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Rheumatic Disease Disfigurement Linked to Depression

(PSYCHIATRIC TIMES) - SYDNEY, Australia, March 12 -- Unhappiness with the appearance of swollen and twisted joints in the hands and feet of rheumatoid arthritis patients can predict depression, researchers here said.

The same holds true for the skin rashes and lesions characteristic of systemic lupus erythematosus, said Louise Sharpe, M.D., of the University of Sydney here.

Nearly one-third of RA patients reported concerns about their physical appearance, as did more than half of those with SLE, Dr. Sharpe and colleagues reported in the March 15 issue of Arthritis & Rheumatism.

Concern about physical appearance was a significant predictor of depression in both patient groups, the researchers found. Patients should be routinely screened for such concern and receive psychological treatment for it, they added.

"Although RA and SLE are associated with perceptible changes in physical appearance, body image concerns have received little empirical investigation," the researchers said.

The study included 53 patients with recent-onset RA, 44 with chronic RA, and 60 with SLE. Patients underwent psychological assessments as well as clinical exams and health assessments to identify the extent of any disability.

In the recent RA group, 34% reported being unhappy with their physical appearance, compared with 30% of the chronic RA group and 53% of the SLE group. "This finding suggests that appearance concerns are frequently associated with rheumatic diseases," the researchers said.

"However, the fact that a similar proportion of patients with recent-onset RA and chronic RA reported concerns regarding their physical appearance implies that objective disfigurement is not the sole cause," they added. "Participants in the recently diagnosed group were still in the early stages of disease and had few, if any, objectively observable disfigurements."

In the combined RA group (recent and chronic), dissatisfaction with physical appearance was an independent and significant predictor of depression (P=0.006), accounting for about 6% of the variance in depression, the study found.

But the extent of disability was an even stronger predictor of depression in this group (P=0.001), accounting for 24% of the variance in depression.

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