Depression and Fatigue in Rheumatoid Arthritis- A Study in Southern India

Abstract

Rheumatoid Arthritis is a chronic autoimmune condition in which the patient experiences pain, joint immobility which in some instance can also lead to disability, and thus difficulty in carrying out various activities of daily living. It is a natural consequence that patients may experience varying degrees of depressive symptoms and fatigue. Aim and Objectives: In our study, it is our objective to find out the prevalence of depression, its severity and its correlation with disease activity, pain and inflammatory markers like ESR. We also attempted to quantify the fatigue using the MAF scale by calculating the GFI (Global Fatigue Index) and its prevalence in remission vs non remission patients. Study design: The study is a cross-sectional observational study of consecutive patients with a diagnosis of RA as per EULAR 2020 criteria. The patients were interviewed using standard questionnaires MAF (multidimensional assessment of fatigue questionnaire) and PHQ9 (Patient Health Questionnaire 9). Tools used in the study: Fatigue was measured by using MAF (Multidimensional Assessment of Fatigue). Depression is measured using the PHQ9 questionnaire. Results: The population studied was found to have a prevalence of 33.5% depression. The patients’ mean age was 52.4510.53 years and disease duration 8.026.22 years. Their mean DAS28 was 2.961.1. The mean PHQ-9 score was 3.993.5., mild (26%), moderate (5.5%), moderately severe (1.5%) and severe (0.5%) degrees. Correlation of PHQ9 scores with DAS, VAS and ESR was done to see if there is a relation of depression to any of the clinical outcomes. It was found that depression had a positive correlation with disease activity score DAS 28 (coefficient of correlation 0.167, p = 0.018), VAS pain scores (coefficient = 0.361, p < 0.001) as well as ESR (coefficient = 0.217, and p = 0.002). Fatigue was evaluated using the MAF which gave the Global Fatigue Index (GFI). The mean MAF score was 8.623.33. 78% of patients had fatigue in the level (0-10), 20.5% in the (10-20) level and 1.5% in the (20-30) level. Statistical test for comparison between groups using t test was found to be significant with p value 0.034. Conclusion: Our study on both depression and fatigue once again emphasises the need for rheumatologists especially in the Indian scenario to address them in their routine clinical practice. There should be regular screening for these conditions during the patient visits similar to other risk factors screening in RA.