medwireNews: Depression and anxiety are associated with reduced rates of joint remission among patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA), researchers report.
These comorbidities “are not widely considered in routine care of arthritis patients,” despite being “more common in RA and PsA compared with the general population, with reported prevalence between 10%–42% in RA and 9%–37% in PsA,” say Brigitte Michelsen (Diakonhjemmet Hospital, Oslo, Norway) and fellow researchers.
“Increased emphasis on the negative predictive value of depression and anxiety ought to be considered as part of a treat-to-target strategy in patients not reaching remission,” they add.
Using data from the Norwegian Disease-Modifying Anti-Rheumatic Drug (NOR-DMARD) register, the team found that 43.2% of 1326 patients with RA and 44.8% of 728 participants with PsA had depression or anxiety at baseline according to EuroQol-5D-3L questionnaire scores.
RA patients with depression or anxiety were significantly less likely than those without these comorbidities to achieve a Disease Activity Score at 28 joints based on erythrocyte sedimentation rate (DAS28-ESR) of less than 2.6 points after 3 or 6 months of treatment with tumor necrosis factor inhibitors or methotrexate, with corresponding odds ratios of 0.66 and 0.48 after adjustment for age, gender, disease duration, and smoking.
Patients with RA and depression and anxiety were also significantly less likely to experience joint remission measured by the Simplified Disease Activity Index, Clinical Disease Activity Index, or ACR/EULAR Boolean scores.
The findings were similar in patients with PsA, with a consistently lower incidence of joint remission at both timepoints among those with versus without these comorbidities, but the differences did not reach statistical significance for all measures of remission.
The observed associations remained consistent in sensitivity analyses adjusting for factors including C-reactive protein and erosive disease, in subgroup analyses of treatment regimens, and with different measures of depression and anxiety.
“The consistent findings for these different predictors support the validity and the robustness of the results,” write Michelsen and colleagues in the Annals of the Rheumatic Diseases.
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