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北京大学学报（医学版） ›› 2020, Vol. 52 ›› Issue (6): 1048-1055. doi: 10.19723/j.issn.1671-167X.2020.06.010

• 论著 • 上一篇    下一篇

银屑病关节炎抑郁和焦虑患病情况及相关因素

耿研,宋志博,张晓慧,邓雪蓉,王昱,张卓莉()   

  1. 北京大学第一医院风湿免疫科,北京 100034
  • 收稿日期:2020-08-03 出版日期:2020-12-18 发布日期:2020-12-13
  • 通讯作者: 张卓莉 E-mail:zhuoli.zhang@126.com
  • 基金资助:
    国家自然科学基金(81901646);国家自然科学基金(81771740);国家自然科学基金(81971524);北京大学第一医院青年临床研究专项基金(2019CR28)

Depression and anxiety in patients with psoriatic arthritis: Prevalence and associated factors

Yan GENG,Zhi-bo SONG,Xiao-hui ZHANG,Xue-rong DENG,Yu WANG,Zhuo-li ZHANG()   

  1. Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing 100034, China
  • Received:2020-08-03 Online:2020-12-18 Published:2020-12-13
  • Contact: Zhuo-li ZHANG E-mail:zhuoli.zhang@126.com
  • Supported by:
    National Natural Science Foundation of China(81901646);National Natural Science Foundation of China(81771740);National Natural Science Foundation of China(81971524);Youth Clinical Research Project of Peking University First Hospital(2019CR28)

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摘要：

目的:评估银屑病关节炎(psoriatic arthritis,PsA)患者抑郁及焦虑的患病率,比较与类风湿关节炎(rheumatoid arthritis,RA)患者之间的差异,探索PsA患者发生抑郁及焦虑的相关因素。方法:连续入选2018年5月至2019年9月就诊于北京大学第一医院风湿免疫科门诊的PsA和RA患者,采用抑郁自评量表和焦虑自评量表评估患者抑郁和焦虑情况,并进行对比。收集PsA患者的人口学及临床数据,包括性别、年龄、病程、疾病活动度及用药情况等,同时应用能量多普勒与灰阶超声评价关节及附着点病变。采用多因素Logistic回归分析相关因素。结果:入选114例PsA患者,37例(32.5%)患有精神障碍,其中36例(31.6%)合并抑郁,15例(13.2%)合并焦虑。与201名RA患者相比较,PsA患者合并抑郁的比例更高(31.6% vs. 18.9%,P=0.011), 经过校正分析发现PsA比RA发生抑郁的风险更高(校正OR=2.7,95%CI:1.1~6.4);合并焦虑患者的比例也较RA有升高趋势(13.2% vs. 8.5%,P=0.185),但差异无统计学意义。在PsA患者中,年龄(OR=0.95,P=0.008)、银屑病病程(OR=0.94,P=0.018)、疼痛视觉模拟评分(OR=1.47,P=0.011)、银屑病皮损面积及严重程度指数(psoriasis area and severity index,PASI)(OR=1.07,P=0.007)、超声附着点炎阳性(OR=4.13,P=0.009)是抑郁的相关因素;PASI(OR=1.07,P=0.001)是焦虑的相关因素。结论:PsA患者患抑郁与焦虑的比例较高,其中抑郁患病风险更是高于RA患者。年龄小、银屑病病程短、银屑病皮疹重、疼痛评分高、存在超声附着点炎症的PsA患者更容易出现抑郁,银屑病皮疹重是PsA患者发生焦虑的相关因素。

关键词: 银屑病关节炎, 抑郁, 焦虑, 患病率

Abstract:

