title: Clinical significance of lifetime mood and panic-agoraphobic spectrum symptoms on quality of life of patients with rheumatoid arthritis.
abstract: BACKGROUND
  Previous studies suggested that rheumatoid arthritis (RA) is associated with depressive and anxiety symptomatology. The well-being and functioning of patients with RA may be significantly influenced by subthreshold psychiatric comorbidity. Health-related quality of life (HRQoL) of patients with RA, compared with the Italian norms and patients with diabetes, was assessed by the influence of lifetime mood and panic-agoraphobic spectrum symptoms and demographic and clinical variables.
  
  
  METHODS
  Ninety-two patients were consecutively recruited at the Department of Rheumatology at the University Hospital of Pisa, Italy. All patients met diagnostic criteria of RA according to the American College of Rheumatology. Health-related quality of life was measured using the Medical Outcomes Study 36-Item Short-Form Health Survey questionnaire (MOS SF-36). Mood and panic-agoraphobic spectra were assessed by two different structured self-report instruments: the Mood Spectrum (MOODS-SR) and the Panic-Agoraphobic Spectrum (PAS-SR), respectively.
  
  
  RESULTS
  Patients with RA were compared, as regards the MOS SF-36 scale scores, with the Italian normative population and patients with diabetes. Compared with the Italian population, patients with RA showed significantly lower MOS SF-36 scale scores, except for role emotional. Moreover, patients with RA scored significantly lower on the role physical, bodily pain, and social functioning scales compared with patients with diabetes and higher on role emotional and mental health. A significant worsening of all MOS SF-36 scale scores was related to higher scores of the depressive domains of MOODS-SR, except for social functioning and bodily pain. A statistically significant negative association was also found between PAS-SR total score and the MOS SF-36 scales physical functioning, vitality, role emotional, and mental health. There were no statistically significant correlations between MOS SF-36 scales and the manic MOODS spectrum. In the multivariate models, the negative correlations between depressive MOODS, role emotional, and mental health were confirmed and the severity of arthritis showed a significant impact on all MOS SF-36 areas with the exception for social functioning; moreover, manic MOODS was associated with better general health.
  
  
  CONCLUSIONS
  The present report shows that lifetime depressive spectrum symptoms negatively affects HRQoL of patients with RA and subthreshold mania improves the perception of general health. Diagnosis and appropriate clinical management of depression, including subthreshold symptoms, might enhance HRQoL in these patients.
authors.affiliation: Department of Psychiatry, Pharmacology and Biotechnology, Psychiatry II Unit, University of Pisa, 56100 Pisa, Italy. apiccinn@med.unipi.it
authors.forename: Armando
authors.initials: A
authors.lastname: Piccinni
authors.forename: Jack D
authors.initials: JD
authors.lastname: Maser
authors.forename: Laura
authors.initials: L
authors.lastname: Bazzichi
authors.forename: Paola
authors.initials: P
authors.lastname: Rucci
authors.forename: Laura
authors.initials: L
authors.lastname: Vivarelli
authors.forename: Alessandro
authors.initials: A
authors.lastname: Del Debbio
authors.forename: Mario
authors.initials: M
authors.lastname: Catena
authors.forename: Stefano
authors.initials: S
authors.lastname: Bombardieri
authors.forename: Lilliana
authors.initials: L
authors.lastname: Dell'Osso
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000379:Agoraphobia / Q000523:psychology*; D001172:Arthritis, Rheumatoid / Q000523:psychology*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D007558:Italy; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D019964:Mood Disorders / Q000523:psychology*; D015999:Multivariate Analysis; D016584:Panic Disorder / Q000523:psychology*; D011788:Quality of Life; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires