gms | German Medical Science

Background: Pain and depressive symptoms are common in patients with rheumatoid arthritis (RA). Information on the prevalence of both comorbid conditions as well as their treatment in German RA patients is scarce.

Materials and Methods: Using data from a nationwide statutory health insurance fund (BARMER GEK), RA patients aged 18 to 79 were provided with a questionnaire covering a variety of items such as demographic variables, medical condition and quality of life in June 2015. Pain caused by the joint disorder in the last seven days (11 point scale) was classified as none existent/mild (0-3), moderate (4-6) and severe (7-10). Depressive symptoms based on the last two weeks were determined using the World Health Organization’s 5-item Well-Being Index (scores transformed to 0-100) and categorized as none existent (51-100), mild (29-50) or moderate to severe (0-28). Data were linked to dispensation records from the statutory health insurance fund for the year 2015. Examined drugs included analgesics, antidepressants (AD) and anticonvulsants.

Results: A total of 3140 RA patients was included in the analysis. Median age was 66 years (79.4% female) and about 70% of patients were classified as having moderate or severe pain. Depressive symptoms were found in 52% of patients and were far more common among patients with higher pain levels. Analgesic treatment ranged from 45.8% in patients with no/mild pain to 82.0% in those reporting severe pain. Non-opioid analgesics increased from 44.6% to 76.4% and opioid use from 6.0% to 32.6%, respectively. In patients reporting moderate or severe pain, depressive symptoms substantially increased opioid use. Depending on depressive state, AD use ranged from 7.2% to 36.8%. The AD drug classes used differed substantially with respect to pain intensity. Use of anticonvulsants was low.

Conclusion: Pain and depressive symptoms are highly prevalent in German RA patients, both conditions often present together and influence each other’s treatment.