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Immune Activation and Depression in Women with Rheumatoid Arthritis
ALEX J. ZAUTRA, DAVID C. YOCUM, ISIDRO VILLANUEVA, BRUCE SMITH, MARY C. DAVIS, JEANNE ATTREP, and MICHAEL IRWIN
ABSTRACT. Objective. We examined markers of immune activation during periods of stress and depressive symptoms in 45 female patients with rheumatoid arthritis (RA) in comparison to 106 controls with no autoimmune disease. Methods. Depressive symptoms were recorded, clinician ratings of disease activity were made, and blood was drawn for RA patients and controls at baseline and during a designated stressful week. Results. Counts of T cell subpopulations revealed significant differences between RA and control groups in proportions of CD8 and CD4 cells, with higher CD4 and lower CD8 counts for the RA participants. Significant depression by diagnosis interactions were found, revealing greater CD4 activation among RA patients who were depressed in comparison to other groups. Only marginally significant effects of stress were found on T cell counts. Interleukin 6 (IL-6) concentrations also differentiated groups, with the highest levels of IL-6 observed for depressed RA patients under stress. Conclusion. These findings provide new evidence that psychosocial factors play a significant role in autoimmune processes that underlie RA. (J Rheumatol 2004;31:457-63) Key Indexing Terms:
AUTOIMMUNITY
From the Department of Rheumatology, Arizona State University, Tempe, Arizona, USA. Supported by grants from the National Institute of Arthritis and Musculoskeletal and Skin Diseases, 5 R01 AR41687-05, and The Arthritis Foundation. A.J. Zautra, PhD, Professor of Psychology; B. Smith, PhD, Postdoctoral Fellow; M.C. Davis, PhD, Associate Professor of Psychology, Arizona State University; D.C. Yocum, MD, Professor and Chief of Rheumatology; I. Villanueva, MD, Research Scientist, University of Arizona; J. Attrep, MD, Phoenix Veterans Administration Hospital, Phoenix, Arizona; M. Irwin, MD, Professor of Psychiatry and Biobehavioral Sciences, Clinical Rheumatologist, Neuropsychiatric Institute, University of California, Los Angeles. Address reprint requests to Dr. A.J. Zautra, Department of Psychology, Arizona State University, PO Box 871104, Tempe, AZ 85287-1104. E-mail: alex.zautra@asu.edu Submitted February 5, 2003; revision accepted August 11, 2003. |