POS1433 IMPACT OF RHEUMATOID ARTHRITIS ON STRESS: A SYSTEMATIC SCOPING REVIEW
Authors: C. Vervloesem, D. De Cock, A. Van Breda, D. Bertrand, M. Doumen, S. Pazmino, R. Westhovens, P. Verschueren
Journal: Annals of the Rheumatic Diseases (2021)

Background: The literature about the impact of Rheumatoid Arthritis (RA) on mental health is mostly focused on depression and anxiety. Yet, patients can experience stress without depressed mood or anxiety. Objectives: To examine the impact of RA on psychological stress excluding depression and anxiety focusing on 3 questions: 1) What is the stress level of RA patients compared to a control group? 2) Which types of stress do RA patients experience? 3) Which are risk factors to develop stress as an RA patient? Methods: Four scientific databases, EMBASE, PubMed (including MEDLINE), Web of Science Core Collection and Cochrane Library, were systematically searched from inception until 19/04/2020. Eligible studies included psychological stress in RA patients as outcome. Two reviewers (CV&amp;AVB) independently screened titles and abstracts, and later full texts for eligibility. Full-text screening excluded studies without a separate RA population, with a focus on only anxiety and/or depression or not answering at least 1/3 research questions. Quality was appraised by MINORS/AXIS tools. Results: From 11 115 potentially relevant studies, 16 studies met the inclusion criteria (Table 1). Remarkably, 13 different stress measurement instruments were picked-up in this review. Work stress and interpersonal stress seem more prevalent in RA patients compared to healthy controls. Stress at disease onset was more prevalent in RA compared to osteoarthritis. Psychological stress was higher in patients with chronic pain compared to RA. Role stress, social stress and work stress were induced by RA. More disability, more pain, less social support, lower income, younger age and personality factors like excessive worrying, pessimism, and sensitivity to anxiety, seem to increase the risk for increased stress levels. Table 1. Included Studies First Author Year Country Population Age Mean ±SD Stress Instrument Quality Assessment Bugajska 2010 Poland N=437 Polish N=137 German &gt;50y (71%) &gt;50y (38%) SF36v2 AXIS: 16/20 Coty 2017 USA N=80 54y ±12y RCQW AXIS: 17/20 Cunha 2016 Portugal N=80 58y DASS-21 AXIS: 10/20 Goulia 2015 Greece N=168 55y ±13y SCL-90R MINORS: 11/16 Latman 1996 USA RA, N=128 OA, N=79 56y 63y SRRS AXIS: 20/20 Mancuso 2006 USA RA, N=122 HC, N=122 49y ±12y 49y ±12y DUSOCS MINORS: 20/24 Nyklicek 2015 The Netherlands N=201 57y ±12y PSS MINORS: 13/16 Persson 2005 Sweden N=158 52y SCL-90R MINORS: 12/16 Rahim 2018 Malaysia N=189 52y ±11y DASS-21 AXIS: 17/20 Rice 2017 Canada RA, N=226 CP, N=229 58y ±15y 45y ±12y DASS-21 AXIS: 17/20 Rice 2016 Canada RA, N=163 CP, N=167 56y ±13y 45y ±11y DASS-21 AXIS: 18/20 Richter 2018 Germany RA, N=163 HC, N=167 48y ±10y 43y ±10y ERI AXIS: 17/20 Smith 2002 USA RA, N=93 OA, N=82 HC, N=80 RA, 62y OA, 65y HC, 62y 1 question probing stress MINORS: 17/24 Treharne 2007 UK N=134 55y PSS MINORS: 11/16 Turner-Cobb 1998 UK RA, N=13 CP, N=24 42y ±8y 39y ±4y LEI/HUS MINORS: 17/24 Zautra 1997 USA N=41 55y ±10y ISLE MINORS: 12/16 Conclusion: This scoping review is to our knowledge the first to address the heterogeneity of measurement tools and definitions of stress in RA research. It provides the basis for further research, which is needed to predict different stress trajectories and respond to these with patient-centered interventions. Disclosure of Interests: None declared