Objective: To determine the prevalence of depression and anxiety in patients with psoriatic arthritis (PsA), to investigate whether there is a difference in the prevalence of depression and anxiety between PsA and rheumatoid arthritis (RA) patients and to identify associated risk factors for depression and anxiety in PsA patients. Methods: PsA and RA patients who visited Department of Rheumatology and Clinical Immunology in Peking University First Hospital from May 2018 to Sep 2019 were recruited. Self-rating anxiety scale and self-rating depression scale were surveyed and compared between PsA and RA patients. Demographics and clinical features including age, gender, disease duration, disease activity score, psoriasis area and severity index (PASI), and medical application were collected. Power Doppler and grey-scale ultrasound of joints, tenosynovitis and enthesis were performed. Multivariate Logistic regression was used to identify the factors associated with mood disorders and the odds ratio of depression and anxiety between the PsA and RA patients. Results: Among the 114 enrolled PsA patients, 37 (32.5%) had mood disorders, in which 36 (31.6%) with depression and 15 (13.2%) with anxiety. Compared with 201 RA patients, PsA patients showed greater odds for depression [adjusted OR (95%CI): 2.7 (1.1-6.4)]. Depression was more often observed in the PsA than in the RA patients (31.6% vs. 18.9%, P=0.011). The similar trend for anxiety was also observed, although the difference was insignificant (13.2% vs. 8.5%, P=0.185). Age (OR=0.95, P=0.008), psoriasis duration (OR=0.94, P=0.018), pain visual analogue scale (OR=1.47, P=0.011), PASI score (OR=1.07, P=0.007) and presence of ultrasound enthesitis (OR=4.13, P=0.009) were identified as factors associated with depression in the PsA patients. PASI score (OR=1.07, P=0.001) was identified as associated factor for anxiety in the PsA patients. Conclusion: The prevalence of depression and anxiety is elevated in PsA patients. Depression is significantly more prevalent in PsA patients than in RA patients. Younger age, shorter psoriasis duration, worse pain and presence of ultrasound enthesitis are associated with depression, while severe psoriasis rash is associated with both depression and anxiety in PsA patients.

Key words: Psoriatic arthritis, Depression, Anxiety, Prevalence

中图分类号: 

  • R593.2

表1

PsA、RA患者临床特点及抑郁和焦虑患病情况比较"

Items PsA (n=114) RA (n=201) P
Female 55 (48.2) 166 (82.6) <0.001
Age/years 47.6±13.5 49.5±13.0 0.222
Disease duration/years 14.0 (7.0, 24.3) 3.4 (1.0, 10.0) <0.001
TJC 28 3.0 (1.0, 8.0) 2.0 (0.0, 6.5) 0.253
SJC 28 2.0 (0.0, 6.0) 1.0 (0.0, 3.5) 0.054
ESR/(mm/h) 11.5 (5.0, 27.3) 21.0 (10.0, 40.0) <0.001
CRP/(mg/L) 5.5 (2.0, 15,6) 6.1 (2.6, 14.8) 0.176
PGA (0-10) 4.0 (2.0, 6.0) 3.0 (2.0, 6.0) 0.276
EGA (0-10) 3.0 (2.0, 5.0) 2.0 (1.0, 5.0) 0.124
Pain VAS (0-10) 3.8 (2.0, 5.0) 3.0 (1.3, 5.0) 0.615
DAS28-CRP 3.4±1.5 3.6±1.6 0.419
SDAI 14.1 (7.3, 24.4) 10.6 (5.6, 24.0) 0.067
HAQ 1.0 (0.0, 8.0) 4.0 (0.5, 15.0) 0.001
PASI 3.2 (0.8, 9.4) 0.0 (0.0, 0.0) <0.001
Mood disorder
Depression 36 (31.6) 38 (18.9) <0.001
Anxiety 15 (13.2) 17 (8.5) 0.185
Cigarette smoking <0.001
Non-smokers 76 (66.7) 170 (84.6)
Ex-smokers 14 (12.3) 15 (7.5)
Current smokers 24 (21.1) 16 (8.0)
csDMARDs used <0.001
csDMARDs-naive 14 (12.3) 66 (32.8)
Single csDMARDs 80 (70.2) 49 (24.4)
Combined csDMARDs 20 (17.5) 86 (42.8)
Biological DMARDs used 2 (1.8) 4 (2.0) 0.882
Metabolic syndrome 38 (33.3) 19 (9.5) <0.001

