НЕВРОПСИХИЧНИ ПРОЯВИ ПРИ ПАЦИЕНТИ С ВЪЗПАЛИТЕЛНИ И ДЕГЕНЕРАТИВНИ СТАВНИ ЗАБОЛЯВАНИЯ
MANIFESTATIONS OF NEUROPSYCHIATRIC DISEASE IN PATIENTS WITH OSTEOARTHRITIS AND INFLAMMATORY JOINT DISEASE

Summary/Abstract: Inflammatory joint diseases, such as rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondilitis (AS), and osteoarthritis are conditions of great social importance, due to their relatively high prevalence. The forementioned conditions usually show progressive development and tend to be disabling in nature. They put a great strain on patients’ quality of life physically as well as mentally. Numerous randomized trials, retrospective analyses and cohort studies show statistically significant association between these rheumatological conditions and certain psychiatric manifestations (mainly anxiety and depression, but not only). Data regarding the most common autoimmune joint disease – RA shows that 15% of those patients develop some sort of depressive disorder. Low self-esteem and anxiety as more common as well. A longer lasting and more active RA is more likely to cause some sort of mental disorder. Elevated levels of CRP (biochemical marker of disease activity) have been found to be associated with higher likelihood for the development of anxiety and depression. Psoriatic arthritis and the psoriatic disease in general lead to a higher prevalence of depression, anxiety and sleep disorders, sexual disturbances and low self-esteem. Approximately half of the patients with PsA have some sort of sleep disorder, nearly 70% have sexual problems. The percentages for depression and anxiety are between 22% and 36%. A lot of attention has been drawn to the underlying mechanisms causing this link between the rheumatological condition and the mental disorder. The consistently high levels of psychological stress in patients with PsA lead to a pathological overactivation of the hypothalamic-pituitary-adrenal axis. This over-activation produces to higher quantities of CRH and cortisol which lead to subsequent physiological changes. Research has shown that mediators of greater importance for the development of neuropsychiatric manifestations are TNF-alfa, IL-6, IL17. The prevalence of depression and anxiety in patients with AS is far lower than in those with RA and PsA, however higher than the one in the otherwise healthy population. Prospective trials show that on average one in every ten patients with AS develops some form of depression. This is markedly higher that in the general population – 6%. OA being the most common joint disease of them all shows similar results when being investigated from mental stand point. OA elevates the risk for developing depression, anxiety or any other psychiatric disorder. The most common factors associated with higher likelihood ratio are obesity, impaired joint mobility, general disability. The current state of knowledge leaves little room for doubt about the correlation between the described joint diseases and the most common psychiatric conditions. However, we are lacking data explaining the intimate mechanisms of this correlation. The discovery of these mechanisms and the possible ways of interfering with them are one of the main challenges in the field of today’s rheumatology. Any breakthrough in this direction would definitely give new hope for treatment and prevention.

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