Depression and anxiety are highly prevalent in rheumatoid arthritis (RA) patients, with a recent meta-analysis reporting a 16.8% prevalence of depression, diagnosed via clinical interview. There is evidence to suggest a downstream relationship between distress and disease outcomes, with depression increasing pain and disease activity and decreasing short- and long-term treatment efficacy in RA.
Findings from a recent study published in the journal Rheumatology revealed that baseline and persistent symptoms of depression/anxiety predict several subjective and objective rheumatological outcome measures.
To examine the longitudinal impact of symptoms of depression/anxiety on treatment response, long-term disease activity and physical disability in RA, in a study entitled “Symptoms of depression and anxiety predict treatment response and long-term physical health outcomes in rheumatoid arthritis: secondary analysis of a randomized controlled trial”, Faith Matcham from the Department of Psychological Medicine, Institute of Psychiatry, King’s College London in the United Kingdom and colleagues, performed a secondary analysis of an existing randomized controlled trial in patients with early RA.
The researchers assessed three interrelated hypotheses: more symptoms of depression and anxiety at baseline status will predict increased Disease Activity Score (DAS-28) and Health Assessment Questionnaire (HAQ) outcomes (two RA calculators) over a 2-year follow-up period; patients with persistent symptoms of depression and anxiety will show increased DAS-28 and HAQ outcomes over a 2-year follow-up period when compared to patients without such symptoms; depression and anxiety symptoms at baseline will be associated with restricted treatment response to glucocorticoid treatment, measured via HAQ and the DAS-28.
Results revealed that in a population of 379 patients, early RA baseline depression/anxiety symptoms were associated with increased DAS-28 outcomes and increased tender joint counts. There was also an association between persistent depression/anxiety symptoms and increased DAS-28 scores, HAQ scores, tender joint counts and patient global assessment of disease activity, and reduced odds of reaching clinical remission. Furthermore, patients with symptoms of depression/anxiety at baseline had a 50% reduction in prednisolone treatment effect, compared to patients with no symptoms of depression/anxiety at baseline.
Based on these results the team suggests that measuring depression/anxiety is an easily collected and significant psychomarker of rheumatological outcome. Given the high frequency of depression/anxiety in this population the researchers warrant the need to identify and treat depression/anxiety as part of routine care, in line with the NICE guidelines. The authors further suggest the need for randomized controlled trials examinations to understand whether the treatment of depression/anxiety in RA impacts physical health outcomes.