[Perception of pain in rheumatoid arthritis: relation to inflammation, psychic disorders, functional status, and quality of life].

Pain perception was analyzed depending on the inflammatory activity of rheumatoid arthritis (RA), variants and manifestations of psychic disorders (including depressive, anxious and moderate cognitive ones), chronic fatigue, changes in the functional status and quality of life. The study included 125 patients (mean age 47.4 +/- 1.01 yr) with definitive diagnosis of RA 138.4 +/- 10.1 months in duration. RA activity was estimated from the DAS28 index, pain intensity and degree of fatigue by BPI and FSS scales respectively, the functional status and life quality by HAQ and EQ-5D. Psychic disorders were diagnosed by a psychiatrist in accordance with ICD-10 with the use of relevant psychiatric and psychological scales and methods. Pain perception was unrelated to the patients' age and RA duration. The multifactor analysis provided a basis for the prognostic model suggesting that the most severe pain in RA is related to the functional status and quality of life (VAS of general health status), hsCRP level, inflammatory activity index RA DAS28, peripheral platelet count, degree of fatigue (FSS) and depression (YADS), female sex. Depression and its severity is one more factor influencing pain perception in RA and accounting for functional insufficiency and low quality of life. Early diagnostics of psychic disorders (in the first place anxious and depressive ones) is mandatory to ensure effective combined therapy of pain in RA patients.

[Cognitive impairment and anxiety-depressive disorders in patients with rheumatoid arthritis].

Data on the prevalence and features of cognitive impairment in patients with rheumatoid arthritis (RA) are presented. Cognitive impairment was noted in 66% of patients, it did not reach the threshold of dementia and met the diagnostic criteria for moderate cognitive impairment. Anxiety-depressive spectrum disorders were found in 94% patients. Cognitive impairment was associated with apathic affect and anxiety-depressive spectrum disorders (depressive episodes, dysthymia, and elevated anxiety). The impairment of thinking was correlated with the high to moderate inflammatory activity including non-joint RA symptoms, higher levels of proinflammatory cytokines and low doses of glucocorticoids. Cognitive impairment was not associated with the duration and character of standard treatment of RA and concomitant cardiovascular diseases.

[Prevalence of mental disorders in SLE patients: correlations with the disease activity and comorbid chronic conditions].

AIM: To study effects of the disease activity and comorbid chronic conditions on the incidence of mental disorders in patients with systemic lupus erythematosus (SLE) treated in the State Institute of Rheumatology, RAMS. MATERIAL AND METHODS: A total of 115 patients with documented SLE (age 24-45 years, median 34 years, SLE duration 4-17, median 8 years) participated in the study. SLE activity was evaluated by SLEDAI scale, atherosclerosis--by ultrasonic arterial dopplerography, mental disorders--by psychological and psychic scales according to IDC-10. RESULTS: Mental disorders were detected in 76 of 115 (66%) patients: anxiety and depression (83%), depression episodes (40%), maladaptation (24%), generalized anxiety (10%), dysthymia (9%). Manifest cognitive disorders were seen in 7% of examinees. SLE patients with and without mental disorders did not differ by age, gender, SLE duration and activity, cumulative doses of glucocorticoids and cytotoxic drugs, but differed by diagnosed atherosclerosis (23 and 8%, respectively). All SLE patients with the history of myocardial infarction had mental disorders. SLE patients with antiphospholipid syndrome had mental disorders in 85%, while controls--in 49%. CONCLUSION: Mental disorders are found frequently in SLE patients (66%). 83% of these disorders are anxiodepressive. Incidence of mental disorders in SLE patients do not correlate with age, gender, SLE duration and activity, doses of glucocorticoids and cytotoxic drugs, but correlate with comorbid diseases (atherosclerosis, myocardial infarction, acute cerebral attacks, antiphospholipid syndrome and Sjogren's syndrome.