Introduction

Rheumatoid Arthritis (RA) is a severe chronic progressive inflammatory autoimmune disorder of unknown etiology [1,2]. Genetic and environmental causes are believed to have a role, as in the case of other autoimmune diseases [3]. The disease is characterized by systemic inflammation where the connective tissues (cartilage and joint synovium) are most frequently targeted and affected [4]. It is associated with personal cost and challenge, due to the increasing prevalence, chronic periodicity with acute exacerbations, functional impairment and progressive disability [1].

For almost a century it has been observed that there is an epidemiological link and associations between RA and psychological problems [5]. Patients with RA have a high prevalence of depression comorbidity. The lifetime prevalence of depression in RA patients was reported to be 41-66% [6-8]. A Canadian study reported that the prevalence of depression was 46% higher in patients with RA compared to a matched control group [9]. 

The factors that contribute to depression in rheumatic patients are diverse. It is not clear whether the mechanism of psychiatric comorbidity related to the immune-inflammatory state or it is a squeal of the chronic illness and disability [10]. The disease activity with long term pain [11], suffering from somatic symptoms [12,13] functional limitations [14] and disease progression may contribute to depression development [12].

Psychiatric disorders have been identified as major causes of disease burden and disability [15]. They can worsen HealthRelated Quality Of Life (HRQoL) [15], compromise medical treatment, management [15] and leading to high costs of health care services [16]. Moreover RA patients with comorbid depression were shown to have increased levels of pain, irrespective the disease activity [17] and expanded mortality rates [18,19]. Comorbid depression is an independent risk factor for cardiovascular disease as myocardial infarction [20] and increase overall mortality [21]. Several studies suggested that depression may also be important determinants of work impairment [22]. In RA, depression has been found to predict future disability pension [23] and functional disability [24].

Despite the associated adverse outcomes that occurred there is no optimal management of comorbid depression in rheumatic patients. It is not fully characterized in the medical literature or prioritized in major treatment guidelines. It is not appropriately recognized and managed by all healthcare providers [25-27]. The studies that estimate the prevalence of comorbid depression received less attention in medical literature [28,29]. The aim of the study to was determine the prevalence of depression among patients with rheumatoid arthritis and its relationship with socio demographic factors and disease activity measuring parameters.

Patients and Methods

This cross section analytical study was conducted at the clinical rheumatology and immunology department at Kasr-Alainy hospital, Egypt. Data was collected starting from February 2018 till December 2019. A total of 200 patients fulfilling the American College of Rheumatology/European League against Rheumatism (ACR/EULAR) 2010 classification criteria for Rheumatoid arthritis diagnosis [30]. The mean duration of the disease among participants was 6.75 years. The diagnosis was determined after detailed reviewing of the patients' complete medical records and discussing the case with their resident doctors.

All the patients were above 18 years old. The patients excluded from the study were A) Patients with CNS lupus, psycho-organic syndrome or cognitive impairment B) Patients who were receiving daily dose of prednisolone more than 10 mg, because of the potential impact on Beck Depression Inventory (BDI) results. C) Patients having any chronic disease beside rheumatoid arthritis. Moreover, C) Patients with disease duration was shorter than one month, because the reaction to diagnosis report can increase BDI scores. Also, patients who were not willing to write consent were excluded.