Stressors and depressive disorders in rheumatic diseases

The paper discusses the common comorbidity of immune inflammatory rheumatic diseases (RD) and depression. It considers the causes and mechanisms, which are common to these diseases, namely, the provocative role of chronic psychosocial stress; neuroendocrine dysregulations of an immune response, which give rise to the hyperproduction of the proinflammatory cytokines determining the magnitude of the major clinical syndromes of RD and depression — chronic pain, fatigue, sleep disorders, functional insufficiency. The impact of depression on patient treatment adherence and efficiency and the course and outcome of RD is discussed. Particular attention is given to the timely therapy of depression in RD, to the effect of genetically engineered biological agents on depressive symptomatology, to the need for a personified approach to prescribing antidepressants. By taking into account the importance of detection and treatment of depressive disorders in rheumatologic practice from the clinical standpoint and in terms of medical, social, and economic consequences, the author propose an interdisciplinary approach to managing the patients with RD with the participation of rheumatologists, psychiatrists, neurologists, and medical psychologists

ANTIMALARIAL DRUGS IN THERAPY OF SYSTEMIC LUPUS ERYTHEMATOSUS: PAST, PRESENT, FUTURE

The data available in the literature on experience in using antimalarial drugs in the treatment of systemic lupus erythematosus are summarized. A major emphasis is placed on therapy with hydroxychlorochine (plaquenil) versus chlorine. Possible mechanisms of action of the drug and its effect on the course of the disease itself and concomitant abnormalities are described. Data on the toxicity of the drug and its safe use in pregnancy and lactation are also discusse

Proinflammatory cytokines and depression in rheumatoid arthritis

Objective: to specify the association between the levels of proinflammatory cytokines, such as tumor necrosis factor-а (TNF-а), interleukin-1 β (IL-1 β), and IL-6, and the presence and degree of depression and anxiety spectrum disorders (ADSDs) in patients with rheumatoid arthritis (RA). Subjects and methods. The investigation included 45 patients with a valid RA diagnosis. Their mean age was 45.5+3.09 years; the mean disease duration was 155.0+26.5 months. The authors determined RA activity with the DAS28 index; fatigue degree with the Fatigue Severity Scale (FSS), and pain magnitude with the Brief Pain Inventory (BPI). Mental disorders were diagnosed by a psychiatrist in accordance with the ICD-10 and DSM-IV, by applying a number of psychiatric and psychological scales and tests. The concentration of proinflammatory cytokines was measured using the xMAP (27-plex) technology on a BioPlex-200 analyzer (Bio-Rad, USA). Results. There were mental ADSDs in 82.2% of the patients and moderate cognitive impairments (CI) in 67.7%. 80% of the examinees reported clinical fatigue; 64.5% experienced severe and moderate pain. The levels of TNF-а and IL-1ß were slightly higher in patients with ADSDs and CI than in those without these disorders. The concentration of IL-6 was highest in the presence of anxiety disorders. However, these differences were statistically insignificant. The level of TNF-а was somewhat higher in patients with clinical fatigue and significantly higher in those who experienced intense pain. That of IL-1ß was significantly higher in patients with severe and moderate pain than in those with mild pain (p < 0.05). Conclusion. ADSDs and CI in patients with RA are associated with the elevated levels of proinflammatory cytokines (TNF-а, IL-1ß, and IL-6), which confirms the implication of chronic inflammation in the pathogenesis of these conditions in RA. High TNF-а and IL-1ß levels are typical of RA patients with clinical fatigue and marked pain