Fatigue, a common and debilitating symptom of rheumatoid arthritis, may be up to ten percent higher in patients who also have a history of depression and anxiety disorders, according to a new study.
“Much research has been done tying fatigue to concurrent symptoms in rheumatoid arthritis patients, such as the accompanying pain, sleep interruptions and inflammation,” said lead author Judith Fifield, PhD, of the University of Connecticut School of Medicine. “Our study suggests episodes of depression and other mood disorders, which occurred as much as three decades earlier, contribute and could be a predictor of fatigue levels in these patients.”
Fifield and her research team conducted yearly phone interviews between 1989 and 1995 with 415 patients diagnosed with rheumatoid arthritis to assess their levels of fatigue and distress, as well as record their histories of major depression and anxiety disorder. Participants were predominantly upper middle age (average 58 years), married women.
The results of the study are published in the February 2001 issue of Annals of Behavioral Medicine.
Rheumatoid arthritis, an autoimmune disease, is characterized by chronic inflammation of tissues as well as joint pain, stiffness and swelling. The researchers found those rheumatoid arthritis patients with a history of major affective disorders, which included major depression and generalized anxiety disorder, reported a 10 percent higher level of fatigue in the first year of the study, and those levels remained elevated throughout the study period.
“Although fatigue tends to increase slowly over time, the fatigue level of this group did not worsen at a faster rate,” said Fifield. “In fact, changes in fatigue tended to be smaller year to year. They start with high levels and continue to report high levels of fatigue over time.”
Researchers believe higher levels of fatigue among those with a history of affective disorder are, in part, a function of enduring levels of distress; the higher the distress level, the greater the fatigue.
“Our findings point out the far-reaching effects of a history of major depression or generalized anxiety disorder on quality of life of individuals over time,” said Fifield. “We suggest more research be done to explore altered biochemical processes and stable personality characteristics that would help explain higher levels of either perceived or actual fatigue.”
This study was supported by a clinical science grant from the National Arthritis Foundation.
Annals of Behavioral Medicine is the official peer-reviewed publication of The Society of Behavioral Medicine.