Insights into Arthritis and Depression

Arthritis patients experience depression much more often than the general population, according to Patricia Katz, PhD. During her 15 years on the faculty of the UCSF Division of Rheumatology, she has significantly advanced understanding of the links among arthritis, loss of function and the onset of depression. One of her major contributions has been to redefine disability to include a broader range of life activities than had been traditionally considered. She is the author or co-author of nearly 150 publications and her work has been honored by both the Arthritis Foundation and the Association of Rheumatology Health Professionals.

Q. How serious a problem is depression among arthritis patients?
Katz: "The proportion of people with rheumatoid arthritis who are depressed is at least twice that of the general population, where about 5 – 7 percent of people experience depression. Some studies show numbers that are much bigger. There is some evidence to suggest that it's more common in people with osteoarthritis, but there's not so much work done there. In lupus, it's particularly high: Depending on the study, anywhere from 15 to 70 percent of lupus patients are depressed."

Q: From your work, do you have a sense of what causes the depression?
Katz: "Pain is one thing that is fairly well established. What I've been looking at primarily is the loss of function, and that also seems to be really important. When people lose the ability to do things that are important to them, it's a strong predictor of the onset of depression.
One specific kind of activity that we found important was the loss of social activities. If you can't go out and go see your friends for lunch that has a huge impact on your psychological well-being."

Q. What have you learned about how people can keep doing the kinds of activities they want to do?
Katz: "We've learned that people can be pretty creative in maintaining activities. Sometimes it means lowering the bar, so your standards change a little bit about what you expect from yourself. Maybe you used to go for an hour walk with your friend, and so maybe you do that hour walk, but you do it more slowly, or maybe you don't go as far, or maybe you don't go as often. It's a balancing act. It's about adaptation."

Q: What should people with arthritis be on the lookout for in terms of depression, and what should they do about it?
Katz: "There are diagnostic criteria for depression, and they're pretty simple. You can have a loss of interest or pleasure in activities. You can have changes in your appetite. You can have sadness or a depressed mood. Sleep disturbances. You can have changes in your behavior, where you're either agitated or you really slow down. You can have low energy. Feelings of worthlessness or feeling guilty about things. Problems with concentration or thinking. And then suicidal thoughts, thoughts of death. And these aren't just things that happen for a little while. This has to be for at least two weeks for more than one of these.
"The problem is that some of these things are confounded with aspects of rheumatoid arthritis. People with RA often have a lot of fatigue. And they can have sleep disturbance because of pain or because of some of medication. These things can also change your appetite. So it can be difficult sometimes to tease out whether it's depression or whether it's the RA. And that's why it's important that people take the first step, which is to talk to their rheumatologist or their primary care physician about it."

"The proportion of people with rheumatoid arthritis who are depressed is at least twice that of the general population."
--- Dr. Patricia Katz

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