The results of a study to be presented at the Annual European Congress of Rheumatology (EULAR 2018) suggest that rates of anxiety and depression in patients with rheumatoid arthritis correlate with measures of disease activity over the first year following diagnosis.
Rheumatoid arthritis (RA) is a chronic inflammatory disease that affects a person's joints, causing pain and disability. It can also affect internal organs. RA is more common in older people, but there is also a high prevalence in young adults and adolescents. It affects women more frequently than men. High rates of depression and anxiety have been shown in patients with RA.
"These results confirm both depression and anxiety as significant comorbidities at the time of rheumatoid arthritis diagnosis," said Professor Thomas Dörner, Chairperson of the Abstract Selection Committee, EULAR. "It is interesting to see the changes in anxiety and depression scores appear in tandem with disease activity over time, which requires further investigation."
The study included data from 848 patients and results showed significant reductions in anxiety from 19.0% to 13.4% (p=0.004) and depression from 12.2% to 8.2% (p=0.01) one year after RA diagnosis, this was in line with observed decrease in disease activity. Both depression and anxiety scores demonstrated significant correlation with disease activity scores (DAS28) at baseline, six months and at 12 months (p<0.0001). In addition, change in DAS28 (final-baseline) also significantly correlated with change in both depression and anxiety scores at six months and 12 months.
"Our results demonstrate a number of interesting associations with socioeconomic and other variables," said Dr. George Fragoulis, honorary research fellow at the University of Glasgow (study author). "Most interestingly c-reactive protein, which is a blood test marker for inflammation, was highly associated with depression but not anxiety at all time points. This provides further support to compelling data linking inflammation and depression."
Investigators conducted statistical analysis to highlight potential associations between depression and anxiety scores and multiple variables at each time point. When looking at anxiety scores, statistically significant associations were found with female gender, younger age, and patient global assessment score (PGA) at baseline. At six months and 12 months, significant association was demonstrated between anxiety scores and low body mass index (BMI), PGA and baseline anxiety scores. When looking at depression scores, significant associations were found with PGA at baseline. At six months and 12 months, depression score was significantly associated with PGA, c-reactive protein (CRP) levels as well as baseline depression and anxiety scores.
The study used data from patients in the Scottish Early Rheumatoid Arthritis (SERA) cohort of newly diagnosed patients with RA. Patients had been followed-up every six months following diagnosis and tested for pre-specified clinical, laboratory and psychosocial features. This included anxiety and depression which was measured using the hospital anxiety and depression score.
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Fragoulis GE, Cavanagh J, Derakhshan MH, et al. Depression and anxiety in an early rheumatoid arthritis inception cohort. Associations with epidemiological, socioeconomic and disease features. EULAR 2018; Amsterdam: Abstract OP0350. DOI: 10.1136/annrheumdis-2018-eular.7083