Socioeconomic and therapy factor influence on self-reported fatigue, anxiety and depression in rheumatoid arthritis patients

Lapčević, Mirjana; Vuković, Mira; Gvozdenović, Branislav S.; Mioljević, Vesna; Marjanović, Snežana

doi:10.1016/j.rbre.2017.02.004

Mirjana Lapčević

Primary Healthcare Center, Department of General Medicine, Belgrade, Serbia

Mira Vuković

General Hospital Valjevo, Education Center, Belgrade, Serbia

Branislav S. Gvozdenović ^**Corresponding author. E-mail: bgvozden@verat.net (B.S. Gvozdenović).

Pharmaceutical Product Development Serbia, Pharmacovigilance Department, Belgrade, Serbia

Vesna Mioljević

Clinical Center of Serbia, Department of Hospital Epidemiology and Nutrition Hygiene, Belgrade, Serbia

Snežana Marjanović

General Hospital Valjevo, Department of Psychiatry, Valjevo, Serbia

*Corresponding author. E-mail: bgvozden@verat.net (B.S. Gvozdenović).

Conflicts of interest

The authors declare no conflicts of interest.

Variables	f (%)
Gender
Female	356 (87.0)
Male	53 (13.0)
Occupation
Worker	46 (11.3)
Farmer	5 (1.2)
Housewife	53 (13.0)
Official	41 (11.7)
Pensioner	227 (53.7)
Unemployed	37 (9.0)
Formal education level
Without school	7 (1.6)
Elementary school	89 (21.9)
Secondary school	146 (35.8)
College	98 (23.9)
Faculty	69 (16.8)
Maritial status
Married	274 (67.0)
Unmarried	32 (7.9)
Divorced	28 (6.9)
Widow/widower	67 (16.4)
Extramarital communities	8 (1.8)
Employment status
Employed - able to work	82 (20.1)
Employed - disable due to RA	13 (3.2)
Unemployed - working capable	61 (15.0)
Unemployed - disable due to RA	26 (6.3)
Retired	227 (55.4)
Need of another person's assistance
Yes	178 (43.5)
No	231 (56.5)
Frequent taxi use
Yes	182 (44.6)
No	227 (55.4)
Self-payment of physiotherapist
Yes	106 (25.9)
No	303 (74.1)
The use of assistive devices
Yes	96 (23.5)
No	313 (76.5)
Other diseases
Without other diseases	174 (42.5)
With other rheumatic disease	22 (5.5)
With other non-rheumatic disease	213 (52.0)
Osteoporosis
Yes	139 (34.0)
No	270 (66.0)
Orthopedic surgery for RA
Yes	105 (25.7)
No	304 (74.3)
Fractures due to RA
Yes	65 (15.8)
No	344 (84.2)

Variables	f (%)
The current RA therapy
NSAIDs and/or analgesics and/or corticosteroids	51 (12.5)
Synthetic DMARDs alone or in combination with corticosteroids and/or NSAIDs	198 (48.4)
Any RA treatment which includes biologic DMARDs	160 (39.1)
Proton-pump inhibitors
Yes	273 (66.8)
No	136 (33.2)
Histamine H ₂ receptor antagonist
Yes	117 (28.5)
No	292 (71.5)
Supplement of glucosamine sulphate, chondroitin sulphate, hyaluronic acid
Yes	56 (13.6)
No	353 (86.4)
Antirheumatic creams
Yes	239 (58.5)
No	170 (41.5)
Vitamin D ₃
Yes	279 (68.2)
No	130 (31.8)
Calcium supplements
Yes	175 (42.9)
No	234 (57.1)
Patients discontinuation of RA therapy
Yes	75 (18.4)
No	334 (81.6)
Bleeding from the stomach or duodenum or the appearance of "black stool" during RA therapy
Yes	45 (10.9)
No	364 (89.1)
Operations due to bleeding from the stomach or duodenum or the appearance of "black stools"
Yes	18 (4.4)
No	391 (95.6)
Use of alternative methods of RA treatment
Yes	52 (12.7)
No	357 (87.3)

Variables	Outcome	Percentiles			p
		25	50	75
The duration of the current RA therapy (months)	PHQ ≥ 10 absence	18.00	53.00	84.00	0.001
The duration of the current RA therapy (months)	PHQ ≥ 10 presence	36.00	72.00	120.00	0.001

RA duration (months)	PHQ ≥ 10 absence	84.00	120.00	204.00	0.008
RA duration (months)	PHQ ≥ 10 presence	96.00	168.00	240.00	0.008

