NAGOYA, Japan—Rheumatoid arthritis (RA) patients are twice as likely to be depressed as people without this autoimmune disease, and now new research links RA pain to both depression severity and levels of C-reactive protein (CRP).

“A clinical approach that takes into account both the body and the mind could have benefits and could enable optimal pain control.”—Masayo Kojima, MD, PhD
The new findings, which appear in the August 15th issue of Arthritis Care & Research, emphasize the importance of taking both the body and the mind into account when treating RA patients.1

“A clinical approach that takes into account both the body and the mind could have benefits and could enable optimal pain control,” conclude the researchers who were led by Masayo Kojima, MD, PhD of Nagoya University Graduate Schools of Medicine in Japan.

Inflammation, depression independently increased severe pain risk in RA

In the study, 218 RA patients completed questionnaires on their sociodemographic characteristics, smoking and drinking habits, onset year of RA, and current pain level. Study participants also completed the Japanese version of the Beck Depression Inventory. The researchers measured serum CRP levels.

Inflammation, as measured by CRP levels, and depression each independently increased the likelihood of severe pain. The combined effects of high CRP levels and depression predicted severe pain even more strongly, the study found.

Translating research into practice: Treat the mind and the joints

“Results of our research demonstrate the potential for clinicians to improve pain control by addressing their patients’ psychological symptoms in addition to conducting anti-inflammation therapy,” the researchers write.

For RA patients with severe pain without high CRP levels, psychotherapy and/or psychotropic medication may be an option, they write. “Some patients may benefit from treatment that is focused on physical symptoms rather than psychological approach.”

In some cases, both pain and depression may be treated concomitantly. Tricyclic acid has been shown to be effective for both depression and neuropathic pain. The amygdala may be the link between depression and pain.

Going forward, “the management of patients with RA may find new possibilities by approaching the common mechanism of chronic pain, depression and inflammation.”

Reference
1. Kojima M, Kojima T, Suzuki S, et al. Depression, inflammation, and pain in patients with rheumatoid arthritis. Arthritis Care & Research. 2009;61:1018-1024.