The magnitude of fatigue and its association with depression, pain, and inflammatory activity in rheumatoid arthritis


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Abstract

AIM: To analyze the rate of clinically significant fatigue and to search for its predictors in patients with rheumatoid arthritis (RA)/MATERIAL AND METHODS: The investigation included 95 patients with a valid RA diagnosis. The majority of the patients were women (87.4%); mean age was 46.7±1.2 years; mean disease duration was 135.5±11.6 months. The authors evaluated RA activity by the Disease Activity Score (DAS28), magnitude of fatigue by the Fatigue Severity Scale (FSS), that of pain by the Brief Pain Inventory, and functional status and quality of life by the Health Assessment Questionnaire and EQ-5D. A psychiatrist diagnosed mental disorders in accordance with ICD-10 and using the psychiatric and psychological scales and procedures/RESULTS: 80% of the patients felt clinically significant fatigue (FSS scores of ≥4). Multivariate analysis yielded a prognostic model that made it possible to state that clinically significant fatigue was primarily associated with the magnitude of depression by the Hospital Anxiety and Depression Scale, the presence of a depressive episode, the duration of anxiety and depressive spectrum, the magnitude of pain (Ritchie index), DAS28, and the presence of osteoporosis/CONCLUSION: The presence and magnitude of depression along with the magnitude of pain are an important factor that influences the formation of fatigue in RA, which gives rise to evident functional failure and a low quality of life. Combination therapy for RA may be effective when mental disorders, mainly the anxiety and depressive spectrum, are timely diagnosed.

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Выраженность усталости и ее связь с депрессией, болью и воспалительной активностью при ревматоидном артрите. - Резюме. Цель исследования. Анализ частоты и поиск предикторов клинически значимой усталости у больных ревматоидным артритом (РА). Материалы и методы. В исследование включили 95 пациентов с достоверным диагнозом РА. Большинство пациентов составили женщины (87,4%), средний возраст - 46,7±1,2 года, средняя длительность болезни - 135,5±11,6 мес. Активность РА определяли с помощью индекса DAS28, выраженность усталости - по шкале FSS, выраженность боли - по шкале BPI, функциональный статус и качество жизни - по шкалам HAQ и EQ-5D. Психические расстройства диагностировал психиатр в соответствии с МКБ-10 и использованием психиатрических и психологических шкал и методик. Результаты. Клинически значимую усталость (FSS ≥4 балла) ощущали 80% пациентов. В результате многофакторного анализа получена прогностическая модель, позволяющая констатировать, что клинически значимая усталость при РА в первую очередь связана с выраженностью депрессии по шкале HADS, наличием депрессивного эпизода, длительностью расстройства тревожно-депрессивного спектра, выраженностью боли (индекс Ричи), значением DAS28 и наличием остеопороза. Заключение. Наличие и выраженность депрессии наряду с выраженностью боли является значимым фактором, влияющим на формирование усталости при РА, что приводит к выраженной функциональной недостаточности и низкому качеству жизни. Эффективная комплексная терапия усталости у больных РА возможна при своевременной диагностике психических расстройств, прежде всего тревожно-депрессивного спектра.
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