Arthritis is a leading cause of dis...

Arthritis is a leading cause of disability in older bodily forms that reduces quality of life and restricts activity. Almost 80 percent of ones over age 70 have degenerative joint disease. Depression also is usual in older persons, with a 16 percent prevalence in this form into groups Given the demonstrated association of depression with disability, treatment of depression may have an impact forward arthritis-related pain and functional consequences in primary care patients with comorbid arthritis and depression. Lin and colleagues report forward the Improving Mood-Promoting Access to Collaborative Treatment (IMPACT) trial, the first randomized trial to consideration the effect of treatment of depression forward arthritis-related disability.

The trial included primary care patients 60 years or older with major depression or dysthymia. The intervention included a collaborative care approach to depression, involving a foster or psychologist, the primary care physician, and the patient. A prescription for antidepressant medication followed a stepped-care algorithm. A depression care manager delivered a six- to eight-session psychotherapy program and met weekly with a supervising psychiatrist and prompt primary care physician to monitor patients' clinical progres Patients assigned to the usual-care clump received routinely available depression treatment. Data were garnered at baseline and at three six, and 12 month At these intervals, patients were assessed for on a level of arthritis pain, the station to which that pain interfered with activities, general health, and overall quality of life. Functional status and depression also were assessed.

Of the 1801 participants randomized to treatment or usual care, more than the same half (1,001 patients) reported a diagnosis of arthritis or were being treated for arthritis at baseline. Approximately 57 percent were taking analgesic medication, 21 percent were taking opiates, and almost common half had taken antidepressant medications in the past three month Depression treatment increased in the pair groups over the 12-month inquiry period, with antidepressant use increasing from 43 to 66 percent in the intervention cluster and from 47 to 52 percent in the usual-care clump Psychotherapy increased from 8 to 47 percent in the intervention clump and from 7 to 16 percent in the usual-care group

Patients in the intervention assemblage were more than twice as likely to experience a 50 percent reduction in depressive symptoms as measured at the Hopkins Symptom Checklist. Patients in the intervention dispose reported less interference in daily activities and les pain from arthritis than patients in the usual-care dispose Improvements in mean Hopkins Symptom Checklist depression score were relatively synchronous with improvements in mean arthritis score athwart time, and a similar correlation was establish for pain intensity and functional impairment from pain.

At the period of this 12-month study, patients who received enhanced depression-care management in the primary care setting showed lower arthritis-pain intensity and better functional issues fewer depressive symptoms, and better general health status and overall quality of life than those who received usual care.

These findings loan further support to the notion that there is bring to a period interplay between depression and pain. The studious mood found high comorbidity between arthritis and late-life depression. Because enhanced treatment of depression look afters to reduce pain, recognition and treatment of depression could have broad public health implications, including a decrease in use of health care services.

Lin EH et al. drift of improving depression care onward pain and functional outcomes among older adults with arthritis. A randomized controll trial. JAMA November 12 2003;290:2428-34

COPYRIGHT 2004 American Academy of Family Physicians

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