Depression, anxiety may decrease chances of sustained MDA in psoriatic arthritis
medwireNews: Depression and anxiety are linked to a decreased likelihood of achieving sustained minimal disease activity (MDA) in people with psoriatic arthritis (PsA), Canadian researchers report.
Based on their findings, Vinod Chandran (University Health Network, Toronto, Ontario) and co-investigators believe that “[c]omprehensive management of PsA should therefore include measures for addressing anxiety and depression so that more patients achieve a state of MDA.”
Their prospective study included 743 people (mean age 50.2 years, 56% men) with PsA. Of these, 44.5% had depression or anxiety when defined as a score of 38 points or lower on the Mental Component Summary (MCS) score of the short form (SF)-36 questionnaire.
The proportion was 49.0% when using a score of 56 points or lower on the Mental Health subscale of SF-36 and 28.4% according to a rheumatologist’s report of a diagnosis or treatment for depression or anxiety. Just under a third (31.0%) of participants met all three definitions.
The researchers report in Arthritis Care & Research that, between 2008 and 2017, 44.5% of patients failed to achieve MDA at two or more consecutive visits, with MDA defined as meeting five of the following seven criteria: a tender joint count, swollen joint count, or tender entheseal points score of 1 or lower; a PASI score of 1 or lower or Body Surface Area score of 3 or lower; a patient pain VAS score of 15 or lower; a patient global disease activity VAS score of 20 or lower; or a HAQ score of Health 0.5 or lower.
Chandran and team found that people who had depression or anxiety according to the SF-36 MCS criteria were a significant 70% less likely to achieve sustained MDA than those who had no depression or anxiety, after adjustment for potential confounders.
They were a significant 66% less likely to achieve sustained MDA when depression or anxiety were defined according to the SF-36 Mental Health subscale criteria and a significant 53% less likely when the rheumatologist’s report was used to determine depression or anxiety.
The investigators note that not applying formal psychiatric assessment and not including a specific anxiety or depression questionnaire were limitations of the study that meant they were “not able to distinguish if it was depression or anxiety or both that are associated with the outcome.”
They therefore conclude: “Future studies will need to confirm these findings and differentiate between anxiety disorder and depression using more definitive assessment of mental health status.”
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