Is alexithymia associated with high disease activity in rheumatoid arthritis?

Abstract

AimTo investigate the association between alexithymia and disease activ-ity in patients with rheumatoid arthritis.MethodA total of 97 female patients diagnosed with RA were enrolled in the study. First, the pa-tients were classified into two groups as alexithymics and non-alexithymics according to the Toronto Alexithymia Scale-20 (TAS-20) threshold score of 61. Subsequently, non-alexithymic patients were divided into three groups according to tertile values as high-normal, middle-normal, and low-normal. Disease activity was determined by the Disease Activity Index with 28 joints using erythrocyte sedimentation rate (DAS28-ESR). To understand the con-tribution of patient-reported components to DAS28-ESR, a DAS28-ESR-de-rived index called DAS28-P [Disease Activity Score in 28 joints attributable to Patient-reported Components (tender joint count and patient global as-sessment of disease activity)] was used. The DAS28-P index was calculated as the ratio of the fraction of the total DAS28-ESR score contributed by the tender joint count and patient global assessment of disease activity score to total the DAS28-ESR score. Differences across TAS-20 score groups for DAS28-ESR and for DAS28-P were studied.ResultsTwenty-eight of 97 pa-tients (28.8%) were classified as alexithymic. The mean DAS28-ESR score was significantly higher in the alexithymic group than in the low-normal TAS-20 score group (p=0.004). The median DAS28-P score was significantly higher in the alexithymic group than in the low-normal and middle-normal TAS-20 score groups (p=0.001, p=0.015, respectively). The median DAS28-P score was also significantly higher in the high-normal TAS-20 score group than in the low-normal TAS-20 score group (p=0.047).ConclusionIn patients with high disease activity, the presence of alexithymia may be a confound-ing factor.

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