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La relación entre el dolor y la depresión y la ansiedad en personas con artritis inflamatoria: una revisión
Natasha Cox1, Ashley Hawarden1, Chelsea Kettle2
1Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK; Haywood Academic Rheumatology Centre, Haywood Hospital, Midlands Partnership University NHS Foundation Trust, High Lane, Burslem, Staffordshire, UK.
Seminars in arthritis and rheumatism
|September 3, 2025
Resumen
El dolor y la depresión tienen una relación bidireccional en la artritis inflamatoria. Los tratamientos para la depresión pueden reducir el dolor, lo que sugiere un enfoque biopsicosocial para controlar el dolor de la artritis inflamatoria.
Área de la Ciencia:
- Reumatología y Psiquiatría
- Revisión sistemática y metaanálisis
- El modelo biopsicosocial del dolor
Sus antecedentes:
- La artritis inflamatoria (IA) ocurre con frecuencia junto con la depresión y la ansiedad.
- La compleja interacción entre el dolor y la angustia psicológica en la IA requiere una síntesis.
- Comprender la direccionalidad y los mediadores de estas asociaciones es crucial para una gestión eficaz.
Objetivo del estudio:
- Revisar sistemáticamente la literatura sobre las asociaciones entre el dolor y la depresión/ansiedad en la IA.
- Para determinar la dirección del efecto entre el dolor y la angustia psicológica.
- Identificar posibles mediadores y el impacto de los tratamientos psicológicos sobre el dolor.
Principales métodos:
- Se realizó una búsqueda sistemática de la literatura hasta mayo de 2023.
- La inclusión de estudios que evalúen el dolor y la depresión/ansiedad en la artritis reumatoide/espondilitis.
- Conteo de votos y metanálisis para datos transversales; síntesis narrativa para datos longitudinales, mediadores y efectos del tratamiento.
- Evaluación del riesgo de sesgo y de la solidez de la evidencia utilizando las herramientas JBI y GRADE.
Principales resultados:
- Se incluyeron 79 estudios; se observó una relación bidireccional entre el dolor y la depresión.
- Se encontraron asociaciones moderadas entre el dolor y la depresión en puntos de tiempo individuales (SMD=0,69) y longitudinalmente.
- Encontros mixtos para la ansiedad; asociación moderada entre la ansiedad y el dolor (SMD=0,55), pero mínima para el dolor y la ansiedad (SMD=0,03).
- Pruebas limitadas sobre los mediadores; los antidepresivos mostraron potencial para reducir el dolor en la depresión comórbida.
- El treinta y cinco por ciento de los estudios tenían un alto riesgo de sesgo; la calidad de la evidencia en general era muy baja.
Conclusiones:
- Existe una modesta asociación bidireccional entre el dolor y la depresión en la artritis inflamatoria, a pesar de la evidencia de muy baja calidad.
- Los hallazgos apoyan la aplicación de estrategias biopsicosociales de manejo del dolor para la artritis inflamatoria.
- Se necesitan más investigaciones de alta calidad para aclarar las complejas relaciones y los impactos del tratamiento.
Palabras clave:
AnsiedadLa depresiónEl dolorLa artritis reumatoideLa espondiloartritisExamen sistemáticoMás Videos Relacionados
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