Possible rheumatoid arthritis subtypes in terms of rheumatoid factor, depression, diagnostic delay and emotional expression: an exploratory case-control study

Tillmann, T., Krishnadas, R. , Cavanagh, J. and Petrides, K.V. (2013) Possible rheumatoid arthritis subtypes in terms of rheumatoid factor, depression, diagnostic delay and emotional expression: an exploratory case-control study. Arthritis Research and Therapy, 15(2), R45. (doi: 10.1186/ar4204)

Abstract

<p>Introduction: Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis has been implicated in the pathology of Rheumatoid Arthritis (RA), particularly as vulnerable personality types are exposed to chronic stress. Emotions are powerful modulators of stress responses. However, little is known about whether patients with RA process emotions differently to matched controls. In this study we: 1) assessed whether the trait emotional intelligence (trait EI) scores of patients with RA differ from healthy controls at the facet level; 2) explored any subgroups in RA, in terms of trait EI and common risk factors.</p> <p>Methods: 637 patients with RA were compared to 496 controls on the trait EI Questionnaire (TEIQue). RA subgroups were explored in terms of trait EI, rheumatoid factor status (RF+/-), depression, and time from onset of symptoms until diagnosis (diagnostic delay).</p> <p>Results: 1) RA group rated themselves lower on Adaptability, Stress-management, Emotion management, Self-esteem, Sociability, Assertiveness, Impulsiveness, and Well-being, and higher on Empathy and Relationships than healthy controls. 2) The RF- subtype reported more time with depression (25.2 vs. 11.3 months), a longer diagnostic delay (3.0 vs. 1.7 years), and greater emotional expression (5.15 vs. 4.72), than the RF+ subtype. These differences were significant at the p<0.05 level, but not following strict Bonferroni corrections and should therefore be treated as indicative only. RF- patients with a longer diagnostic delay reported depression lasting three times longer (42.7 months), when compared to three other subtypes (11.0-12.7 months).</p> <p>Conclusions: 1) RA patients and controls differ in their emotion-related personality traits, as operationalized by trait EI. These differences may make people with RA more susceptible to chronic stress and HPA-axis dysregulation. 2) RA may be a highly heterogeneous illness where at least two subtypes may be characterized by personality, psychiatric and immunological differences. RF- status, as well as diagnostic delay, and emotional expression, may predict future risk of depression. Research on the causes of RA could benefit from a systems science approach.</p>

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Krishnadas, Dr Rajeev and Cavanagh, Professor Jonathan
• Authors: Tillmann, T., Krishnadas, R., Cavanagh, J., and Petrides, K.V.
• Subjects: R Medicine > R Medicine (General)
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Mental Health and Wellbeing
• Journal Name: Arthritis Research and Therapy
• Publisher: BioMed Central
• ISSN: 1478-6354
• ISSN (Online): 1478-6362
• Published Online: 21 March 2013
• Copyright Holders: Copyright © 2013 The Authors
• First Published: First published in Arthritis Research and Therapy 15(2):R45
• Publisher Policy: Reproduced under a Creative Commons License