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142 Grondin et al. | Journal of Clinical and Translational Research 2024; 10(2): 141-150
with better precision [5]. Likewise, psychological support is 2.2. Psychological assessment tools
increasingly integrated into the management of patients with CIR
as they are more prone to mental and overall health disorders. An experienced psychiatrist collected information during a
Emotional repression refers to the tendency to inhibit the semi-structured, semi-directed interview lasting 1.5 – 2 h. The
expression of negative feelings and/or unpleasant thoughts and is psychological parameters assessed were (i) depressive symptoms
a common manifestation in CIR patients. Hence, an assessment and their severity (based on the Montgomery-Asberg Depression
of the patients’ emotional profile could provide a more relevant Rating Scale) [6]; (ii) history of major depression episodes;
and effective approach to managing emotional repression and (iii) anxiety symptoms using a 21-question multiple-choice
treating CIR. In this regard, we hypothesized that a particular self-report inventory (i.e., the Beck Anxiety Inventory) [7];
psychological profile, namely, emotional repression, could be (iv) alexithymia, a behavioral trait of individuals who are unable
associated with autoimmune deregulation. to identify and describe their interior feelings, have limited
Herein, this preliminary and exploratory study primarily imaginative capacity, and tend to focus their thoughts externally
investigated the emotional function of CIR patients by assessing rather than resorting to introspection [8,9], and its severity using
their psychological profiles to explore a possible association the 20-item Toronto Alexithymia Scale [10]; (v) social desirability
between autoimmunity and emotional regulation. In addition, intensity, that is, the tendency to seek approval of others and preserve
we further evaluated the emotional profiles for potential one’s self-image, using the Marlowe-Crowne Social Desirability
associations with other conditions (i.e., rheumatoid arthritis scale (MCSD), a 33-item self-report questionnaire [11]; (vi) the
[RA] and spondyloarthritis [SpA]) and different rheumatological severity of emotional repression, that is, the tendency to inhibit
characteristics (i.e., biological inflammatory syndrome, sacroiliitis, the expression of negative feelings or disagreeable thoughts,
structural involvement (i.e., osteoarticular destruction of the joint in accordance with the Weinberger classification; and (vii) the
due to the inflammatory activity of rheumatism), and positive combination of State-Trait Anxiety Inventory (STAI) [12] and
rheumatoid factor [RF], anti-citrullinated peptide antibody MCSD as emotionally repressed individuals typically have a low
[ACPA], and human leukocyte antigen [HLA]-B27 allele). STAI score and high MCSD.
The psychiatrist used a Likert-type scale to assess the severity
2. Methods of the psychological parameters in a specific questionnaire, which
assessed (i) the severity of somatic and psychological complaints
2.1. Population and study design (i.e., severe complaints referred to personalized responses to most
This monocentric cross-sectional observational pilot study of the questions); (ii) emotional-expressivity intensity (i.e., graded
was conducted in the rheumatology department of a university as “mild” when the patient had several emotional moments
hospital. During a routine follow-up, the CIR patients were offered without excessive reactions, “moderate” when the patient’s facial
an evaluation based on the global CIR management framework, expressions were accompanied by fluctuating emotions as the
which included dermatological, dental, and gynecological discussion progressed, or “severe” when the patient had a tendency
consultations, as well as rheumatologist-requested psychiatric for hyper-expressivity throughout the interview); (iii) life events
assessments (anxiety disorders, depressive disorders, sleep (i.e., type 1 for events occurring before 15 years old and type 2
disorders, conjugal violence, and childhood traumas). None of for events occurring within 3 years preceding the rheumatological
the recruited 59 patients refused to participate in the evaluation. disease onset) and their intensities (i.e., classified as “mild” when
The exclusion criteria were: age <18 or >65 years old, cognitive stressful events were non-existent or mild, “moderate” when
disorders, substance dependence, or acute somatic or any stressful events did not incur traumatic stress [e.g., emotional
psychiatric disorders requiring emergency hospitalization. deprivation concerning socio-economic difficulties, severe or
The participating patients were accompanied to the disabling diseases of close friends/relatives], or “severe” for a
rheumatology department by seven different rheumatologists. traumatic event [e.g., sudden death of a person caring for a child,
CIR patients were classified as having RA (based on the 2010 physical or sexual assault, patient witnessed a death, or thought
classification by the American College of Rheumatology/European he/she would die]); (iv) somatic escalation (i.e., the occurrence of
League Against Rheumatism) SpA (based on the 2009 criteria a series of several somatic disorders or another chronic pathology
by the Assessment of SpA International Society), or psoriatic before disease onset); (v) actual stress level; (vi) impact of the
arthritis (based on the ClASsification criteria for Psoriatic rheumatological disease on the patient’s professional activities,
ARthritis [CASPAR]). We identified 12 patients with ankylosing corresponding to the occupational repercussions experienced
SpA and eight with psoriatic arthritis, and these patients were (i.e., classified as “mild” for minor impact, “moderate” for
categorized under SpA to facilitate statistical analyses. Although notable impact, or “severe” for a painful experience [e.g., loss
their clinical characteristics might differ slightly, their pathologies of professional environment and activity, feeling of injustice,
share common pathophysiological mechanisms and genetic or elevated fear of losing one’s job]); (vii) manual labor; and
backgrounds, such as the presence of HLA-B27. (viii) physical activity enjoyment before and after disease onset.
Non-CIR patients constituted the control group, and these For the different psychological parameters, we combined the
patients were in the rheumatology department for other “mild” and “moderate” intensities for comparison against the
rheumatological diseases. “severe” intensity. The mild-to-moderate psychological disorders
DOI: https://doi.org/10.36922/jctr.23.00099