The period from the first appearance of RA symptoms to the start of the current RA therapy (months)	PHQ ≥ 10 absence	25.50	66.00	151.50	0.645
	PHQ ≥ 10 presence	24.00	73.00	183.50	0.645

Duration of symptoms due to RA (months)	PHQ ≥ 10 absence	90.00	145.00	221.00	0.006
Duration of symptoms due to RA (months)	PHQ ≥ 10 presence	112.50	180.00	263.50	0.006

The duration of the current RA therapy (months)	FAS ≥ 22 absence	18.00	48.00	77.00	0.000
The duration of the current RA therapy (months)	FAS ≥ 22 presence	24.50	61.50	120.00	0.000

RA duration (months)	FAS ≥ 22 absence	84.00	120.00	186.00	0.012
RA duration (months)	FAS ≥ 22 presence	96.00	156.00	240.00	0.012

The period from the first appearance of RA symptoms to the start of the current RA therapy (months)	FAS ≥ 22 absence	27.00	60.00	144.00	0.749
	FAS ≥ 22 presence	24.00	73.00	181.00	0.749

Duration of symptoms due to RA (months)	FAS ≥ 22 absence	88.00	144.00	210.00	0.013
Duration of symptoms due to RA (months)	FAS ≥ 22 presence	108.00	177.00	263.50	0.013

The duration of the current RA therapy (months)	GAD ≥ 10 absence	20.00	60.00	84.00	0.002
The duration of the current RA therapy (months)	GAD ≥ 10 presence	36.00	72.00	120.00	0.002

RA duration (months)	GAD ≥ 10 absence	84.00	144.00	204.00	0.015
RA duration (months)	GAD ≥ 10 presence	96.00	168.00	240.00	0.015

The period from the first appearance of RA symptoms to the start of the current RA therapy (months)	GAD ≥ 10 absence	25.00	72.00	161.00	0.018
	GAD ≥ 10 presence	24.00	66.00	189.00	0.018

Duration of symptoms due to RA (months)	GAD ≥ 10 absence	93.00	152.00	228.00	0.790
Duration of symptoms due to RA (months)	GAD ≥ 10 presence	122.00	180.00	274.50	0.790

Variables	PHQ-9 score ≥10 Correlation (p)		FAS score ≥22 Correlation (p)		GAD-7 score ≥10 Correlation (p)
	Absence n1 = 212	Presence n2 = 197	Absence n1 = 212	Presence n2 = 197	Absence n1 = 212	Presence n2 = 197
Gender
Female	-0.082 (0.101)		-0.072 (0.136)		-0.067 (0.165)
Male
Occupation
Worker
Farmer
Housewife
Official	0.341^a a Level of statistical significance for p ≤ 0.01. (0.000)		0.273^a a Level of statistical significance for p ≤ 0.01. (0.000)		0.229^a a Level of statistical significance for p ≤ 0.01. (0.000)
Pensioner
Unemployed
Formal education level
Without school
Elementary school
Secondary school	0.329^a a Level of statistical significance for p ≤ 0.01. (0.000)		0.323^a a Level of statistical significance for p ≤ 0.01. (0.000)		0.259^a a Level of statistical significance for p ≤ 0.01. (0.000)
College
Faculty
Maritial status
Married
Unmarried
Divorced	0.130 (0.148)		0.138 (0.083)		0.141 (0.077)
Widow/widower
Extramarital communities
Employment status
Employed - able to work
Employed - disable due to RA
Unemployed - working capable	0.302^a a Level of statistical significance for p ≤ 0.01. (0.000)		0.267^a a Level of statistical significance for p ≤ 0.01. (0.000)		0.209^a a Level of statistical significance for p ≤ 0.01. (0.003)
Unemployed - disable due to RA
Retired
Need of another person's assistance
Yes	-0.368^a a Level of statistical significance for p ≤ 0.01. (0.000)		-0.369^a a Level of statistical significance for p ≤ 0.01. (0.000)		-0.271^a a Level of statistical significance for p ≤ 0.01. (0.000)
No
Frequent taxi use
Yes	-0.346^a a Level of statistical significance for p ≤ 0.01. (0.000)		-0.282^a a Level of statistical significance for p ≤ 0.01. (0.000)		-0.246^a a Level of statistical significance for p ≤ 0.01. (0.000)
No
Self-payment of physiotherapist
Yes	-0.312^a a Level of statistical significance for p ≤ 0.01. (0.000)		-0.224^a a Level of statistical significance for p ≤ 0.01. (0.000)		-0.229^a a Level of statistical significance for p ≤ 0.01. (0.000)
No
The use of assistive devices
Yes	-0.290^a a Level of statistical significance for p ≤ 0.01. (0.000)		-0.199^a a Level of statistical significance for p ≤ 0.01. (0.000)		-0.186^a a Level of statistical significance for p ≤ 0.01. (0.000)
No
Other diseases
Without other diseases
With other rheumatic disease	0.190^a a Level of statistical significance for p ≤ 0.01. (0.001)		0.214^a a Level of statistical significance for p ≤ 0.01. (0.000)		0.152^a a Level of statistical significance for p ≤ 0.01. (0.007)
With other non-rheumatic disease
Osteoporosis
Yes	-.173^a a Level of statistical significance for p ≤ 0.01. (0.001)		-0.156^a a Level of statistical significance for p ≤ 0.01. (0.002)		-0.182^a a Level of statistical significance for p ≤ 0.01. (0.000)
No
Orthopedic surgery for RA
Yes	0.117 (0.083)		0.049 (0.632)		0.113 (0.088)
No
Fractures due to RA
Yes	-0.110^b b Level of statistical significance for p ≤ 0.05. (0.031)		-0.134^a a Level of statistical significance for p ≤ 0.01. (0.007)		-0.078 (0.116)
No

