rspНаучно-практическая ревматологияRheumatology Science and Practice1995-44841995-4492IMA-PRESS, LLC10.14412/1995-4484-2009-141rsp-476Research ArticleСтатьиArticlesПрименение антидепрессантов у больных ревматоидным артритом с коморбидной депрессиейAntidepressants administration in rheumatoid arthritiswith comorbid depressionYaltsevaN VYaltsevaN Vkni@yar.ruGrigorjevaE AGrigorjevaE A-КоршуновН. И.KorshunovN I-200915022009471№1 (2009)4349Copyright © Yaltseva N.V., Grigorjeva E.A., Коршунов Н.И., 20092009Yaltseva N.V., Grigorjeva E.A., Коршунов Н.И.Yaltseva N.V., Grigorjeva E.A., Korshunov N.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://rsp.mediar-press.net/rsp/article/view/476

Цель. Изучить влияние коморбидной депрессии у больных ревматоидным артритом (РА) на течение основного заболевания, эффективность применения антидепрессантов у этой категории пациентов.Материал и методы. Включены 70 больных РА (все женщины) с достоверным по критериям ACR (1987) диагнозом РА и коморбидными депрессивными расстройствами. 30 больных РА прошли курс терапии антидепрессантами – основная группа;20 отказались от предложенной терапии – главная группа контроля; 20 пациентов РА без депрессии – дополнительная группа контроля, за которыми также осуществлялось динамическое наблюдение. Использовались шкалы депрессии и тревоги Гамильтона.Результаты. Исходно клинические показатели основной группы, главной группы контроля и дополнительной достоверно не различались. При использовании анти- депрессантов у пациентов основной группы такие клинические характеристики болезни, как число болезненных суставов, число припухших суставов (DAS-28), длительность утренней скованности, интенсивность боли (в баллах), Functional Disability Index (FDI) достоверно улучшались через 3 мес. терапии антидепрессантами (соответственно p <0,001, p <0,001, p <0,01, p <0,001, p <0,001). Это улучшение продолжало нарастать к 6-му мес наблюдения. Сравнение главной и дополнительной групп контроля свидетельствовало о лучшей динамике процесса в отсутствии коморбидной депрессии и негативном влиянии последней на результаты лечения. Заключение. Эффективная терапия депрессий у пациентов РА современными антидепрессантами – селективными ингибиторами обратного захвата серотонина (СИОЗС), устранение ее симптомов улучшает клиническое течение основного заболевания, его прогноз и качество жизни пациентов.

Objective. To study comorbid depression influence on course of rheumatoid arthritis (RA)and antidepressants efficacy in such pts. Material and methods. 70 pts with RA (all women) fulfilled the 1987 ACR criteria with comorbid depression disturbances were included. 30 from them received course of treatment with antidepressants (main group). 20 refused proposed therapy (main control group). 20 RA pts without depression were included in an additional control group which was also followed up. Hamilton scales of depression and anxiety were used. Results. Baseline clinical measures did not significantly differ between study groups. Antidepressants application in main group pts was accompanied by significant improvement of tender and swollen joint count, morning stiffness duration, pain intensity (score),functional disability index (FDI) after 3 months (<0,001,<0,001, <0,01, <0,001,<0,001). This improvement further increased to sixth month of follow up. Comparison of main and additional control groups showed better outcome in the absence of comorbid depression and its negative influence on results of treatment. Conclusion. Effective treatment of depression with modern antidepressants (selective inhibitors of reverse serotonin capture) in pts with RA improves clinical course of the disease, its prognosis and pts quality of life.

