The Study On The Correlation Among The Disease Activity,the Mental State And The Quality Of Life In Patients With Rheumatoid Arthritis Based On Smart System Of Disease Management(SSDM)

ObjectiveTo observe the relationship among real disease activity,depression,anxiety and quality of life(QOL)in patients with rheumatoid arthritis(RA)by assessment scales on Smart System of Disease Management(SSDM).MethodsPatients meeting the criteria for RA were recruited from outpatient department in Jiangsu Subei People'Hospital and was assessed with Twenty-eight-joint Disease Activity Score(DAS28),Health Assessment Questionnaire(HAQ),Hospital Anxiety and Depression Scale(HADS)and the Short Form(36)Health Survey(SF-36)through the Smart System Of Disease Management(SSDM).All data are analysed by SPSS 23.ResultsFirstly,Patient's assessment of global disease activity(PtGA)less than 60(OR=2.454,95%Cl:1.32-4.56,p=0.004)and positive joint tenderness(OR=3.096,95%CI:1.71-5.62,p<0.001)were major risk factors for patients with RA and depression.Positive erythrocyte sedimentation rate(ESR)(OR=1.968,95%CI:1.09-3.56,p=0.025),positive joint tenderness(OR=2.672,95%CI:1.17-6.12,p=0.02),and somatic dysfunction(OR=2.313,95%Cl:1.24-4.33,p=0.009)were major risk factors for patients with RA and anxiety.The multible linear regression shows that anxiety,depression,high disease activity and physical dysfunction lead to poor quality of life(P=<0.001).Secondly,after a six-month treatment of conventional disease modifying anti-rheumatic drugs(cDMARD),the Stanford health assessment questionnaire(Z=-6.825,P<0.001),time of morning stiffness(Z=-3.811,P<0.001),DAS28(Z=-2.857,P<0.001),depression(Z=-7.749,P<0.001),anxiety(Z==-7.097,P<0.001),quality of life(Z=-8.988,P<0.001),physical health(Z=-8.391,P<0.001)and mental health(Z=-7.240,P<0.001)improved significantly.Baseline depression in patients with RA had no effect on the remission of disease activity.The disease activity of patients with baseline anxiety was still significantly higher than that of patients without baseline anxiety at six months.The quality of life of patients with RA and baseline depression was still significantly worse than that of patients without baseline depression at six months.The quality of life of patients with RA and baseline anxiety at 6 months was still significantly worse than that of patients without baseline anxietyThirdly,after the 12-month treatment with cDMARDS,number of joint tenderness,ESR,C-reactive protein,other disease activity indicators,depression,anxiety and quality of life improved.There was no significant difference in the decrease of disease activity between the group with baseline depression and the group without baseline depression at 12 months(p?0.574).There was also no significant difference in the decrease of disease activity between the group with baseline anxiety and the group without baseline anxiety at 12 months(p?0.117).The quality of life of patients with baseline depression and those without baseline depression improved significantly at 12 months,but the quality of life of patients with baseline depression at 12 months was still significantly worse than that of patients without baseline depression.The quality of life of patients with baseline anxiety and those without anxiety improved significantly at 12 months,but the quality of life of patients with baseline anxiety at 12 months was still significantly worse than that of patients without baseline anxiety.ConclusionThe incidence of depression and anxiety in RA patients was significantly higher than that in the general population.Depression and anxiety was related to the disease activities of patients with RA.Joint tenderness is the main factor associated with psychological symptoms in patients with RA.The quality of life of patients with RA is lower than that of the general population,which is not only related to RA disease activity and physical function,but also affected by depression and anxiety.Baseline depression did not affect the improvement of disease activity in patients with RA at 6 months,but baseline anxiety affected the improvement of disease activity at 6 months.Neither depression nor anxiety affect the improvement of disease activity at 12 months.Both anxiety and depression affects the improvement of quality of life in patients with RA.Intervention should be given to improve the quality of life of patients with RA and psychiatric symptoms.After 12 months of reasonable anti-rheumatism treatment and regular follow-up,the disease activity,physical function,psychological symptoms and quality of life of the patients with RA improved.It can be seen that reasonable use of SSDM can facilitate patients to understand the condition,take medicine regularly,improve compliance,better alleviate the disease and improve the quality of life.