表2

预测抑郁患病风险模型(PsA与RA风险比,Logistic回归)"

Items OR 95%CI P
PsA vs. RA 2.70 1.14-6.44 0.025
Age 0.97 0.95-0.99 0.004
Disease duration 0.94 0.91-0.98 0.002
SDAI 1.00 0.98-1.03 0.977
HAQ 1.04 1.01-1.08 0.031
PASI 1.06 1.02-1.11 0.009

表3

抑郁与非抑郁PsA患者临床表现和超声特点比较"

Items PsA with depression (n=36) PsA without depression (n=78) P
Female 18 (50.0) 37 (47.40) 0.799
Age/years 41.6±14.5 50.4±12.1 0.001
Disease duration of PsO/years 10.0 (5.3, 15.8) 15.5 (7.8, 29.3) 0.048
Disease duration of PsA/years 3.5 (1.0, 9.5) 3.3 (1.2, 8.5) 0.932
TJC 68 3.0 (1.3, 9.8) 2.5 (1.0, 8.0) 0.495
SJC 66 3.0 (0.3, 6.0) 2.0 (0.0, 5.3) 0.641
Pain VAS (0-10) 4.0 (3.0, 6.0) 3.0 (2.0, 5.0) 0.015
PGA (0-10) 5.0 (3.0, 6.8) 4.0 (2.0, 5.0) 0.059
EGA (0-10) 3.0 (2.0, 5.0) 3.0 (1.5, 4.3) 0.207
CRP/(mg/L) 5.7 (2.4, 20.3) 4.6 (1.9, 15.6) 0.592
ESR/(mm/h) 12.5 (7.0, 27.0) 11.0 (5.0, 28.3) 0.676
DAPSA 17.4 (8.7, 27.7) 14.2 (7.8, 24.4) 0.239
HAQ 2.5 (0.0, 8.8) 1.0 (0.0, 7.3) 0.305
PSAI 4.4 (1.2, 29.4) 2.6 (0.7, 7.7) 0.018
Ultrasonographic feathers
Synovitis GS total score 1.5 (0.0, 3.8) 1.5 (0.0, 4.0) 0.957
Synovitis PD total score 0.0 (0.0, 1.0) 0.0 (0.0, 2.0) 0.414
Tenosynovitis GS total score 0.0 (0.0, 2.0) 0.0 (0.0, 2.0) 0.279
Tenosynovitis PD total score 0.0 (0.0, 1.0) 0.0 (0.0, 1.0) 0.528
Presence of enthesitis 23 (63.9) 33 (42.3) 0.032
Bone erosion 16 (44.4) 32 (41.0) 0.731
csDMARDs used 0.165
csDMARDs-naive 4 (11.1) 10 (11.8)
Single csDMARD 22 (61.1) 58 (74.4)
Combined csDMARDs 10 (27.8) 10 (12.8)
Biological DMARDs used 1 (2.8) 1 (1.3) 0.534
NSAIDs used 12 (33.3) 19 (24.4) 0.317
BMI/(kg/m2) 23.2±2.8 24.0±3.0 0.178
Waist circumference/cm 82.3±10.5 84.6±8.5 0.250
Onychosis 16 (44.6) 53 (62.4) 0.069
Ophthalmitis 2 (5.6) 1 (1.3) 0.234
Metabolic syndrome 8 (22.2) 30 (38.5) 0.087
Cigarette smoking 0.902
Non-smoker 23 (63.9) 53 (67.9)
Ex-smoker 5 (13.9) 9 (11.5)
Current smoker 8 (22.2) 16 (20.5)
Family history of PsO/PsA 17 (47.2) 23 (29.5) 0.065

