Are Depression and Anxiety Associated with Disease Activity in Rheumatoid Arthritis? A Prospective Study

Overview

Journal BMC Musculoskelet Disord

Publisher Biomed Central

Specialties Orthopedics
Physiology

Date 2016 Apr 13

PMID 27068100

Citations 35

Authors

Faith Matcham

Sheila Ali

Katherine Irving

Matthew Hotopf

Trudie Chalder

Affiliations

Soon will be listed here.

Abstract

Background: This study aimed to investigate the impact of depression and anxiety scores on disease activity at 1-year follow-up in people with Rheumatoid Arthritis (RA).

Methods: The Hospital Anxiety Depression Scale (HADS) was used to measure depression and anxiety in a cross-section of RA patients. The primary outcome of interest was disease activity (DAS28), measured one-year after baseline assessment. Secondary outcomes were: tender joint count, swollen joint count, erythrocyte sedimentation rate and patient global assessment, also measured one-year after baseline assessment. We also examined the impact of baseline depression and anxiety on odds of reaching clinical remission at 1-year follow-up.

Results: In total, 56 RA patients were eligible for inclusion in this analysis. Before adjusting for key demographic and disease variables, increased baseline depression and anxiety were associated with increased disease activity at one-year follow-up, although this was not sustained after adjusting for baseline disease activity. There was a strong association between depression and anxiety and the subjective components of the DAS28 at 12-month follow-up: tender joint count and patient global assessment. After adjusting for age, gender, disease duration and baseline tender joint count and patient global assessment respectively, higher levels of depression and anxiety at baseline were associated with increased tender joint count and patient global assessment scores at 1-year follow-up.

Conclusions: Symptoms of depression and anxiety have implications for disease activity, as measured via the DAS28, primarily due to their influence on tender joints and patient global assessment. These findings have implications for treatment decision-making as inflated DAS28 despite well controlled inflammatory disease markers may indicate significant psychological morbidity and related non-inflammatory pain, rather than true disease activity.

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References

Jensen K, Petzke F, Carville S, Fransson P, Marcus H, Williams S . Anxiety and depressive symptoms in fibromyalgia are related to poor perception of health but not to pain sensitivity or cerebral processing of pain. Arthritis Rheum. 2010; 62(11):3488-95. DOI: 10.1002/art.27649. View

Katon W, Lin E, Von Korff M, Ciechanowski P, Ludman E, Young B . Collaborative care for patients with depression and chronic illnesses. N Engl J Med. 2010; 363(27):2611-20. PMC: 3312811. DOI: 10.1056/NEJMoa1003955. View

McInnes I, Schett G . The pathogenesis of rheumatoid arthritis. N Engl J Med. 2011; 365(23):2205-19. DOI: 10.1056/NEJMra1004965. View

Rathbun A, Reed G, Harrold L . The temporal relationship between depression and rheumatoid arthritis disease activity, treatment persistence and response: a systematic review. Rheumatology (Oxford). 2012; 52(10):1785-94. DOI: 10.1093/rheumatology/kes356. View

Matcham F, Rayner L, Steer S, Hotopf M . The prevalence of depression in rheumatoid arthritis: a systematic review and meta-analysis. Rheumatology (Oxford). 2013; 52(12):2136-48. PMC: 3828510. DOI: 10.1093/rheumatology/ket169. View

Matcham F, Rayner L, Hutton J, Monk A, Steel C, Hotopf M . Self-help interventions for symptoms of depression, anxiety and psychological distress in patients with physical illnesses: a systematic review and meta-analysis. Clin Psychol Rev. 2014; 34(2):141-57. DOI: 10.1016/j.cpr.2014.01.005. View

Rayner L, Matcham F, Hutton J, Stringer C, Dobson J, Steer S . Embedding integrated mental health assessment and management in general hospital settings: feasibility, acceptability and the prevalence of common mental disorder. Gen Hosp Psychiatry. 2014; 36(3):318-24. DOI: 10.1016/j.genhosppsych.2013.12.004. View

Matcham F, Scott I, Rayner L, Hotopf M, Kingsley G, Norton S . The impact of rheumatoid arthritis on quality-of-life assessed using the SF-36: a systematic review and meta-analysis. Semin Arthritis Rheum. 2014; 44(2):123-30. DOI: 10.1016/j.semarthrit.2014.05.001. View

Matcham F, Ali S, Hotopf M, Chalder T . Psychological correlates of fatigue in rheumatoid arthritis: a systematic review. Clin Psychol Rev. 2015; 39:16-29. DOI: 10.1016/j.cpr.2015.03.004. View

10.

Matcham F, Norton S, Scott D, Steer S, Hotopf M . Symptoms of depression and anxiety predict treatment response and long-term physical health outcomes in rheumatoid arthritis: secondary analysis of a randomized controlled trial. Rheumatology (Oxford). 2015; 55(2):268-78. PMC: 4710801. DOI: 10.1093/rheumatology/kev306. View

11.

DiMatteo M, Lepper H, Croghan T . Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence. Arch Intern Med. 2000; 160(14):2101-7. DOI: 10.1001/archinte.160.14.2101. View

12.

Sharpe L, Sensky T, Allard S . The course of depression in recent onset rheumatoid arthritis: the predictive role of disability, illness perceptions, pain and coping. J Psychosom Res. 2001; 51(6):713-9. DOI: 10.1016/s0022-3999(01)00266-5. View

13.

Carney R, Freedland K, Miller G, Jaffe A . Depression as a risk factor for cardiac mortality and morbidity: a review of potential mechanisms. J Psychosom Res. 2002; 53(4):897-902. DOI: 10.1016/s0022-3999(02)00311-2. View

14.

Covic T, Adamson B, Spencer D, Howe G . A biopsychosocial model of pain and depression in rheumatoid arthritis: a 12-month longitudinal study. Rheumatology (Oxford). 2003; 42(11):1287-94. DOI: 10.1093/rheumatology/keg369. View

15.

Waraich P, Goldner E, Somers J, Hsu L . Prevalence and incidence studies of mood disorders: a systematic review of the literature. Can J Psychiatry. 2004; 49(2):124-38. DOI: 10.1177/070674370404900208. View

16.

Treharne G, Lyons A, Booth D, Mason S, Kitas G . Reactions to disability in patients with early versus established rheumatoid arthritis. Scand J Rheumatol. 2004; 33(1):30-8. DOI: 10.1080/03009740310004685. View

17.

Zigmond A, SNAITH R . The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983; 67(6):361-70. DOI: 10.1111/j.1600-0447.1983.tb09716.x. View

18.

van der Heijde D, van t Hof M, van Riel P, van de Putte L . Development of a disease activity score based on judgment in clinical practice by rheumatologists. J Rheumatol. 1993; 20(3):579-81. View

19.

Maes M, Bosmans E, De Jongh R, Kenis G, Vandoolaeghe E, Neels H . Increased serum IL-6 and IL-1 receptor antagonist concentrations in major depression and treatment resistant depression. Cytokine. 1998; 9(11):853-8. DOI: 10.1006/cyto.1997.0238. View

20.

McAllister-Williams R, Ferrier I, Young A . Mood and neuropsychological function in depression: the role of corticosteroids and serotonin. Psychol Med. 1998; 28(3):573-84. DOI: 10.1017/s0033291798006680. View