Indian Write-Ups

Caring for a patient involves not just the management of his symptoms per se, but getting to the psychological aspects of the disease. The author adroitly expounds these facts.

Introduction

Arthritis is a chronic illness and the two major forms of arthritis, Osteoarthritis and Rheumatoid Arthritis, are a leading cause of chronic disability, especially in the elderly. Rheumatoid Arthritis (RA) is, like most chronic diseases, characterized by an unknown etiology and an unknown course and prognosis on the individual level. Particularly in recent onset cohorts, the disease has a highly variable and unpredictable course. However, sooner or later all patients with RA will be confronted with the physical consequences of the disease, i.e. a decrease in functional ability performance of tasks, like activities of work and leisure.

While arthritis is not usually a life-threatening condition, it does threaten a sufferer’s quality of life. It is the leading cause of physical disability in the United States, according to the American Academy of Orthopaedic Surgeons (AAOS). In addition to physical disabilities, arthritis takes a powerful psychological and emotional toll. The psychological and emotional toll also impacts the caregiver of the arthritis sufferer.

The Link Between Depression and Arthritis

Depression and arthritis pain are often linked and the link is often complex and interrelated. Findings from the Centers for Disease Control and Prevention show that depression is a common side effect of arthritis pain. This is especially true for those with rheumatoid arthritis, which affects the joints and causes stiffness, pain, tenderness and fatigue.

The link between arthritis and depression is not surprising. Coping with pain day after day is exhausting for sufferers, who often confront emotional and physical stress and worries about their treatment. With improved medical care, life expectancy has gone up. Hence, there is an increasing awareness of psychiatric problems, especially depression, associated with chronic illnesses like arthritis. The stress of a long-standing illness like arthritis and the resulting disability, definitely are an important causative factor for depression in arthritic patients. Mood disorders are also a primary determinant of severity of the overall functional disability in these patients.

Alternatively, stress or psychological factors may also play a role in genesis of the physical illness itself. William Osler, in as early as 1892, mentioned that shock, worry and grief may be causative factors in Rheumatoid Arthritis. Recognition and treatment of depression in arthritic patients can significantly improve the functional health and overall quality of life of these patients.

Incidence of Depression

Degenerative or osteoarthritis affects nearly 50% of patients over the age of 65 years. Mood disorders, especially depression, occur in about 25% of arthritis patients. A similar study published in the October 1998 issue of Arthritis and Rheumatism linked past depression with arthritis as well. Researchers found that among patients with rheumatoid arthritis, those with a history of depression reported average pain scores of 62.2 on a scale of 100. Patients with current symptoms of depression had an average pain score of 52. The average score for patients with no history or current symptoms of depression was 39.6.

Understanding Depression in Arthritic Patients

Depression is characterized by a prolonged mood disturbance and can present as sadness, irritability or anger (lasting at least 6 weeks). Apart from this, sleep disturbances (usually a decreased sleep but occasionally increased sleep), also appetite disturbances (usually decreased appetite, but occasionally an abnormal increase in appetite), are seen.

Feelings of hopelessness, helplessness, worthlessness or even suicidal ideation may be present. The person may also have a lack of interest in any pleasurable activity or occasionally lack of interest in even routine activities may be observed.

These above mentioned symptoms are the well-known signs of Depression. Some lesser-known symptoms of depression, which may even be presenting features, are chronic pain. Especially in arthritis, a pain that is severe and non-responsive to any medication (NSAIDs, etc.) or maybe even a chronic lower backache, which persists inspite of all investigations ruling out any physical cause for the same, could be a pointer towards depression.

Apart from this, magnifying things and worrying incessantly about oneself one’s health or even about family members, may be a pointer towards depression. It is known that with co morbid depression, the overall functional disability in arthritic patients is definitely increased. Hence, it is important for the treating doctor to diagnose and refer such cases for treatment of depression, so as to improve the quality of life in these patients.

Occasionally, psychiatric disturbances (for e.g. Manic or depressive states, confusion and anxiety) may arise as a complication of treatment with non-steroidal anti-inflammatory agents or prednisolone and this must be kept in mind at all times.