Psychological interactions are frequent among patients with diseases such as rheumatoid arthritis (AR), ankylosing spondylitis or psoriatic arthritis, due to chronic pain produced and due to incapacity.
William Julio, Managing Director, FAPA
Agencia Latina de Noticias Medicina y Salud Pública
Rheumatologists can substantially reduce the symptoms of depression in their patients to determine the cause of their depression. Similarly, prevent pain and incapacity, reduce systemic inflammation, design and implement medical evidence-based programs to mitigate the effects of depression in rheumatoid arthritis.
Summary
It has been recognized that depression is prevalent among patients with rheumatoid arthritis (AR). This article repeats both, the social context as the biological state of the person in AR, and that this disease affects so much physics as psychologically. Understanding the socioeconomic factors, individual characteristics of patients and biological causes for depression in AR can lead to a more complete paradigm, with the aim of logging interventions to eliminate depression in patients with AR.
Abstract
It is recognized that depression is common in patients with rheumatoid arthritis (RA). In this article, both the social context and the biological disease state of a person with RA are treated as this disease affects physically and psychologically. Understanding the socioeconomic factors, individual patient characteristics, and biological causes of depression in RA may lead to a more comprehensive paradigm for focusing on interventions to eliminate depression in RA.
Palabras claws
Depression, Rheumatoid Arthritis
Keywords
Depression, rheumatoid arthritis
The condition of rheumatoid arthritis (AR) is a multifactorial, chronic and inflammatory disease that primarily affects the joints, with a prevalence of between 0.5% and 1%. Suffering, fatigue and incapacity, the wounds can be considered stressful factors, are common commons that can be subsequently left to psychological anguish.
The depression is commonly co-occurring with the AR in a range of 13% to 20% of the mayor, based on clinical evaluations. Studies using auto-reports of depressive symptoms suggest significantly higher grades (ej. 40%), although the levels of scintillation can be subclinical. Longitudinal studies suggest a risky accumulation for depression and intermittent recurrences over time (eg. 40% over 9 years). The prevalence of depression in AR is very high in the report of the general community or primary care, but similar to other chronic conditions. Depression in AR is associated with high levels of illness, pain, fatigue, incapacity, use of medical services, but also with a minor therapeutic complication and risk of suicide and mortality.
As agreed with the Mayor of complex biological systems, the relationship between depression and AR is multifactorial: in some cases it is probable that depression is mediated by the socio-economic results of the AR. In other cases, depression can lead to AR incapacity. Regardless of the initial factors, the socio-economic, functional and biological contributing effects of AR, they can perpetuate depressive symptoms. Understanding the components of depression in AR is critical for effective treatment.
The terms of socio-economic status (ES), social class and socio-economic position are increasingly used in the study of health, especially the importance of these factors in health outcomes. A low ES is generally associated with high psychiatric morbidity, depression and mortality. Destroyed poverty to suffer with situations, life events, exposure to stress and a debilitating social support, are some examples of risk factors for depression that are most prevalent in groups with bad ES. Given the direction of the association of ES and depression, the most consistent results support the idea of causation (although ES increases the risk of depression) while selecting (the depression differs from social mobility), although both directions can operate simultaneously. There is a sustainable research investigation into ES, depression and AR. Without embargo, despite the consensus of experts indicating that the ES is multifactorial, the majority of ES studies in patients with depression and / or AR use a single socioeconomic variable in a single period and level.
It belongs to the female gender and gives to its youth its factors that are associated with depression and confound the relationship between ES and depression in AR. As the women have a mayoral prevalence of AR and depression, the generation falsely ignores the amount of other variables associated with depression.
Comorbidities and pain are commonly associated with both, AR and depression. Unsurprisingly, the pain has been indicated as a mechanism to the extent of the causal view for depression and those with AR. More so, depression can confuse auto-reports of pain. Alternatively, the pain in an AR patient and comorbid depression may cause AR physical symptoms to be incorrectly attributed to depression.
There is conflicting evidence regarding whether the activity of the AR condition mediates documentation of rheumatologists due to the inflammation and pain of the joints, can or does not affect the depression. Some studies show a positive correlation between depression and the activity of the condition of AR, while others do not do it. This is a step in the right direction, it has been demonstrated that the loss of valued activities, even more so in the functional backyard, leads to depression. It is suggested that depression in AR may not have been caused by the aggravated clinical manifestation of AR disease, but may have been caused by the inability to place the plague and give rise to the arthritis associated with arthritis. valoradas activities.
With respect to the treatment of AR conditions, it is not to be expected that patients who have a clinical remission will be less likely to have depression, compared to those who do not have a remission. A common element in the mechanism, which is one of the patient and the characteristics of the AR condition with depression, is the ability to adapt to the load of the AR condition and its treatment. Positive mechanisms to promote conditioning, social support (eg. Casad) and possess the sensation of tener control over the condition of AR is associated with less depressive symptoms.
Most recent studies have shown that systemic inflammation, mediated by acute phase reactants and proinflammatory cytokines, is often associated with the development of depression, and it has been shown that systemic inflammation can be severe. In patients with AR, there is conflicting evidence regarding reactive phase reactants and high sensitivity of the C-reactive protein, and its relationship with depression. The hypothesis that systemic inflammation contributes to a high prevalence of depressive symptoms in patients with AR is supported by the following observations. First, the inflammatory cytokines and reactive phase reactants have been reported in depressive symptoms in AR patients. Second, elevated levels of cytokines such as IL-6 and TNF-α can predict that no response to treatment of depression symptoms will occur. Third, there is evidence that anti-inflammatory therapies have clinical benefits in reducing depressive symptoms. In fact, it has been suggested that medicines such as traditional anti-rheumatic drugs and biologics influence the relationship between inflammation and depression in patients with AR.
None of the factors associated with AR exist in a vacancy. For example, there is a significant interaction between ES and incapacity in patients with AR and comorbid depression. The association with incapacity for depression has increased for people with low ES compared to high ES. The assumption that the incapacity and the ES have independent consequences for the depression in patients with AR is not supported. A potential explanation for this is that, at any level of functioning, the ES staff could not have the support resources to function as well as the higher ES, levels and levels of depression with mayors. The AR affects physicists as much as physiologically, and mediates the focus on causes of depression, social, individual, contextual, and biological, and rheumatologists can consider a more complete paradigm. This is true for other autoimmune conditions as well, such as systemic erythematous lupus, but it is associated with disabilities in the characteristics of patient health, systemic levels of inflammation and high prevalence.
Deberían maintains public health research methods to enable policy development and interventions to reduce disparities associated with ES, depression and AR. In addition, the rapid advances in immunology in Podria have accumulated more convincing data related to systemic inflammation in AR and its serious negative implications at the health level. Rheumatologists should consider depression as a consequence of both, the social context and biological factors of the condition of depression in AR, in order to evaluate which aspect contributes more to the depression in patients with AR. The rheumatologists can substantially reduce the symptoms of depression in their patients through the determination of the cause of depression, prevention of pain and incapacity, reduction of systemic inflammation, as well as treatment of the effects of depression. This move will move more from the associations to establish causal relationships that, in turn, can lead to new therapies and guidance in patient depression with AR.
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