Variable	PHQ-9 score ≥10 Correlation (p)		FAS score ≥22 Correlation (p)		GAD-7 score ≥10 Correlation (p)
	Absent n1 = 212	Present n2 = 197	Absent n1 = 254	Present n2 = 155	Absent n1 = 212	Present n2 = 197
The current RA therapy
NSAIDs and/or analgesics and/or corticosteroids
Synthetic DMARDs alone or in combination with corticosteroids and/or NSAIDs	0.228^a RA, rheumatoid arthritis; f, frequency. (0.000)		0.223^a RA, rheumatoid arthritis; f, frequency. (0.000)		0.193^a RA, rheumatoid arthritis; f, frequency. (0.000)
Any RA treatment which includes biologic DMARDs
Proton-pump inhibitors
Yes	-0.137^a RA, rheumatoid arthritis; f, frequency. (0.007)		-0.145^a RA, rheumatoid arthritis; f, frequency. (0.003)		-0.116^b RA, rheumatoid arthritis; NSAIDs, non-steroidal anti-inflammatory drugs; DMARDs, disease-modifying antirheumatic drugs; f, frequency. (0.019)
No
Histamine H ₂ receptor antagonist
Yes	-0.157^b RA, rheumatoid arthritis; NSAIDs, non-steroidal anti-inflammatory drugs; DMARDs, disease-modifying antirheumatic drugs; f, frequency. (0.011)		-0.131^b RA, rheumatoid arthritis; NSAIDs, non-steroidal anti-inflammatory drugs; DMARDs, disease-modifying antirheumatic drugs; f, frequency. (0.037)		-0.165^a RA, rheumatoid arthritis; f, frequency. (0.005)
No
Supplement of glucosamine sulphate, chondroitin sulphate, hyaluronic acid
Yes	0.161^a RA, rheumatoid arthritis; f, frequency. (0.008)		0.111 (0.090)		0.122 (0.055)
No
Antirheumatic creams
Yes	-0.191^a RA, rheumatoid arthritis; f, frequency. (0.000)		0.131^b RA, rheumatoid arthritis; NSAIDs, non-steroidal anti-inflammatory drugs; DMARDs, disease-modifying antirheumatic drugs; f, frequency. (0.027)		0.137^b RA, rheumatoid arthritis; NSAIDs, non-steroidal anti-inflammatory drugs; DMARDs, disease-modifying antirheumatic drugs; f, frequency. (0.021)
No
Vitamin D ₃
Yes	0.023 (0.644)		0.031 (0.523)		-0.104^b RA, rheumatoid arthritis; NSAIDs, non-steroidal anti-inflammatory drugs; DMARDs, disease-modifying antirheumatic drugs; f, frequency. (0.039)
No
Calcium supplements
Yes	-0.140^a RA, rheumatoid arthritis; f, frequency. (0.004)		-0.110^b RA, rheumatoid arthritis; NSAIDs, non-steroidal anti-inflammatory drugs; DMARDs, disease-modifying antirheumatic drugs; f, frequency. (0.025)		-0.065 (0.230)
No
Patients discontinuation of RA therapy
Yes	-0.065 (0.230)		-0.045 (0.395)		-0.082 (0.116)
No
Bleeding from the stomach or duodenum or the appearance of "black stool" during RA therapy
Yes	-0.243^a RA, rheumatoid arthritis; f, frequency. (0.000)		0.120^b RA, rheumatoid arthritis; NSAIDs, non-steroidal anti-inflammatory drugs; DMARDs, disease-modifying antirheumatic drugs; f, frequency. (0.014)		0.139^a RA, rheumatoid arthritis; f, frequency. (0.005)
No
Operations due to bleeding from the stomach or duodenum or the appearance of "black stools"
Yes	-0.154^a a Level of statistical significance for p ≤ 0.01. (0.003)		-0.057 (0.246)		-0.113^b b Level of statistical significance for p ≤ 0.05. (0.024)
No
Use of alternative methods of RA treatment
Yes	0.079 (0.122)		-0.055 (0.271)		0.043 (0.385)
No

