Rheumatoid arthritis

Pain, disability not the only reason for depression in RA

The chronic pain and disability associated with rheumatoid arthritis may not be the only reason why up to a third of patients go on to develop a mental health illness, a leading psychiatrist says.

Speaking to the limbic as part of Arthritis Awareness Week Professor Ian Hickie said it was possible that inflammatory processes also affected the brain.

“People have underrated the extent to which immune activation has adverse effects on the brain with simple narrative explanations – pain causes depression and disability.

Mental health and arthritis are not a simple consequence of the other –  they are both different end organ representations of problems the body is having regulating immune processes, he explained.

“We’ve missed the point that actually there’s a physiology which is shared between the immune activation disorders and depression,” he said.

Professor Hickie acknowledged that immune activation often led to key characteristics of depression such as loss of pleasure in daily activities, change in sleep-wake cycles, the overwhelming sense of fatigue and a sense of the hopelessness or the sense of the struggle of conducting everyday life.

However, those feelings were often considered to be an understandable response to living with arthritis rather than a condition that can, and should, be a marker of disease progression, he said.

Professor Hickie says clinicians can use neurocognitive and psychological symptoms as a marker for the effectiveness of immune modulatory treatment.

“In terms of the choice of treatment it may well be that it becomes as much about getting the right immune regulatory therapy for improving the depression as it is about preserving a patient’s joints or reducing the inflammation and disability associated with joint destruction,” he said.

He says the continuous tracking of mood, cognition, sleep, and activity in response to different treatment choices is critical to reducing the burden of depression in RA patients.

“By tracking [their patients] physicians are aware, as they chose different kinds of interventions, which systems are responding to which intervention”.

“If you do something for the pain but nothing for the depression then you haven’t done the whole job.”

Professor Hickie also said patients can be directed to online tools that provide more insight into the signs and symptoms of depression and what to look for as they track their mood and emotional response to treatment.

For example, EMPOWERED has been independently developed by Arthritis Australia with an educational grant from Janssen-Cilag. The website includes videos with clinicians and patients, highlighting the link between arthritis and mental health.

The site also includes a special geo-locator function to help patients with arthritis access support groups and services in their local area.

Arthritis Australia and beyondblue have also collaborated to produce an ‘Arthritis and emotional wellbeing’ patient resource.

For further information patients can visit www.empowered.org.au

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