Depression Prevalence in Patients With Rheumatoid Arthritis

Patients with rheumatoid arthritis (RA) are more likely to be affected by depression, an under-diagnosed condition in this patient population which may impact the perception of the disease, according to a study published in Advances in Rheumatology.¹

“Depression is a quite common comorbidity in patients with RA and is thought to influence its severity,” investigators stated. “In patients with RA, the prevalence of depression ranges between 14.8 and 22.5%, which is 2 to 3 times higher than in the general population, reaching a 47% lifetime risk. In addition, about 39% of patients affected by RA have also sub-threshold depressive symptoms.”

In this observational, cross-sectional study, 490 patients with RA who were receiving disease-modifying antirheumatic drugs (DMARDs) for at least 1 year were analyzed in order to determine the correlation between depressive disorders and RA. Eligible patients were aged 18 years or older and had a diagnosis of RA according to the American College of Rheumatology (ACR) or European League Against Rheumatism (EULAR) 2010. Current medication, antidepressants, comorbidities, smoking habits, and body mass index (BMI) were reported.

Factors such as disease duration, tender and swollen joint counts, the Visual Analogue Scale (VAS), Physician Global Assessment (PhGA), Patiient Global Assessment (PGA), 28-joints, Disease Activity Score (DAS28), Clinical Disease Activity Index (CDAI), and Health Assessment Questionnaires (HAQ) were used to determine RA-related characteristics. The Hospital Anxiety and Depression Scale (HADS) was implemented to analyze depression and anxiety in this patient population.

Of the 490 patients, 80% were female with the mean age of 60 years. Depression was seen in 14.3% of patients (95% CI: 11–17%) and 70 patients scored ≥ 11 in the HADS-D questionnaire. In depressed patients, 42.9% (n = 30) had a previous history of depression and 15.7% (n = 11) were currently being treated with antidepressants. These patients were also receiving a higher number of drugs when compared with the non-depressed cohort (6.4 vs 5.0, p < 0.001, respectively).

Depression was most common in females and those who were unemployed (p = 0.001 and p = 0.034, respectively). Higher RA activity and disability scores were seen in depressed patients and became more frequent in patients with severe or very severe disability according to HAQ scores.

The study was strengthened by the large sample of patients with RA recruited within routine clinical practice and by the standardized questionnaires that focused on depression, disease activity, and disability. However, the cross-sectional nature hindered inferences on the correlation between RA and depression. Additionally, depression was not confirmed by a psychiatrist.

“This [study] suggests the importance for the rheumatologist to screen and monitor depression in patients affected by RA in order to treat them appropriately. In addition, recognizing and treating depression may increase treatment adherence, further improving disease control,” investigators concluded. “Although it could sound obvious, one should not forget that treating depression has significant positive effects on patients’ well-being that is one of the main target of the rheumatologist work.”

Reference:

Pezzato S, Bonetto C, Caimmi C, et al. Depression is associated with increased disease activity and higher disability in a large Italian cohort of patients with rheumatoid arthritis. Adv Rheumatol. 2021;61(1):57. Published 2021 Sep 15. doi:10.1186/s42358-021-00214-3