Examined outcome - PHQ-9 score ≥ 10							95.0% Confidence interval
Predictors	B	SE	Wald	df	p	odds ratio	lower	upper
The current RA therapy			4.982	2	0.083
NSAIDs and/or analgesics and/or corticosteroids	0.324	0.447	0.525	1	0.469	1.383	0.575	3.323
Synthetic DMARDs alone or in combination with corticosteroids and/or NSAIDs	0.630	0.283	4.972	1	0.026	1.878	1.079	3.269
Self-payment of physiotherapist	1.250	0.349	12.841	1	0.000	3.490	1.762	6.914
Employment status			18.117	4	0.001
Employed - disable due to RA	0.404	0.864	.218	1	0.640	1.498	0.275	8.151
Unemployed - working capable	1.357	0.435	9.731	1	0.002	3.884	1.656	9.111
Unemployed - disable due to RA	1.900	0.697	7.423	1	0.006	6.687	1.704	26.238
Retired	1.384	0.354	15.252	1	0.000	3.989	1.992	7.989
Frequent taxi use	0.785	0.275	8.179	1	0.004	2.193	1.280	3.755
Use of alternative methods of RA treatment	0.772	0.385	4.024	1	0.045	2.164	1.018	4.600
Constant	-2.756	0.493	31.274	1	0.000	0.064
Examined outcome - FAS score ≥ 22							95.0% Confidence interval
Predictors	B	SE	Wald	df	p	odds ratio	lower	upper

Need of another person's assistance	1.102	0.384	8.220	1	0.004	3.009	1.417	6.389
GAD-7 score	0.320	0.048	43.986	1	0.000	1.377	1.253	1.514
Calcium supplements	0.855	0.357	5.738	1	0.017	2.352	1.168	4.736
Age > 65 godina	-1.031	0.478	4.653	1	0.031	0.357	0.140	0.910
Formal education level			13.994	4	0.007
Without school	17.112	18,629.741	0.000	1	0.999	27,004.818	0.000
Elementary school	0.270	0.530	0.259	1	0.611	1.310	0.463	3.702
Secondary school	1.589	0.452	12.389	1	0.000	4.901	2.023	11.876
College	0.693	0.474	2.142	1	0.143	2.000	0.790	5.062
Constant	-1.532	0.586	6.837	1	0.009	0.216
Examined outcome - GAD score ≥ 10							95.0% Confidence interval
Predictors	B	SE	Wald	df	p	odds ratio	lower	upper
Occupation			17.908	5	0.003
Farmer	-0.024	1.207	0.000	1	0.984	0.976	0.092	10.400
Housewife	1.245	0.448	7.717	1	0.005	3.474	1.443	8.366
Official	-0.719	0.590	1.486	1	0.223	0.487	0.153	1.548
Pensioner	0.837	0.370	5.121	1	0.024	2.309	1.119	4.766
Unemployed	0.675	0.489	1.901	1	0.168	1.963	0.752	5.123
Proton-pump inhibitors	0.491	0.238	4.248	1	0.039	1.634	1.024	2.608
Constant	-1.566	0.382	16.822	1	0.000	0.209

[1] *Corresponding author. E-mail: bgvozden@verat.net (B.S. Gvozdenović).

Brasil

Brasil

Socioeconomic and therapy factor influence on self-reported fatigue, anxiety and depression in rheumatoid arthritis patients

Abstract

Introduction:

Goals:

Method:

Results:

Conclusion