title: Psychological distress over time in early rheumatoid arthritis: results from a longitudinal study in an early arthritis cohort.
abstract: OBJECTIVE
  RA is a chronic disease with frequent psychological co-morbidities, of which depression and anxiety are two common manifestations. We aimed to identify predictive factors of psychological distress in a large prospective cohort of very early RA patients.
  
  
  METHODS
  ESPOIR (Etude et Suivi des Polyarthrites Indifférenciées Récentes) is a multicentre, longitudinal and prospective cohort study of patients with early arthritis (<6 months disease duration). The study sample comprised 641 patients with very early RA according to the 2010 ACR/European League Against Rheumatism RA criteria from the ESPOIR cohort. Psychological distress was assessed over 3 years by the five-item Mental Health Inventory questionnaire at various time points (baseline, 6, 12, 18, 24 and 36 months). Logistic regression with a generalized estimating equation model was used to analyse the association of disease variables and risk of psychological distress.
  
  
  RESULTS
  At baseline, 46.9% of RA patients were screened as positive for psychological distress. Over 3 years, psychological distress decreased significantly, with a prevalence of 25.8% at 36 months. The HAQ Disability Index (HAQ-DI) score was the most important factor predicting psychological distress over 3 years [odds ratio 2.10 (95% CI 1.41, 3.14)-3.59 (2.29, 5.63)]. Baseline biological and radiological variables and treatment regimens were not associated with distress.
  
  
  CONCLUSIONS
  Psychological distress in very early RA is frequent and the HAQ-DI score is a predictor of depression and anxiety in these patients. A psychological evaluation in patients with early RA is important for further individual psychiatric diagnosis and management.
authors.affiliation: Lapeyronie Hospital, Montpellier I University, UMR 5535, EA2415, Montpellier, France, Lille University Hospital, Lille 2 University, Lille, Tours University Hospital, UMR CNRS 7292, University of Tours, Tours and La Colombiere Hospital, CHRU Montpellier I University, Montpellier, France.
authors.forename: Ludovic
authors.initials: L
authors.lastname: Bacconnier
authors.affiliation: Lapeyronie Hospital, Montpellier I University, UMR 5535, EA2415, Montpellier, France, Lille University Hospital, Lille 2 University, Lille, Tours University Hospital, UMR CNRS 7292, University of Tours, Tours and La Colombiere Hospital, CHRU Montpellier I University, Montpellier, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Rincheval
authors.affiliation: Lapeyronie Hospital, Montpellier I University, UMR 5535, EA2415, Montpellier, France, Lille University Hospital, Lille 2 University, Lille, Tours University Hospital, UMR CNRS 7292, University of Tours, Tours and La Colombiere Hospital, CHRU Montpellier I University, Montpellier, France.
authors.forename: René-Marc
authors.initials: RM
authors.lastname: Flipo
authors.affiliation: Lapeyronie Hospital, Montpellier I University, UMR 5535, EA2415, Montpellier, France, Lille University Hospital, Lille 2 University, Lille, Tours University Hospital, UMR CNRS 7292, University of Tours, Tours and La Colombiere Hospital, CHRU Montpellier I University, Montpellier, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Goupille
authors.affiliation: Lapeyronie Hospital, Montpellier I University, UMR 5535, EA2415, Montpellier, France, Lille University Hospital, Lille 2 University, Lille, Tours University Hospital, UMR CNRS 7292, University of Tours, Tours and La Colombiere Hospital, CHRU Montpellier I University, Montpellier, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Daures
authors.affiliation: Lapeyronie Hospital, Montpellier I University, UMR 5535, EA2415, Montpellier, France, Lille University Hospital, Lille 2 University, Lille, Tours University Hospital, UMR CNRS 7292, University of Tours, Tours and La Colombiere Hospital, CHRU Montpellier I University, Montpellier, France.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Boulenger
authors.affiliation: Lapeyronie Hospital, Montpellier I University, UMR 5535, EA2415, Montpellier, France, Lille University Hospital, Lille 2 University, Lille, Tours University Hospital, UMR CNRS 7292, University of Tours, Tours and La Colombiere Hospital, CHRU Montpellier I University, Montpellier, France. b-combe@chu-montpellier.
authors.forename: Bernard
authors.initials: B
authors.lastname: Combe
mesh_terms: D000328:Adult; D001007:Anxiety / Q000453:epidemiology; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology*; D015331:Cohort Studies; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology; D004185:Disability Evaluation; D042241:Early Diagnosis; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D013315:Stress, Psychological / Q000150:complications*; D011795:Surveys and Questionnaires; D013997:Time Factors
keywords: HAQ; depression; early rheumatoid arthritis; psychological distress