Depression and Anxiety Predict Treatment Response and Health Outcomes in Rheumatoid Arthritis

Depression and Anxiety Predict Treatment Response and Health Outcomes in Rheumatoid Arthritis

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.

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