Joint Pain in rheumatology patients: the role of anxiety-depressive disorders
Summary. The aim of the study was to determine the clinical course of chronic pain syndrome in rheumatoid arthritis in combination with secondary osteoarthritis and the effectiveness of pain control depending on the correction of anxiety-depressive disorders in these patients. Materials and methods of research. We examined 99 patients with rheumatoid arthritis in combination with secondary osteoarthrosis (median age 53.7 [44.8, 61.3] years). All patients underwent general clinical examination, assessment of pain intensity in VAS at rest and under physical exertion, general and biochemical examination of blood with determination of ESR, rheumatoid factor, C-reactive protein; X-ray of the joints with the determination of the X-ray stage of the disease, assessment of the level of anxiety and depressive state using the PHQ questionnaire, the Hamilton HARS-14 scale at the beginning of the observation and the dynamics of treatment. When symptoms of anxiety, depressive disorders and patient consent were detected, treatment was received aimed at correcting the psychosomatic status. Results. Depressive disorders were detected in 85 (85.9%) patients in the main group and in 22 (59.5%) patients in the comparison group (p<0.05). Among the patients of the main group, persons with a moderate-severe degree of depression predominated, significantly higher by 22.1% than in the comparison group (p<0.05). The dynamics of pain intensity decrease on the VAS scale at rest and under physical exertion is more pronounced among patients receiving additional treatment aimed at correcting the psycho-emotional state. A more significant reduction in VAS was noted among patients with correlated anxiety-depressive disorders. Conclusion: in patients with rheumatoid arthritis in combination with secondary osteoarthritis, the severity of the pain syndrome does not fully correspond to the degree of organic changes in the musculoskeletal system. In conditions of correction of depression on standard scales more than 50%, the most pronounced dynamics of pain syndrome improvement was established against the background of treatment in this category of patients.
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