The Relationship Between Depression and Biologic Treatment Response in Rheumatoid Arthritis: An Analysis of the British Society for Rheumatology Biologics Register

Objective: To investigate the relationship between depressive symptoms and treatment response and disease activity in RA over a 1-year follow-up.

Methods: Data from the British Society for Rheumatology Biologics Register were used, representing 18 421 RA patients receiving biologic treatment. Depressive symptoms were identified through one of three assessments: reporting a history of depression, the Medical Outcomes Survey 36-item Short Form or the EuroQol five-dimension scale. Logistic regression analyses examined the relationship between baseline depressive symptoms and odds of good treatment response by 1 year. Multilevel models addressed the association between baseline depressive symptoms and disease activity outcomes over 1-year follow-up, adjusting for age, gender, disease duration, comorbidities and baseline disease activity and physical disability.

Results: Depression symptoms at biologic treatment initiation were associated with 20-40% reduced odds of achieving a good treatment response at 1 year. Depressive symptoms at baseline also associated with reduced improvement in disease activity over the course of follow-up. Patients with a history of depression or reporting symptoms of depression according to the EuroQol five-dimension scale showed reduced improvement in tender and swollen joints, patient global assessment and ESR over 1-year follow-up. Patients with depression symptoms according to the 36-item Short Form showed reduced improvement in tender and swollen joints, but not ESR or patient global assessment.

Conclusion: Experiencing symptoms of depression at the start of biologics treatment may reduce the odds of achieving a good treatment response, and reduce improvement in disease activity over time. Depression should be managed as part of routine clinical care to optimize treatment outcomes.