Half of Patients With Rheumatoid Arthritis Reported Symptoms of Depression

High rates of depression and anxiety were observed in patients with rheumatoid arthritis (RA), pointing to a potential association between inflammation and depression and anxiety, according to a study published in Reumatologia.¹ These findings underscore the issues patients with RA face compared with the general population. Investigators propose psychiatric assessments and mental status evaluations in conjunction with physical examinations in this patient population.

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“Depression is extremely common in patients with RA, with an incidence 1.7-fold greater than in individuals without RA,” wrote a team of international investigators led by Ayşe Unal Enginar, MD, associated with the Department of Rheumatology at Konya City Hospital in Turkey.

Previous studies showed depression, which has been linked to reduced remission rates, reduced the response to treatment by 30%.²

Adult patients with RA, defined according to the American College of Rheumatology/European Alliance of Associations for Rheumatology (ACR/EULAR) 2010 classification criteria, were enrolled in the single-center study. Demographic data, such as age, sex, marital status, education status, and disease duration, as well as the Health Assessment Questionnaire (HAQ) score, Disease Activity Score with 28-joint counts (DAS28), and Hospital Anxiety and Depression Scale (HADS) were evaluated in the analysis. The HADS assesses the risk of anxiety and depression in a patient, the levels of anxiety and depression, and the severity of change. Exclusion criteria included malignancy, psychosis, and patients who were pregnant or breastfeeding.

In total, 182 patients with RA were included, with a mean age of 52.9 years, a mean disease duration of 11.7 years, and 75% of patients were female.

Within the study sample, depression symptoms were present in 50.3% (HADS cut-off value of 7) and anxiety (HADS cut-off value of 10) was reported in 25.3%. Depression was significantly higher in female patients (56.2% vs 33.3%), housewives (60.8%), and those with lower education levels (66.7% for patients in the “uneducated” category vs 23.8% for those in the “university graduate” category). Anxiety was significantly higher in blue-collar workers when compared with retired patients. Significant differences between age, body mass index, and disease duration were not observed between patients with and without anxiety or depression.

In a multivariate logistic regression analysis, which used anxiety and depression as dependent variables, the HAQ score was significantly associated with both anxiety (odds ratio [OR] = 1.04, 95% confidence interval [CI]: 1.00 – 1.09, P = .041) and depression (OR = 1.10, 95% CI: 1.04 – 1.16, P = .000), indicating worse functional status and higher disease activity. University graduates reported a significantly decreased risk of depression (OR = 0.16, 95% CI: 0.02 – 0.94, P = .043). These patients experiencing depression and anxiety had higher HAQ and DAS28 scores when compared with other studied patients with RA.

Investigators noted that the cross-sectional design, conducted at a single center rheumatology clinic (Rheumatology Polyclinic), may have limited the study. The lack of control group and the relatively small number of patients may have also hindered the analysis. Lastly, results may not be generalizable to all patients with RA as these patients were being cared for in a tertiary-level center.

“Depression and anxiety are observed extremely frequently in RA patients,” investigators concluded. “It should be taken into consideration that this may affect the remission response of patients, the prognosis, and even mortality, and there should be collaboration with the psychiatry department in these cases.”

References

1. ^{Enginar AU, Nur H. The frequency and factors affecting anxiety and depression in patients with rheumatoid arthritis. Reumatologia. 2023;61(1):30-37. doi:10.5114/reum/161282}
2. ^{Matcham F, Davies R, Hotopf M, . The relationship between depression and biologic treatment response in rheumatoid arthritis: an analysis of the British Society for Rheumatology Biologics Register. Rheumatology (Oxford) 2018; 57: 835–843, DOI: 10.1093/rheumatology/kex528}