Depression and Its Association With Disease Activity and Quality of Life in Patients With Rheumatoid Arthritis at the Kenyatta National Hospital

Abstract

Background Rheumatoid arthritis severity can range from self-limiting disease to severe destruction and systemic complications. RA affects patients physically, psychologically and socially. Patients experience pain, joint swelling, stiffness, functional limitations and fatigue and overall poor quality of life. In addition, they report anxiety and depressive symptoms and concerns about increased physical limitations. Experiencing psychological distress may inflate the subjective severity of patient-reported symptoms such as pain and tenderness. Furthermore, patients experience a loss of independence and restrictions in participation, i.e. a decrease in socializing which may in turn propagate symptoms of depression. An accurate description of the xiv relationship between depression, disease severity and quality of life is necessary for our setting. If an interaction exists then there is a group of vulnerable patients who could benefit from earlier identification of depression and the impact their disease has on Health Related Quality of Life (HRQoL) and appropriate management provided. Objective To determine the prevalence of depression and the relationship between depression, disease activity and quality of life in ambulatory patients with Rheumatoid Arthritis at the Kenyatta National Hospital. Methods A descriptive-cross sectional study carried out at The Rheumatology clinic at The Kenyatta National Hospital. The study population included ambulatory patients with a diagnosis of rheumatoid arthritis who are above the age of 14 years. The Physical Health Questionnaire-9 (PHQ-9), Short Form-36 (SF-36) and Clinical Disease Activity Index form (CDAI) were used to asses for depression and quality of life and severity of disease respectively. Statistical associations of patients’ characteristics, co-morbid depression and HRQoL scores were analyzed using Chi-square test. Factors associated with HRQoL and CDAI were analyzed using Pearson correlation or Spearman rank correlation. Results A total of 74 patients with rheumatoid arthritis were studied. The prevalence of comorbid depression in patients with Rheumatoid Arthritis at the outpatient clinic in KNH using the PHQ-9 was 28.4%, of which 13.5% had mild depression, 9.5% had moderate depression and 5.4% had severe depression. The bulk of the patients had moderate to high disease activity (71.6%). The PHC and MHC summary scores were categorized as fair (49.1 and 57.2 respectively). The mean CDAI score for depressed group was 23.5(SD xv 14.3) compared to a lower mean score of 19.5 (SD 16.9) for those not depressed. Patients with poorer physical health quality of life scores were more likely to be depressed (p=0.041). Patients who had poorer energy scores, poorer emotional well-being scores and poorer social functioning scores were significantly more likely to be depressed. Conclusion In our study population of rheumatoid arthritis, the prevalence of depression is much higher than the prevalence of depression in global estimates. The bulk of the patients had moderate to high disease activity. Generally fair QoL scores were noted. Poorer disease severity scores were noted in the clinically depressed recruits than those not depressed. Poor QoL scores in the sub-types- emotional well being, social functioning and energy scores showed significant correlation to the presence of depression. Poor physical health scores were also found to be correlated to the presence of depression. Depression is a treatable disease and regular screening for undiagnosed depression may improve disease activity, symptoms of arthritis and quality of life in these patients.