiety in psoriatic disease: prevalence and associated factors. The Journal of Rheumatology, 41(5), 887–896. https://doi.org/10.3899/jrheum.130797
Meesters, J. J., Bremander, A., Bergman, S., Petersson, I. F., Turkiewicz, A., & Englund, M. (2014). The risk for depression in patients with ankylosing spondylitis: a population-based cohort study. Arthritis Research & Therapy, 16(4), 418. https://doi.org/10.1186/s13075-014-0418-z
Milaneschi, Y., Hoogendijk, W., Lips, P., Heijboer, A. C., Schoevers, R., van Hemert, A. M., Beekman, A. T. F., Smit, J. H., & Penninx, B. W. J. H. (2014). The association between low vitamin D and depressive disorders. Molecular Psychiatry, 19(4), 444–451. https://doi.org/10.1038/mp.2013.36
Parkinson, J. T., Foley, É. M., Jadon, D. R., & Khandaker, G. M. (2020). Depression in patients with spondyloarthritis: prevalence, incidence, risk factors, mechanisms and management. Therapeutic Advances in Musculoskeletal Disease, 12, 1759720X20970028. https://doi.org/10.1177/1759720X20970028
Pereira, D., Severo, M., Barros, H., Branco, J., Santos, R. A., & Ramos, E. (2013). The effect of depressive symptoms on the association between radiographic osteoarthritis and knee pain: a cross-sectional study. BMC Musculoskeletal Disorders, 14, 214. https://doi.org/10.1186/1471-2474-14-214
Rathbun, A. M., Yau, M. S., Shardell, M., Stuart, E. A., & Hochberg, M. C. (2017). Depressive symptoms and structural disease progression in knee osteoarthritis: data from the Osteoarthritis Initiative. Clinical Rheumatology, 36(1), 155–163. https://doi.org/10.1007/s10067-016-3495-3
Reddy, K. N., Sabu, N., Pandey, N., Raut, A., Joag, K., & Patil, P. (2022). Anxiety and depression among patients with axial spondyloarthritis. European Journal of Rheumatology, 9(1), 8–13. https://doi.org/10.5152/eurjrheum.2021.21022
Sharma, A., Kudesia, P., Shi, Q., & Gandhi, R. (2016). Anxiety and depression in patients with osteoarthritis: impact and management challenges. Open Access Rheumatology : Research and Reviews, 8, 103–113. https://doi.org/10.2147/OARRR.S93516
Solmaz, M., Binbay, Z., Cidem, M., Sağir, S., & Karacan, İ. (2014). Alexithymia and Self-Esteem in Patients with Ankylosing Spondylitis. Noro Psikiyatri Arsivi, 51(4), 350–354. https://doi.org/10.5152/npa.2014.6977
Stubbs, B., Aluko, Y., Myint, P. K., & Smith, T. O. (2016). Prevalence of depressive symptoms and anxiety in osteoarthritis: a systematic review and meta-analysis. Age and Ageing, 45(2), 228–235. https://doi.org/10.1093/ageing/afw001
Tan, V., Jinks, C., Chew-Graham, C., Healey, E. L., & Mallen, C. (2015). The triple whammy anxiety depression and osteoarthritis in long-term conditions. BMC Family Practice, 16, 163. https://doi.org/10.1186/s12875-015-0346-2
VanDyke, M. M., Parker, J. C., Smarr, K. L., Hewett, J. E., Johnson, G. E., Slaughter, J. R., & Walker, S. E. (2004). Anxiety in rheumatoid arthritis. Arthritis and Rheumatism, 51(3), 408–412. https://doi.org/10.1002/art.20474