表4

焦虑与非焦虑PsA患者临床表现和超声特点比较"

Items PsA with anxiety (n=15) PsA without anxiety (n=99) P
Female 8 (53.3) 47 (47.5) 0.672
Age/years 42.8±16.8 48.3±12.8 0.140
Disease duration of PsO/years 11.0 (4.0, 20.0) 14.0 (8.0, 26.0) 0.401
Disease duration of PsA/years 7.0 (1.0, 12.0) 3.0 (1.0, 8.0) 0.233
TJC 68 2.0 (0.0, 10.0) 3.0 (1.0, 8.0) 0.939
SJC 66 2.0 (0.0, 6.0) 2.0 (0.0, 5.0) 0.963
Pain VAS (0-10) 3.0 (3.0, 6.0) 4.0 (2.0, 5.0) 0.343
PGA (0-10) 3.0 (2.0, 6.0) 4.0 (2.0, 6.0) 0.922
EGA (0-10) 2.0 (2.0, 5.0) 3.0 (2.0, 5.0) 0.806
CRP/(mg/L) 5.5 (1.3, 11.9) 5.4 (2.0, 15.8) 0.672
ESR/(mm/h) 11.0 (5.0, 21.0) 12.0 (5.0, 29.0) 0.540
DAPSA 14.5 (5.1, 31.5) 15.7 (8.3, 24.4) 0.983
HAQ 3.0 (0.0, 14.0) 1.0 (0.0, 7.0) 0.263
PSAI 7.6 (0.6, 39.0) 3.0 (0.8, 8.4) 0.047
Ultrasonographic feathers
Synovitis GS total score 0.0 (0.0, 2.0) 2.0 (0.0, 4.0) 0.147
Synovitis PD total score 0.0 (0.0, 0.0) 0.0 (0.0, 2.0) 0.270
Tenosynovitis GS total score 0.0 (0.0, 2.0) 0.0 (0.0, 2.0) 0.608
Tenosynovitis PD total score 0.0 (0.0, 0.0) 0.0 (0.0, 1.0) 0.200
Presence of enthesitis 7 (46.7) 49 (49.5) 0.838
Bone erosion 5 (33.3) 43 (43.4) 0.460
csDMARDs used 0.068
csDMARDs-naive 2 (13.3) 12 (12.1)
Single csDMARDs 7 (46.7) 73 (73.7)
Combined csDMARDs 6 (40.0) 14 (14.1)
Biological DMARDs used 1 (6.7) 1 (1.0) 0.617
NSAIDs used 3 (20.0) 28 (28.3) 0.718
BMI/(kg/m2) 24.3±2.4 23.6±3.0 0.417
Waist circumference/cm 84.7±11.8 83.7±8.8 0.734
Onychosis 6 (40.0) 58 (58.6) 0.176
Ophthalmitis 0 3 (3.0) 0.652
Metabolic syndrome 6 (40.0) 32 (32.3) 0.557
Cigarette smoking 0.266
Non-smokers 11 (73.3) 65 (65.7)
Ex-smokers 3 (20.0) 11 (11.1)
Current smokers 1 (6.7) 23 (23.2)
Family history of PsO/PsA 7 (46.7) 33 (33.3) 0.313

表5

PsA患者发生抑郁/焦虑的相关因素(多因素Logistic回归)"

Items OR 95%CI P
Associated factors for depression
Age 0.95 0.91-0.99 0.008
Disease duration 0.94 0.90-0.99 0.018
Pain VAS 1.47 1.09-1.98 0.011
PASI 1.07 1.02-1.13 0.007
Presence of ultrasound enthesitis 4.13 1.42-12.05 0.009
Associated factor for anxiety
PASI 1.07 1.03-1.12 0.001
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ISSN 1671-167X
CN 11-4691/R
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