Pain and psychological health status over a 10-year period in patients with recent onset rheumatoid arthritis

Objective: To examine rheumatoid arthritis ( RA) with short disease duration over 10 years, and to identify factors that are associated with the course of pain, depression and anxiety. Methods: A cohort of 238 patients with RA ( age 20-70 years, mean disease duration 2.3 years, 68% rheumatoid factor positive) was followed with assessments at baseline and after 1, 2, 5 and 10 years. Self-reported health status was assessed by pain on a 100 mm visual analogue scale, the Arthritis Impact Measurement Scales ( AIMS), the 28-item version of General Health Questionnaires, and the Health Assessment Questionnaire. We also examined the erythrocyte sedimentation ratio, grip strength ( kg) and radiographic progression of the hands ( van der Heijde modified Sharp score). Repeated measures analyses of variance were used to explore the effect of time on measures of outcome among completers, whereas repeated measures analyses using a mixed model were applied to identify factors that were longitudinally associated with pain, depression and anxiety. Results: At the various assessment points 30% had a visual analogue scale pain score of >= 40 mm, 5-13% had an AIMS depression score of >= 4.0 and 20-30% had an AIMS anxiety score of >= 4.0. The perceived level of pain was explained longitudinally by anxiety, disease activity, physical function and female gender, depression by high disease activity and anxiety, whereas anxiety was explained by low disease activity and depression. Conclusion: More patients had increased levels of anxiety (20-30%) than increased levels of depression (5-13%). Several factors, including anxiety, but not depression, were associated with the course of pain.