Prospective study of posttraumatic stress disorder and disease activity outcomes in US veterans with rheumatoid arthritis
Article first published online: 30 JAN 2013
Copyright © 2013 by the American College of Rheumatology
Arthritis Care & Research
Volume 65, Issue 2, pages 227–234, February 2013
How to Cite
Mikuls, T. R., Padala, P. R., Sayles, H. R., Yu, F., Michaud, K., Caplan, L., Kerr, G. S., Reimold, A., Cannon, G. W., Richards, J. S., Lazaro, D., Thiele, G. M. and Boscarino, J. A. (2013), Prospective study of posttraumatic stress disorder and disease activity outcomes in US veterans with rheumatoid arthritis. Arthritis Care Res, 65: 227–234. doi: 10.1002/acr.21778
- Issue published online: 30 JAN 2013
- Article first published online: 30 JAN 2013
- Accepted manuscript online: 27 JUN 2012 11:27AM EST
- Manuscript Accepted: 16 JUN 2012
- Manuscript Received: 11 FEB 2012
- Nebraska Arthritis Outcomes Research Center at the University of Nebraska Medical Center
- Veterans Affairs Health Services Research and Development Program of the Veterans Health Administration
- Abbott Laboratories
- Bristol-Myers Squibb
- Veterans Health Administration (Veterans Affairs Merit award)
- Veterans Affairs Health Services Research and Development Program Career Development Award. Grant Number: CDA 07-221
To examine the relationship between posttraumatic stress disorder (PTSD) and disease activity in US veterans with rheumatoid arthritis (RA).
US veterans with RA were enrolled in a longitudinal observational study and were categorized as having PTSD, other anxiety/depression disorders, or neither of these psychiatric diagnoses using administrative codes. Generalized linear mixed-effects models were used to examine the associations of the diagnostic groups with outcomes measured over a mean followup period of 3.0 years.
At enrollment, 1,522 patients had a mean age of 63 years, they were primarily men (91%), and a majority (78%) reported white race. A diagnosis of PTSD was observed in 178 patients (11.7%), and other anxiety/depression diagnoses (excluding PTSD) were found in 360 patients (23.7%). The presence of a PTSD diagnosis was independently associated with higher values of self-reported pain, physical impairment, tender joint count, and worse patient global well-being scores compared to patients with no psychiatric diagnosis. There were no significant group differences in swollen joint count, erythrocyte sedimentation rate, or Disease Activity Score in 28 joints. There were no differences between any outcomes comparing those with PTSD and those with other anxiety/depression diagnoses.
In this RA cohort, the diagnosis of PTSD was associated with worse patient-reported outcomes and tender joint counts, but not with other physician- or laboratory-based measures of disease activity. These results suggest that PTSD, along with other anxiety/depression disorders, may affect RA disease activity assessments that rely on patient-reported outcomes and the resulting treatment decisions.