ревматоидный артрит (РА)депрессияантидепрессантысертралин (золофт)аффективные расстройстваrheumatoid arthritisdepressionaffective disturbancesantideprtessantssertraline (zoloft)References<div><p>Ang D.C., Choi H., Kroenke K., Wolfe F. Comorbid depression is an independent risk factor for mortality in patients with rheumatoid arthritis. J. Rheumatol., 48 2005, 32, 1013-9.</p><p>Covic T., Adamson B., Spencer D., Howe G. A biopsy- chosocial model of pain and depression in rheumatoid arthritis: a 12-month longitudinal study. Rheumatology (Oxford), 2003, 42, 1287-94.</p><p>Felson D.T., Anderson J.J., Boers M. et al. American College of Rheumatology preliminary definition of improvement in rheumatoid arthritis. Arthritis Rheum., 1993, 36, 729 – 40.</p><p>Gignac M.A., Badley EM, Lacaille D., Cott C.C, Adam P, Anis AH. Managing arthritis and employment: making arthritis-related work changes as a means of adap- tation. Arthritis Rheum., 2004, 51, 909-16.</p><p>Hill CL, Gill T, Taylor A.W., Psychological factors and quality of life in arthritis: a population-based study. Clin. Rheumatol., 2007, 26, 1049-54.</p><p>Hirsh A.T., Waxenberg L.B., Atchison J.W., et al. Evidence for sex differences in the relationships of pain, mood, and disability. J. Pain, 2006, 7, 592-601.</p><p>Kumar A., Clark S., Boudreaux E.D., Camargo C.A. Jr. A multicenter study of depression among emergency department patients. Acad. Emerg. Med., 2004, 11. 1284-9.</p><p>Kvien T.K. Epidemiology and burden of illness of rheumatoid arthritis. Pharmacoeconomics, 2004, 22, 1-12.</p><p>Li X., Gignac M.A., Anis A.H. The indirect costs of arthritis resulting from unemployment, reduced performance, and occupational changes while at work. Med. Care, 2006, 44, 304-10.</p><p>Li X., Gignac M.A., Anis A.H. Workplace, psychosocial factors, and depressive symptoms among working people with arthritis: a longitudinal study. J. Rheumatol., 2006, 33, 1849-55.</p><p>Lipsky P.E., van der Heijde D.M., StClair E.W. et al. Infliximab and methotrexate in the treatment of rheumatoid arthritis. Anti-Tumor Necrosis Factor Trial in Rheumatoid Arthritis with Concomitant Therapy Study Group. N. Engl. J. Med., 2000, 343, 1594.</p><p>Lowe B, Willand L, Eich W., Psychiatric comorbidity and work disability in patients with inflammatory rheumatic diseases. Psychosom. Med., 2004, 66, 395-402.</p><p>Maharaj R.G., Reid S.D., Misir A., Simeon DT. Depression and its associated factors among patients attending chronic disease clinics in southwest Trinidad. West Indian Med. J., 2005, 54, 369-74.</p><p>Monaghan S.M., Sharpe L, Denton F., et al. Relationship between appearance and psychological distress in rheumatic diseases. Arthritis Rheum., 2007, 57, 303-9.</p><p>Nakajima A., Kamitsuji S., Saito A., et al., Disability and patient’s appraisal of general health contribute to depressed mood in rheumatoid arthritis in a large clinical study in Japan. Mod. Rheumatol., 2006, 16, 151-7.</p><p>Ozminkowski R.J., Burton W.N., Goetzel R.Z. et al., Maclean R, Wang S. The impact of rheumatoid arthritis on medical expenditures, absenteeism, and short-term disability benefits. J. Occup. Environ. Med. 2006, 48, 135-48.</p><p>Patten S.B., Williams J.V., Wang J. Mental disorders in a population sample with musculoskeletal disorders. BMC Musculoskelet Disord., 2006, 7, 37 et al.</p><p>Polsky D., Doshi J.A., Marcus S., et al. Long-term risk for depressive symptoms after a medical diagnosis. Arch. Intern Med., 2005, 165, 1260-6.</p><p>Schnittker J. Chronic illness and depressive symptoms in late life. Soc Sci Med., 2005, 60: 13-23.</p><p>Scott D.L., Smith C., Kingsley G. What are the consequences of early rheumatoid arthritis for the individual? Best Pract. Res. Clin. Rheumatol., 2005, 19, 117-36.</p><p>Shih M, Hootman J.M., Strine T.W., et al. Serious psychological distress in U.S. adults with arthritis. J. Gen. Intern. Med., 2006, 21, 1160-6.</p><p>Stein M.B., Cox B.J., Afifi T.O., et al.Does co-morbid depressive illness magnify the impact of chronic physi- cal illness? A population-based perspective. Psychol. Med., 2006, 36, 587-96.</p><p>Wang PS, Beck A, Berglund P., et al. Chronic medical conditions and work performance in the health and work performance questionnaire calibration surveys. J. Occup. Environ. Med., 2003, 45, 1303-11.