Depression Reduces Likelihood of Remission in RA, PsA Patients

Depression and anxiety reduce the likelihood of joint remission in patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA), according to a recent study.

In their study, the researchers evaluated 1326 patients with RA and 728 patients with PsA enrolled in the NOR-DMARD study who were initiating tumor necrosis factor treatments or methotrexate for the first time.
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Baseline depression and anxiety were assessed using scores from the European Quality of Life-5D-3L (EuroQoL-5D-3L), Short Form-36 (SF-36), Mental Health subscale, and SF-36 Mental Component Summary questionnaires. Disease activity was evaluated using the 28-joint Disease Activity Score, Simplified Disease Activity Index, Clinical Disease Activity Index, and the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) Boolean and Disease Activity Index for Psoriatic Arthritis.

Prespecified logistic regression models were used to assess the predictive value of depression and anxiety on remission. Prespecified multiple linear regression models were used to determine the associations between remission criteria and baseline depression and anxiety.

Results indicated that depression and anxiety at baseline had negatively predicted disease activity scores and remission in RA patients and partly in PsA patients after 3 months and 6 months of treatment. The researchers found that depression and anxiety at baseline was associated with increased global assessment of the patient and the evaluator, as well as tender joint count and joint pain in RA patients at follow-up. However, baseline depression and anxiety were not associated with swollen joint count or acute phase reactants.

“Depression and anxiety may reduce likelihood of joint remission based on composite scores in RA and PsA and should be taken into account in individual patients when making a shared decision on a treatment target,” the researchers concluded.

—Christina Vogt

Reference:

Michelsen B, Kristianslund EK, Sexton J, et al. Do depression and anxiety reduce the likelihood of remission in rheumatoid arthritis and psoriatic arthritis? data from the prospective multicentre NOR-DMARD study [Published online July 21, 2017]. Ann Rheum Dis. doi:10.1136/annrheumdis-2017-211284.