High Disease Activity in RA Predictive of Persistent Depression

Depression is a common comorbidity among patients with early rheumatoid arthritis (RA), according to the findings of a recent study.

The study included 496 participants with early RA who were enrolled in the Ontario Best Practices Research Initiative (73% female). Depression was self-reported by participants and disease activity was assessed using the Clinical Disease Activity Index (CDAI). The researchers used multivariate regression models to assess the association between baseline disease activity and persistent depression and to test whether the effect was modified by sex. Additionally, they examined the association between changes in CDAI over time and risk of depression.
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At baseline, the prevalence of depression was 26%, with 23% of participants reporting persistent depression. Higher CDAI was associated with both baseline and persistent depression (odds ratio [OR] 1.03, 95% CI, 1.01-1.05) after the researchers adjusted for potential confounders. This relationship was modified by sex, with an OR of 1.04 (95% CI, 1.01-10.6) for female sex. In addition, participants who continued to have a moderate or high CDAI score over 2 years had an increased risk for future depression.

“Depression in [early] RA is common and initial high disease activity is associated with the probability of depression and its persistence. This risk seems particularly modified in women with active disease and represents an area for targeted focus and screening,” the researchers concluded. “Future studies in [early] RA are needed to determine if intervening during the “window of opportunity” to control disease activity has the potential to mitigate the development and maintenance of adverse mental health outcomes, including depression.”

Reference

Kuriya B, Joshi R, Movahedi M, et al. High disease activity is associated with self-reported depression and predicts persistent depression in early rheumatoid arthritis: results from the Ontario Best Practices Research Initiative [published online May 15, 2018]. J Rheumatol. https://doi.org/10.3899/jrheum.17119