Relationship of phsychosomatic disorders (anxiety, depression) and difficult-to-treat rheumathoid arthritis: a pilot study

Abstract

Background: Despite advances and efficacy of rheumatoid arthritis treatments, there is still an amount of difficult-to-treat patients, with persistence of signs and symptoms of disease activity (DAS 28 3 3.2) and failure to treatment. Not all the regrowths of these patients involve active inflammation (true refractory), because there is a subgroup without inflammation (false refractory). In these patients the cause of refractoriness is not well known (probably the comorbidities that they have are related, and one of them can be psychosomatic disorders). Meanwhile the cause remains unclear, this subgroup of patients follows inadequate treatments assuming an impact on the patient's health and for the socioeconomic system. Objectives: The objective of our study is to see that false refractory patients have greater anxiety and depression than true refractory patients. Design: cross-sectional analytic study Methods: Refractory rheumatoid arthritis patients who attend consultations for 1 year will be collected. We will pass to them some questionnaires to assess depression and anxiety and health status (HADS, SF 36) and refractoriness (DAS 28, RAPID 3). An articular ultrasound and determination of ADAs will be performed in order to differentiate between true and false refractory patients. Participants: Patients with persistent signs and symptoms active disease (DAS 28 3 3.2), failure to second bDMARD, and impossibility to reduce glucocorticoids