Ab0296 the real impact of depression and anxiety on rheumatoid arthritis patients: a cohort study

Background Rheumatoid Arthritis (RA) patients are more prone to have depression and anxiety compared to the general healthy population. Although it’s been increasingly recognised that mental health conditions are associated with higher disease activity and worse disease outcomes, depression and anxiety are not widely considered in routine care of arthritis patients. Objectives This study aims to estimate, in a large cohort of Portuguese patients with RA, the prevalence of depression and anxiety and to explore associations with demographic characteristics and disease-related measures. Methods We performed a retrospective analysis including patients diagnosed with RA, according to the 2010 ACR/EULAR criteria, who started their first biological Disease Modifying Antirheumatic Drug (bDMARD). Demographic, clinical and laboratory data were obtained by consulting Rheumatic Diseases Portuguese Register (Reuma.pt). Associations with demographic characteristics and disease-related measures were examined at baseline, 6, 12, 18 and 24 months. Statistical analyses were performed using SPSS statistical software, version 23.0. Results A total of 357 patients with RA were included. Eighty-two per cent were females (82%). The mean age was 54 ± 11.01 years and the median disease duration was 10 years [min 0.5, max 45]. Rheumatoid Factor (RF) was positive in 75% of patients and Antibodies to Citrullinated Peptides (anti-CCP) in 82%. The prevalence of depression and anxiety were 34.7% and 23.5%, respectively. Both groups (RA depressed/anxiety) had statistically significant differences concerning gender. Patients with RA and depression/anxiety were significantly more likely to be women and had a lower disease duration. Depressed patients showed a younger RA onset. Unemployed patients were more likely to be depressed. Other factors such as education, smoking or alcohol consumption were not significantly associated. Baseline depression/anxiety was associated with increased patient’s global assessment and number of painful joints but not with levels of acute phase reactants. Treatment with conventional synthetic DMARD and/or glucocorticoids did not have any significant association with either depression or anxiety. The proportion of patients achieving disease remission and good/moderate EULAR response was overall lower in patients with depression/anxiety during the follow-up. Conclusion The presence of depression and anxiety among patients with RA was associated with worse response to the first bDMARD. Screening and recognition of such psychosocial disorders may help patients achieve optimal disease control and a good outcome. Reference [1] Michelsen B et al . Do depression and anxiety reduce the likelihood of remission in rheumatoid arthritis and psoriatic arthritis? Data from the prospective multicentre NOR-DMARD study. Ann Rheum Dis. 2017 Nov;76(11):1906-1910. Table 1. Patient and disease characteristics at baseline and comparison between therapeutic groups All patients N=357 Depression N=124 Anxiety* N=84 p -value Sociodemographic characteristics Age (years) 54.1 ± 11.4 52.7 ±11.4 53.6 ± 11.2 NS Gender (Female) 293 (82.1%) 115 (92.7%) 75 (89.3%) < 0.001 0.049 Unemployed 214(60%) 124(74.2%) 63 (75%) 0.002 0,05* Disease characteristics Age at diagnosis 42.3 ± 11.7 41.7 ± 11.9 43.2 ± 12.1 0.005 NS* RF 268 (75%) 93 (75%) 71 (85%) NS Anti-CCP 291 (82%) 102 (82%) 69 (82%) NS Erosive 200 (56%) 78 (63%) 46 (55%) NS Baseline disease activity Tender joints 28 9 ± 6.9 9.9 ± 7.3 9.4 ± 7.4 0.05 NS* Swollen joints 28 7.6 ± 5.7 7.68 ± 5.6 7.21 ± 5.6 NS ESR (mm/1 st hour) 36.9 ± 22.1 39.8 ± 23.9 38.2 ± 21.8 NS CRP (mg/L) 18.5 ± 25.6 19.5 ± 2.3 19.4 ± 36.1 NS Patients VAS 67.3 ± 22.6 74.6 ± 21.7 72.8± 24.4 0.01 NS* DAS 28 5.6 ± 1.1 5.9 ± 1.21 5.8 ± 1.3 0.03 NS* DAS 3V 5.0 ± 13.8 5.4 ± 1.2 5.3 ± 1.3 0.048 NS* HAQ 1.6 ± 0.6 1.8 ± 0.6 1.7 ± 0.7 0.002 0.032* EULAR response (24 months) N=174 Non responders 22/174 (12%) 11/72 (15.3%) 7/40 (17.5%) 0.05 NS* Acknowledgements: NIL. Disclosure of Interests None Declared.