title: Prospective study of posttraumatic stress disorder and disease activity outcomes in US veterans with rheumatoid arthritis.
abstract: OBJECTIVE
  To examine the relationship between posttraumatic stress disorder (PTSD) and disease activity in US veterans with rheumatoid arthritis (RA).
  
  
  METHODS
  US veterans with RA were enrolled in a longitudinal observational study and were categorized as having PTSD, other anxiety/depression disorders, or neither of these psychiatric diagnoses using administrative codes. Generalized linear mixed-effects models were used to examine the associations of the diagnostic groups with outcomes measured over a mean followup period of 3.0 years.
  
  
  RESULTS
  At enrollment, 1,522 patients had a mean age of 63 years, they were primarily men (91%), and a majority (78%) reported white race. A diagnosis of PTSD was observed in 178 patients (11.7%), and other anxiety/depression diagnoses (excluding PTSD) were found in 360 patients (23.7%). The presence of a PTSD diagnosis was independently associated with higher values of self-reported pain, physical impairment, tender joint count, and worse patient global well-being scores compared to patients with no psychiatric diagnosis. There were no significant group differences in swollen joint count, erythrocyte sedimentation rate, or Disease Activity Score in 28 joints. There were no differences between any outcomes comparing those with PTSD and those with other anxiety/depression diagnoses.
  
  
  CONCLUSIONS
  In this RA cohort, the diagnosis of PTSD was associated with worse patient-reported outcomes and tender joint counts, but not with other physician- or laboratory-based measures of disease activity. These results suggest that PTSD, along with other anxiety/depression disorders, may affect RA disease activity assessments that rely on patient-reported outcomes and the resulting treatment decisions.
authors: Omaha VAMC and University of Nebraska Medical Center, Omaha, NE 68198-6270, USA. tmikuls@unmc.edu
authors: Ted R
authors: TR
authors: Mikuls
authors: Prasad R
authors: PR
authors: Padala
authors: Harlan R
authors: HR
authors: Sayles
authors: Fang
authors: F
authors: Yu
authors: Kaleb
authors: K
authors: Michaud
authors: Liron
authors: L
authors: Caplan
authors: Gail S
authors: GS
authors: Kerr
authors: Andreas
authors: A
authors: Reimold
authors: Grant W
authors: GW
authors: Cannon
authors: J Steuart
authors: JS
authors: Richards
authors: Deana
authors: D
authors: Lazaro
authors: Geoffrey M
authors: GM
authors: Thiele
authors: Joseph A
authors: JA
authors: Boscarino
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000453:epidemiology / Q000523:psychology; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D008889:Military Personnel / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D011446:Prospective Studies; D013313:Stress Disorders, Post-Traumatic / Q000150:complications* / Q000453:epidemiology