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Possible rheumatoid arthritis subtypes in terms of rheumatoid factor, depression, diagnostic delay and emotional expression: an exploratory case-control study.

Tillmann T, Krishnadas R, Cavanagh J, Petrides KV - Arthritis Res. Ther. (2013)

Bottom Line: A total of 637 patients with RA were compared to 496 controls on the trait EI Questionnaire (TEIQue).These differences were significant at the P <0.05 level, but not following strict Bonferroni corrections and should therefore be treated as indicative only.Research on the causes of RA could benefit from a systems science approach.

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ABSTRACT

Introduction: Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis has been implicated in the pathology of rheumatoid arthritis (RA), particularly as vulnerable personality types are exposed to chronic stress. Emotions are powerful modulators of stress responses. However, little is known about whether patients with RA process emotions differently to matched controls. In this study we: 1) assessed whether the trait emotional intelligence (trait EI) scores of patients with RA differ from healthy controls at the facet level; 2) explored any subgroups in RA, in terms of trait EI and common risk factors.

Methods: A total of 637 patients with RA were compared to 496 controls on the trait EI Questionnaire (TEIQue). RA subgroups were explored in terms of trait EI, rheumatoid factor status (RF+/-), depression and time from onset of symptoms until diagnosis (diagnostic delay).

Results: The RA group rated themselves lower on Adaptability, Stress-management, Emotion management, Self-esteem, Sociability, Assertiveness, Impulsiveness and Well-being, and higher on Empathy and Relationships than healthy controls. The RF- subtype reported more time with depression (25.2 vs. 11.3 months), a longer diagnostic delay (3.0 vs. 1.7 years), and greater emotional expression (5.15 vs. 4.72), than the RF+ subtype. These differences were significant at the P <0.05 level, but not following strict Bonferroni corrections and should therefore be treated as indicative only. RF- patients with a longer diagnostic delay reported depression lasting three times longer (42.7 months), when compared to three other subtypes (11.0 to 12.7 months).

Conclusions: RA patients and controls differ in their emotion-related personality traits, as operationalized by trait EI. These differences may make people with RA more susceptible to chronic stress and HPA-axis dysregulation. RA may be a highly heterogeneous illness where at least two subtypes may be characterized by personality, psychiatric and immunological differences. RF- status, as well as diagnostic delay and emotional expression, may predict future risk of depression. Research on the causes of RA could benefit from a systems science approach.

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Mean number of months treated for depression, across rheumatoid factor status and diagnostic delay.
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Figure 2: Mean number of months treated for depression, across rheumatoid factor status and diagnostic delay.

Mentions: Subsequently, a two-way ANOVA was conducted with RF status and diagnostic delay as the independent variables, and the number of months spent on treatment for depression as the dependent variable (Figure 2). Significant main effects were found for both RF status (F(1,239) = 4.54, P <0.05) and diagnostic delay (F(1,239) = 5.72, P <0.05), meaning that the RF- subgroup reported longer treatment for depression than the RF+ subgroup. Those whose diagnosis took longer than 12 months reported more treatment for depression than those whose diagnosis took less than 12 months. We also observed an interactive effect (F(1,239) = 4.87, P <0.05), meaning that within the RF+ subgroup, having a long diagnostic delay did not increase the number of months spent on treatment for depression. For the RF- subgroup, however, having a longer diagnostic delay increased the number of months spent on treatment for depression from 12 to 43 months.


Possible rheumatoid arthritis subtypes in terms of rheumatoid factor, depression, diagnostic delay and emotional expression: an exploratory case-control study.

Tillmann T, Krishnadas R, Cavanagh J, Petrides KV - Arthritis Res. Ther. (2013)

Mean number of months treated for depression, across rheumatoid factor status and diagnostic delay.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3672797&req=5

Figure 2: Mean number of months treated for depression, across rheumatoid factor status and diagnostic delay.
Mentions: Subsequently, a two-way ANOVA was conducted with RF status and diagnostic delay as the independent variables, and the number of months spent on treatment for depression as the dependent variable (Figure 2). Significant main effects were found for both RF status (F(1,239) = 4.54, P <0.05) and diagnostic delay (F(1,239) = 5.72, P <0.05), meaning that the RF- subgroup reported longer treatment for depression than the RF+ subgroup. Those whose diagnosis took longer than 12 months reported more treatment for depression than those whose diagnosis took less than 12 months. We also observed an interactive effect (F(1,239) = 4.87, P <0.05), meaning that within the RF+ subgroup, having a long diagnostic delay did not increase the number of months spent on treatment for depression. For the RF- subgroup, however, having a longer diagnostic delay increased the number of months spent on treatment for depression from 12 to 43 months.

Bottom Line: A total of 637 patients with RA were compared to 496 controls on the trait EI Questionnaire (TEIQue).These differences were significant at the P <0.05 level, but not following strict Bonferroni corrections and should therefore be treated as indicative only.Research on the causes of RA could benefit from a systems science approach.

View Article: PubMed Central - HTML - PubMed

ABSTRACT

Introduction: Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis has been implicated in the pathology of rheumatoid arthritis (RA), particularly as vulnerable personality types are exposed to chronic stress. Emotions are powerful modulators of stress responses. However, little is known about whether patients with RA process emotions differently to matched controls. In this study we: 1) assessed whether the trait emotional intelligence (trait EI) scores of patients with RA differ from healthy controls at the facet level; 2) explored any subgroups in RA, in terms of trait EI and common risk factors.

Methods: A total of 637 patients with RA were compared to 496 controls on the trait EI Questionnaire (TEIQue). RA subgroups were explored in terms of trait EI, rheumatoid factor status (RF+/-), depression and time from onset of symptoms until diagnosis (diagnostic delay).

Results: The RA group rated themselves lower on Adaptability, Stress-management, Emotion management, Self-esteem, Sociability, Assertiveness, Impulsiveness and Well-being, and higher on Empathy and Relationships than healthy controls. The RF- subtype reported more time with depression (25.2 vs. 11.3 months), a longer diagnostic delay (3.0 vs. 1.7 years), and greater emotional expression (5.15 vs. 4.72), than the RF+ subtype. These differences were significant at the P <0.05 level, but not following strict Bonferroni corrections and should therefore be treated as indicative only. RF- patients with a longer diagnostic delay reported depression lasting three times longer (42.7 months), when compared to three other subtypes (11.0 to 12.7 months).

Conclusions: RA patients and controls differ in their emotion-related personality traits, as operationalized by trait EI. These differences may make people with RA more susceptible to chronic stress and HPA-axis dysregulation. RA may be a highly heterogeneous illness where at least two subtypes may be characterized by personality, psychiatric and immunological differences. RF- status, as well as diagnostic delay and emotional expression, may predict future risk of depression. Research on the causes of RA could benefit from a systems science approach.

Show MeSH
Related in: MedlinePlus