</p></div><br /><div><p>Ang D.C., Choi H., Kroenke K., Wolfe F. Comorbid depression is an independent risk factor for mortality in patients with rheumatoid arthritis. J. Rheumatol., 48 2005, 32, 1013-9.</p><p>Covic T., Adamson B., Spencer D., Howe G. A biopsy- chosocial model of pain and depression in rheumatoid arthritis: a 12-month longitudinal study. Rheumatology (Oxford), 2003, 42, 1287-94.</p><p>Felson D.T., Anderson J.J., Boers M. et al. American College of Rheumatology preliminary definition of improvement in rheumatoid arthritis. Arthritis Rheum., 1993, 36, 729 – 40.</p><p>Gignac M.A., Badley EM, Lacaille D., Cott C.C, Adam P, Anis AH. Managing arthritis and employment: making arthritis-related work changes as a means of adap- tation. Arthritis Rheum., 2004, 51, 909-16.</p><p>Hill CL, Gill T, Taylor A.W., Psychological factors and quality of life in arthritis: a population-based study. Clin. Rheumatol., 2007, 26, 1049-54.</p><p>Hirsh A.T., Waxenberg L.B., Atchison J.W., et al. Evidence for sex differences in the relationships of pain, mood, and disability. J. Pain, 2006, 7, 592-601.</p><p>Kumar A., Clark S., Boudreaux E.D., Camargo C.A. Jr. A multicenter study of depression among emergency department patients. Acad. Emerg. Med., 2004, 11. 1284-9.</p><p>Kvien T.K. Epidemiology and burden of illness of rheumatoid arthritis. Pharmacoeconomics, 2004, 22, 1-12.</p><p>Li X., Gignac M.A., Anis A.H. The indirect costs of arthritis resulting from unemployment, reduced performance, and occupational changes while at work. Med. Care, 2006, 44, 304-10.</p><p>Li X., Gignac M.A., Anis A.H. Workplace, psychosocial factors, and depressive symptoms among working people with arthritis: a longitudinal study. J. Rheumatol., 2006, 33, 1849-55.</p><p>Lipsky P.E., van der Heijde D.M., StClair E.W. et al. Infliximab and methotrexate in the treatment of rheumatoid arthritis. Anti-Tumor Necrosis Factor Trial in Rheumatoid Arthritis with Concomitant Therapy Study Group. N. Engl. J. Med., 2000, 343, 1594.</p><p>Lowe B, Willand L, Eich W., Psychiatric comorbidity and work disability in patients with inflammatory rheumatic diseases. Psychosom. Med., 2004, 66, 395-402.</p><p>Maharaj R.G., Reid S.D., Misir A., Simeon DT. Depression and its associated factors among patients attending chronic disease clinics in southwest Trinidad. West Indian Med. J., 2005, 54, 369-74.</p><p>Monaghan S.M., Sharpe L, Denton F., et al. Relationship between appearance and psychological distress in rheumatic diseases. Arthritis Rheum., 2007, 57, 303-9.</p><p>Nakajima A., Kamitsuji S., Saito A., et al., Disability and patient’s appraisal of general health contribute to depressed mood in rheumatoid arthritis in a large clinical study in Japan. Mod. Rheumatol., 2006, 16, 151-7.</p><p>Ozminkowski R.J., Burton W.N., Goetzel R.Z. et al., Maclean R, Wang S. The impact of rheumatoid arthritis on medical expenditures, absenteeism, and short-term disability benefits. J. Occup. Environ. Med. 2006, 48, 135-48.</p><p>Patten S.B., Williams J.V., Wang J. Mental disorders in a population sample with musculoskeletal disorders. BMC Musculoskelet Disord., 2006, 7, 37 et al.</p><p>Polsky D., Doshi J.A., Marcus S., et al. Long-term risk for depressive symptoms after a medical diagnosis. Arch. Intern Med., 2005, 165, 1260-6.</p><p>Schnittker J. Chronic illness and depressive symptoms in late life. Soc Sci Med., 2005, 60: 13-23.</p><p>Scott D.L., Smith C., Kingsley G. What are the consequences of early rheumatoid arthritis for the individual? Best Pract. Res. Clin. Rheumatol., 2005, 19, 117-36.</p><p>Shih M, Hootman J.M., Strine T.W., et al. Serious psychological distress in U.S. adults with arthritis. J. Gen. Intern. Med., 2006, 21, 1160-6.</p><p>Stein M.B., Cox B.J., Afifi T.O., et al.Does co-morbid depressive illness magnify the impact of chronic physi- cal illness? A population-based perspective. Psychol. Med., 2006, 36, 587-96.</p><p>Wang PS, Beck A, Berglund P., et al. Chronic medical conditions and work performance in the health and work performance questionnaire calibration surveys. J. Occup. Environ. Med., 2003, 45, 1303-11.</p></div><br />

The authors declare that there are no conflicts of interest present.