Depression, anxiety negatively predict joint remission in RA, PsA
Depression and anxiety appear to reduce the likelihood of achieving joint remission in rheumatoid arthritis (RA) and, partly, in psoriatic arthritis (PsA), according to a study.
Researchers examined 1,326 patients with RA and 728 patients with PsA from the prospective observational Norwegian Disease-Modifying Anti-Rheumatic Drug study. All patients had initiated first-time tumour necrosis factor inhibitors (TNFi) or methotrexate (MTX).
Prespecified logistic and multiple linear regression models were used to estimate the predictive value of depression/anxiety on remission and test the associations between baseline depression/anxiety and the components of the remission criteria.
The number of patients with depression/anxiety was 573 in the RA group (mean age 53.5 years; 75.1 percent) and 326 in the PsA group (mean age 46.9 years; 59.7 percent).
Baseline depression/anxiety negatively predicted 28-joint Disease Activity Score <2.6, Simplified Disease Activity Index ≤3.3, Clinical Disease Activity Index ≤2.8, ACR/EULAR Boolean and Disease Activity Index for Psoriatic Arthritis ≤4 remission after 3 and 6 months of treatment in RA. Corresponding findings in PsA also showed consistently lower point estimates but did not reach significance for all the analyses.
Moreover, baseline depression/anxiety correlated with increased patient’s and evaluator’s global assessment, tender joint count and joint pain in RA at follow-up, as well as with increased patient’s and evaluator’s global assessment in PsA, but not with swollen joint count and acute phase reactants.
The findings were robust across different depression/anxiety and remission criteria, as well as in subgroup analyses of TNFi- and MTX-treated patients.
Psychiatric conditions such as depression and anxiety should be taken into account in individual RA or PsA patients when making a shared decision on a treatment target, researchers said.