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ORIT SCHIEIR, BRETT D. THOMBS, MARIE HUDSON, SUZANNE TAILLEFER, RUSSELL STEELE, LAEORA BERKSON, CAROLE BERTRAND, FRANCOIS COUTURE, MARY-ANN FITZCHARLES, MICHEL GAGNÉ, BRUCE GARFIELD, ANDRZEJ GUTKOWSKI, HARB KANG, MORTON KAPUSTA, SOPHIE LIGIER, JEAN-PIERRE MATHIEU, HENRI MÉNARD, SUZANNE MERCILLE, MICHAEL STARR, MICHAEL STEIN, MICHEL ZUMMER, and MURRAY BARON ABSTRACT. Objective. To assess the longitudinal relationships, including directionality, among chronic pain, symptoms of depression, and disease activity in patients with early inflammatory arthritis (EIA). Methods. One hundred eighty patients with EIA completed an examination, including swollen joint count, and were administered the Center for Epidemiological Studies Depression Scale (CES-D) and the McGill Pain Questionnaire (MPQ) at 2 timepoints 6 months apart. Cross-lagged panel path analysis was used to simultaneously assess concurrent and longitudinal relationships among pain, symptoms of depression, and number of swollen joints. Results. Pain, symptoms of depression, and number of swollen joints decreased over time (p < 0.001) and were prospectively linked to pain, symptoms of depression, and number of swollen joints, respectively, at 6 months. Symptoms of depression and pain were correlated with each other at baseline (0.47) and at 6-month followup assessments (0.28). Baseline symptoms of depression significantly predicted pain symptoms at 6 months (standardized regression coefficient = 0.28, p = 0.001), whereas pain and disease activity did not predict the course of any other variable after controlling for baseline values. Conclusion. Symptoms of depression predicted the trajectory of pain from baseline to 6 months. In addition, there were reciprocal/bidirectional associations between pain and symptoms of depression over time. More research is needed to better understand the relationship between pain and depressive symptoms and how to best manage patients with EIA who have high levels of both. (J Rheumatol First Release Dec 15 2008; doi:10.3899/jrheum.080147) Key Indexing Terms: RHEUMATOID ARTHRITIS PAIN DEPRESSION OUTCOMES ASSESSMENT LONGITUDINAL STUDIES From the Division of Rheumatology and Department of Psychiatry, Sir Mortimer B. Davis–Jewish General Hospital and McGill University; Department of Mathematics; Division of Rheumatology, McGill University; and Service de Rhumatologie, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada. Support for the McGill Early Arthritis Registry has been received in the form of unrestricted educational grants from Merck, Pfizer and Aventis Pharmaceuticals. Drs. Thombs and Hudson are supported by New Investigator Awards from the Canadian Institutes of Health Research and Établissement de Jeunes Chercheurs awards from the Fonds de la Recherche en Santé Québec. O. Schieir, BA, Division of Rheumatology; B.D. Thombs, PhD, Department of Psychiatry; M. Hudson, MD, MPH; S.S. Taillefer, PhD, Division of Rheumatology, Sir Mortimer B. Davis–Jewish General Hospital and McGill University; R.J. Steele, PhD, Department of Mathematics, McGill University; L. Berkson, MD, Division of Rheumatology, Sir Mortimer B. Davis–Jewish General Hospital and McGill University; C. Bertrand, MD, Service de Rhumatologie, Hôpital Maisonneuve-Rosemont; F. Couture, MD; M-A. Fitzcharles, MD; M. Gagné, MD; B. Garfield, MD; A. Gutkowski, MD; H. Kang, MD; M. Kapusta, MD, Division of Rheumatology, McGill University; S. Ligier, MD; J-P. Mathieu, MD, Service de Rhumatologie, Hôpital Maisonneuve-Rosemont; H. Ménard, MD, Division of Rheumatology, McGill University; S. Mercille, MD, Service de Rhumatologie, Hôpital Maisonneuve-Rosemont; M. Starr, MD; M. Stein, MD, Division of Rheumatology, McGill University; M. Zummer, MD, Service de Rhumatologie, Hôpital Maisonneuve-Rosemont; M. Baron, MD, Division of Rheumatology, Sir Mortimer B. Davis–Jewish General Hospital and McGill University. Address reprint requests to Dr. B.D. Thombs, SMBD-Jewish General Hospital, 4333 Cote Ste Catherine Road, Montreal, Quebec H3T 1E4. E-mail: brett.thombs@mcgill.ca Accepted for publication September 4, 2009. |
