medwireNews: A systematic review and meta-analysis published in Clinical Rheumatology shows that anxiety and depression are common among patients with psoriatic arthritis (PsA).
“One in three patients with [PsA] has at least mild anxiety, while one in five reported at least mild depression,” comment Nicola Goodson (University of Liverpool, UK) and study co-authors.
They highlight that these mental health comorbidities are associated with higher disease activity and pain levels, and recommend that “[c]linicians should be mindful of this when managing PsA patient[s].”
The team analyzed data on 31,227 patients with PsA, from 24 studies that reported on the prevalence of comorbid mental health conditions or evaluated the impact of such conditions on disease activity.
The prevalence of anxiety ranged from 3.9% to 60.8%, depending on the screening criteria and thresholds used across studies.
But pooled data based on the Hospital Anxiety and Depression Scale (HADS)-anxiety score or Generalised Anxiety Disorder questionnaire revealed a prevalence of at least mild anxiety of 33% (based on four studies), while the prevalence of at least moderate anxiety was 21% (based on seven studies).
Similarly, the prevalence of depression ranged from 0.9% to 51.2%, but the pooled estimates, based largely on studies using the HADS-depression score, were 20% for mild cases (taken from six studies) and 14% for cases deemed moderate (taken from four studies).
Of note, just two studies reported on sleep problems and there was a “paucity of studies on suicide, self-harm, sexual health, substance misuse and other important mental health–related comorbidities,” say the researchers, stressing the need for more research on these conditions.
The effect of anxiety and depression on PsA disease activity was assessed in two studies and showed an adverse correlation. In both studies DAS28 and pain VAS scores tended to be significantly higher in individuals with anxiety or depression relative to those without comorbid mental health disorders.
But there was no significant difference between patients with and without mental health comorbidities with respect to the swollen joint count, ESR, and CRP.
“These cross-sectional studies do not allow us to distinguish the direction of any causal relationship, but the absence of differences in more objective measures of inflammation suggests it is more likely that these comorbidities are influencing reporting of disease severity,” conclude Goodson et al.
By Hannah Kitt
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Clin Rheumatol 2019; doi:10.1007/s10067-019-04734-8