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Grondin et al. | Journal of Clinical and Translational Research 2024; 10(2): 141-150 143
were easily identified in patients exhibiting severe anxiety or Among the 47 CIR patients (72.3% women and 27.7%
depressive comorbidities and emotional experiences (often men; median age 55.0 years [39.0 – 60.0]), 27 (57.4%) had RA
affected by chronic pain), but retaining the “severe” intensity and 20 (42.6%) had SpA. Among the 27 RA patients (81.5%
enabled a more significant difference. In addition, this approach women median age 57 years [52 – 63]), most were RF-positive,
accounted for the population recruitment bias. ACPA-positive, and had structural involvement. In addition, 10 of
During the same hospitalization, various patient characteristics, the RA patients had biological inflammatory syndrome. Among
mostly rheumatological, were collected from the electronic medical the 20 SpA patients (60.0% women; median age 41.5 years
files using the DxCare (medical information and prescription [34.5 – 53.0]), six of them had a biological inflammatory
software) program. The collected data included: (i) Biological syndrome, nine of them were HLA-B27-positive, and 11 of them
inflammatory syndrome, defined as an erythrocyte sedimentation had MRI-detected sacroiliitis.
rate ≥30 mm/1 h and/or C-reactive protein ≥5 mg/L; (ii) positive
st
ACPA, defined as 7 U/mL by enzyme-linked immunosorbent assay 3.2. Psychological assessments
(ELISA); (iii) RF >15 IU/mL by ELISA; (iv) magnetic resonance A comparison between the CIR and control groups displayed
imaging (MRI) detection of grade-2 bilateral or grade-3 unilateral significant differences in emotional repression, somatic complaints,
sacroiliitis, with active inflammatory (edema) or chronic (erosion, psychological complaints, type-1 life-event severity, manual labor,
bone condensation, bone bridges, and fat conversion) lesions. or physical activity enjoyment before disease diagnosis (Table 2).
2.3. Statistical analysis A comparison of the RA and SpA groups revealed significant
differences in prior depressive episodes, professional impact, and
Continuous variables were expressed as median (first quartile manual labor (Table 3).
[Q1] – third quartile [Q3]). Categorical variables were expressed A comparison between patients with and without biological
as number (percentages), where the percentages were calculated inflammatory syndromes revealed significant differences in
after excluding missing data, and were compared by Chi-squared emotional repression (Table 4).
test or Fisher’s exact test accordingly. Missing data were not A comparison between patients with and without structural
replaced. For all analyses, P < 0.05 was considered statistically involvement revealed significant differences in somatic complaints,
significant. Type I error was not adjusted for multiplicity because emotional expressivity, professional impact, and physical activity
of the exploratory character of the comparisons. All statistical enjoyment before disease onset (Table 5).
analyses were performed with SAS release 9.4 (SAS Institute Inc, In addition, none of the psychological parameters were
USA). significantly associated with ACPA. Likewise, the number of

3. Results patients who were HLA-B27-positive or had sacroiliitis was too
low for analysis. Hence, their significance and association could
3.1. Patient characteristics not be established.
The study population comprised 59 patients: 47 (79.7 %) 4. Discussion
CIR patients and 12 (20.3%) non-CIR patients. The patients’
characteristics according to their disease are summarized in The objective of this study was to assess the relevance of
Table 1. psychological support for patients with CIR. CIR patients,
The control group consisted of 12 women with a median age compared to those with other rheumatological pathologies,
of 65.0 years [55.0 – 72.0] (nine with osteoarthritis, one with presented significantly more frequent severe emotional repression,
viral disease, one with osteoporosis, and one with osteomalacia). whereas those with other pathologies had significantly more
In addition, the nine women with osteoarthritis had structural frequent severe psychological and somatic complaints, potentially
involvement. attesting to their strong emotional repression.

Table 1. Patients’ characteristics according to their disease (n=59)
Characteristics RA (n=27) SpA (n=20) CIR (n=47) Other diseases (n=12)
Median age [Q1 – Q3] (yr) 57.0 [52.0 – 63.0] 41.5 [34.5 – 53.0] 55.0 [39.0 – 60.0] 65.0 [55.0 – 72.0]
F/M sex ratio 22/5 12/8 34/13 12/0
Rheumatoid factor+, n (%) 18 (66.7) 1 (12.5) 19 (54.3) 0 (0)
ACPA+, n (%) 17 (63) 1 (12.5) 18 (51.4) 0 (0)
Elevated ESR and/or CRP, n (%) 10 (37.0) 6 (30) 16 (34.0) 0 (0)
HLA-B27+, n (%) 0 (0) 9 (47.4) 9 (42.9) 0 (0)
Sacroiliitis, n (%) 0 (0) 10 (55.6) 10 (50) 0 (0%)
Structural involvement, n (%) 14 (51.9) 0 (0) 14 (35) 9 (81.8)
Note: CIR refers to the combination of RA and SpA.
Abbreviation: +: Positive; ACPA: Anti-citrullinated peptide antibody; CIR: Chronic inflammatory rheumatism; CRP: C-reactive protein; ESR: Erythrocyte sedimentation rate; F/M: Female-to-male;
HLA-B27: Human leukocyte antigen B27; Q1: First quartile; Q3: Third quartile; RA: Rheumatoid arthritis; SpA: Spondyloarthritis; yr: Year.
DOI: https://doi.org/10.36922/jctr.23.00099