Vol. 11, No 1, 2004 pp. 20 - 25
UC 616.72-002.77+616.895.4]:612.751
THE VALUES OF BONE MINERAL DENSITY IN
PATIENTS WITH RHEUMATOID ARTHRITIS AND DEPRESSION SYNDROME
Branislava Lazarević-Jovanović1,
Milena Dimić2, Aleksandar Dimić3,
Zorica Marković3, Dušica Pavlović4,
Snežana Cekić5
1Psychiatric Clinic, Clinical Center,
Niš, 2Institute for Mental Health, Clinical
Center, Niš
3Institute for Prevention, Treatment
and Rehabilitation of Cardiovascular and Rheumatic Diseases, Niška Banja
4Institute of Biochemistry, Faculty
of Medicine, Niš, 5Institute of Physiology,
Faculty of Medicine, Niš, Serbia
Summary. Aim of the study was to evaluate the occurrence of depression
syndrome (DS) and osteopenia in patients suffering from rheumatoid arthritis
(RA) with respect to the physical, mental and iatrogenic factors. The impact
of duration, severity and type of treatment of RA on these conditions were
also examined.
Methods: A total of 40 RA adult female patients were studied using
ARA criteria. For the estimation of depression, psychiatric interviews,
psycho-tests, and rating on depression scale (Hamilton) were used. A specific
attention was paid to the pre-morbid profile of the patients as related
to previous emotional conflicts, and distressing life events. Bone mineral
density (BMD) of the lumbar vertebras (L2-L4) was measured using Lunar
DEXA densitometer.
Results: Twenty eight patients were found to have some degree of DS.
The occurrence and intensity of DS were positively correlated with duration,
and severity of RA, and negatively correlated with patients' occupational
activities. DS was more frequent in patients treated with disease modifying
drugs (DMD) and glucocorticosteroids (GCS). The mean values for BMD were
somewhat lower in patients in whom DS was present, but the difference was
not statistically significant. The values were also lower in patients who
have been treated with DMD and GCS.
Conclusion: DS was more frequent in patients suffering from severe
RA and was positively correlated with the duration of the disease and treatment
with DMD and GCS. Osteopenia seems to be more pronounced in patients with
DS and in those treated with DMD and GCS. Decreased life dynamism and reduced
dietary intake of calcium, exercise and exposure to sunlight, all associated
with DS could be, at least partially, responsible for the development of
osteopenia. These results indicate to the necessity of careful psychiatric
evaluation of RA patients in order to adapt anti-rheumatic therapy by decreasing
DMD and GCS and eventually using antidepressants.
Key words: Rheumatoid arthritis, depression syndrome, bone mineral
density, osteopenia, antidepressants
VREDNOSTI MINERALNE GUSTINE KOSTI KOD
PACIJENATA SA REUMATOIDNIM ARTRITISON I DEPERESIVNIM SINDROMOM
Kratak sadržaj: Predmet našeg rada je bila uzajamna povezanost reumatoidnog
artritisa (RA) i depresivnog sindroma (DS) kod naših bolesnica, što je
još jedan dokaz o neraskidivoj povezanosti some i psihe i bavljenje uticajem
telesnih, psihičkih i medikamentnih faktora u lečenju RA u nastanku DS
i osteopenije. Cilj rada je bio da ukažemo na korelaciju DS i osteopenije
sa RA u zavisnosti od trajanja, stadijuma i aktivnosti bolesti, funkcionalnog
stanja, kao i terapije RA. Metod rada. Ispitali smo 40 odraslih bolesnica
sa RA (ARA kriterijumi). Za procenu depresivnosti koristili smo psihijatrijski
intervju, psihotest i Rating scale za depresiju po Hamiltonu. Obratili
smo posebnu pažnju na procenu premorbidne ličnosti pacijenta, postojanje
ranog emocionalnog konflikta i uticaj životnih dogadjaja. BMD (Bone mineral
density) – mineralna gustina kosti je merena na lumbalnoj kičmi (L2-L4)
na DEXA denzitometru marke Lunar. Rezultati rada. Od ukupnog broja bolesnica
(40), kod 28 je dokazano prisustvo DS. Pojava DS korelira sa dužinom trajanja
RA, stadijumima RA, aktivnošću RA i funkcionalnim klasama. Depresivni sindrom
se najčešće javljao u grupi bolesnica gde su u lečenju RA bili zastupljeni
i kortikosteroidi. Vrednosti BMD su bile niže u grupi bolesnica gde je
RA bio udružen sa DS, ali ova razlika nije bila statistički signifikantna.
Zaključak. Za nastanak osteopenije odgovorni su glikokortikoidi u terapiji
RA, kao i sniženje dijatelnog unosa kalcijuma, obima fizičke aktivnosti
i umanjenje solarne ekspozicije, što je posledica DS i posledičnog pada
životnih dinamizama. U terapiji RA neophodan je timski rad reumatologa
i psihijatra. Pored antireumatske terapije, značajno mesto bi trebalo dati
i antidepresivnim lekovima, pritom vodeći računa o terapiji osteopenije.
Ključne reči: Reumatski artritis, depresivni sindrom, mineralna
gustina kosti, osteopenija, antidepresivi
