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19-06-2018 | Rheumatology | News | Article

EULAR 2018

Depression and anxiety closely linked to RA disease activity

medwireNews: Depression and anxiety are significant comorbidities in early rheumatoid arthritis (RA) and levels change in line with disease activity, shows research.

George Fragoulis (University of Glasgow, UK) commented at the EULAR 2018 meeting in Amsterdam, the Netherlands, on the problems associated with measuring depression and anxiety in patients with RA, notably that different measuring scales are used, there are not many studies in early RA or real-world studies, and it is impossible to identify a cause–effect relationship due to its bidirectional nature.

His team confirmed findings of a significant correlation between depression and anxiety and early RA in 848 newly diagnosed patients from the Scottish Early Rheumatoid Arthritis (SERA) cohort. Of these, 19.0% had anxiety and 12.2% had depression at baseline according to the Hospital Anxiety and Depression Scale.

Rates of anxiety and depression dropped after 12 months to 13.4% and 8.2%, respectively, and “this could be partially explained by the fact that disease activity is being reduced as time goes by,” said Fragoulis.

Indeed, significant correlations were found between the improvements in anxiety and depression rates and a decline in RA activity, measured using the Disease Activity Score at 28 joints with erythrocyte sedimentation rate (DAS28-ESR) at 6 and 12 months.   

As for disease outcomes, they saw that baseline depression and baseline anxiety scores were associated with increased DAS28 at month 6 and month 12.

The researchers also found that anxiety and depression were associated with socioeconomic and other epidemiological factors at baseline and different time points over the year, which Fragoulis said “could serve as predictors for depression and anxiety in RA,” and possibly lead to better outcomes. He pointed out some of the most important ones.

In univariate analyses, higher anxiety scores were significantly associated with female sex, younger age, unemployment, patient global visual analog scale (VAS) scores, and higher tender joint count. These associations were confirmed in multivariable analyses with an additional association found between higher anxiety scores and lower body mass index.

Similarly, higher depression scores were significantly associated in univariate analyses with unemployment, patient global VAS score, and higher tender joint count. But Fragoulis noted that, unlike anxiety, depression was also highly correlated with higher C-reactive protein (CRP) levels at all time points and this was confirmed in multivariate analyses.

Fragoulis, said that the finding of a link between depression and CRP levels hints at a link between depression and inflammation.

“It seems that there is a close relationship between CRP and depression, but it is very difficult to identify a cause–effect relationship between these two, and so this question will remain open.”

By Lucy Piper

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