Symptoms of Depression Predict the Trajectory of Pain Among Patients with Early Inflammatory Arthritis: A Path Analysis Approach to Assessing Change

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 asses, 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 either 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. (First Release Dec 15 2008; J Rheumatol 2009;36:231 9; doi:10.3899/jrheum.080147)