Osteoarthritis and RA Linked to Anxiety, Depression, Fibromyalgia

Juan Schumukler, MD

Credit: Rush University Medical Center

A new study revealed about 40% of patients with osteoarthritis screened positive for anxiety, depression, and fibromyalgia.¹ As for patients with rheumatoid arthritis (RA), 36.3% had anxiety, depression, and fibromyalgia.

“The rate of positivity for all three comorbidities was associated with the highest scores for RAPID3 and its components,” wrote investigators, led by Juan Schumukler, MD, from Rush University Medical Center in Chicago.

Patients with osteoarthritis and rheumatoid arthritis often experience similar disease burdens. This is reflected in their self-reported pain levels, Western Ontario and McMaster Universities Arthritis Index, Health Assessment Questionnaire, Multidimensional HAQ, and Routine Assessment of Patient Index Data 3 on the Multidimensional HAQ. Common comorbidities between osteoarthritis and RA include heart disease and depression, according to the Osteoarthritis Action Alliance and the Arthritis Foundation.^2,3

Patients with pain tend to have comorbid anxiety, depression, and fibromyalgia.¹ Despite these comorbidities' prevalence, they are not examined during routine screening for osteoarthritis and RA. The reason for this stems from the fact that screening for all 3 comorbidities requires multiple questionnaires, which is unrealistic in routine care.

A multidimensional Health Assessment Questionnaire (MDHAQ) replaces the need for several questionnaires as it screens for anxiety, depression, and fibromyalgia. In this study, investigators sought to assess the prevalence of anxiety, depression, and fibromyalgia among patients with osteoarthritis versus RA by participants completing the MDHAQ during routine care. Investigators also wanted to see the association between these comorbidities and pain based on the Routine Assessment of Patient Index Data 3 (RAPID3).

Investigators conducted a retrospective study of MDHAQ data in patients with osteoarthritis and RA receiving routine care who completed an MDHAQ with 4 indices: MDHAQ anxiety screening, MDHAQ depression screen, Fibromyalgia Assessment Screening Tool, and RAPID3. The team analyzed the prevalence of each comorbidity and the associations with RAPID3 in adjusted and age-adjusted Mantel-Haenszel analyses.

The sample included 366 patients with osteoarthritis (mean age: 66.6 years; female: 80%) and 488 patients with RA (mean age: 56.9 years; female: 86%). The median RAPID3 was 14 (interquartile range [IQR], 10.1) in patients with osteoarthritis and 13.3 (IQR, 13.2) in patients with RA. The differences in patients with osteoarthritis versus AR for RAPID3 and other MDHAQ scores did not reach clinical significance.

The team discovered 40.4% of patients with osteoarthritis and 36.3% of patients with RA screened positive for anxiety, depression, and fibromyalgia. Among patients with both osteoarthritis and RA, RAPID3 was significantly increased in patients who had a positive screening for anxiety, depression, and fibromyalgia (odds ratio [OR], 2.6 – 35.8).

The prevalence of participants who screened positive for anxiety was 29% in osteoarthritis versus 22% in RA (unadjusted odds ratio [OR], 1.44; 95% confidence interval [CI], 1.05 – 1.97; P = .03). Depression had a prevalence of 22% in osteoarthritis compared to 18% in RA (OR, 1.27; 95% CI, 0.91 – 1.79; P = .19). Lastly, fibromyalgia had a prevalence of 28% in osteoarthritis versus 22% in RA (OR, 1.06; 95% CI, 0.77 – 1.47; P = .78).

Although the proportion of patients who screened positive for all 3 indices was numerically greater in those with osteoarthritis versus RA, only the difference in anxiety screenings was significant.

Investigators also conducted an age-adjusted analysis with an age cutoff of 62 years since patients with osteoarthritis were significantly older than patients with RA. The age-adjusted odd ratios for positive screening results were 1.65 for anxiety (95% CI, 1.19 – 2.29; P = .003), 1.42 for depression (95% CI, 1.01 – 2.01; P = .052), and 1.10 for fibromyalgia (95% CI, 0.79 – 1.53; P = .58). This analysis showed the differences between osteoarthritis and RA may be greater for depression and anxiety than as suggested in the unadjusted analyses.

“Differences in the rate of patient distress comorbidities according to patient status were far greater than differences according to a diagnosis of OA versus RA,” investigators wrote. “In other words, knowledge of patient status (eg, persistent pain in OA and untreated inflammatory activity in RA) appears clinically more informative of the risk of comorbidities than the underlying diagnosis.”

References

1. ^{Schmukler J, Malfait AM, Block JA, Pincus T. 36-40% of Routine Care Patients With Osteoarthritis or Rheumatoid Arthritis Screen Positive for Anxiety, Depression, and/or Fibromyalgia on a Single MDHAQ. ACR Open Rheumatol. Published online July 16, 2024. doi:10.1002/acr2.11711}
2. ^{Comorbidities and Co-Occurring Symptoms. Osteoarthritis Action Alliance. https://oaaction.unc.edu/oa-module/comorbidities-and-co-occuring-symptoms/. Accessed August 8, 2024.}
3. ^{Comorbid Conditions in Inflammatory Arthritis. Arthritis Foundation. https://www.arthritis.org/health-wellness/about-arthritis/related-conditions/other-diseases/comorbid-conditions-and-pain. Accessed August 8, 2024.}