Do Depression and Anxiety Reduce the Chance of Remission in Rheumatoid Arthritis and Psoriatic Arthritis?

Brigitte Michelsen^1,2, Karen M Fagerli¹, Elisabeth Lie¹, Hilde Berner Hammer³, Glenn Haugeberg^4,5, Eirik K Kristianslund¹ and Tore K. Kvien¹, ¹Dept. of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway, ²Dept. of Rheumatology, Hospital of Southern Norway Trust, Kristiansand, Norway, ³Rheumatology, Diakonhjemmet Hospital, Oslo, Norway, ⁴Dept. of Rheumatology, Martina Hansens Hospital, Bærum, Norway, ⁵Dept. of Rheumatology, The Norwegian University of Science and Technology, Trondheim, Norway

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: Anxiety, depression, Psoriatic arthritis, remission and rheumatoid arthritis (RA)

Session Information

Date: Tuesday, November 15, 2016

Title: Rheumatoid Arthritis – Clinical Aspects V: Challenges in the Assessment and Management of Established RA

Session Type: ACR Concurrent Abstract Session

Session Time: 4:30PM-6:00PM

Background/Purpose: Depression and anxiety are reported to predict poorer treatment outcomes in rheumatoid arthritis (RA).¹ Whether this can be confirmed in larger, prospective studies as well as in psoriatic arthritis (PsA) remains to be explored. In this study we aimed to assess if baseline depression/ anxiety is associated with remission rates in RA and PsA.

Methods: From the prospective, multicenter NOR-DMARD study we included RA and PsA patients starting first-time tumor necrosis factor inhibitors (TNFi) and DMARD naïve patients starting methotrexate between 2006 and 2012. Depression/anxiety was assessed using the EuroQoL (EQ5D) question 5. The predictive value of baseline moderate/extreme depression/anxiety (present/absent) on remission after 3 and 6 months treatment was explored in prespecified logistic regression models adjusted for age, sex, disease duration and smoking.

Results: A total of 1450 RA/ 805 PsA patients were included (mean (SD) age 54.4 (13.5)/ 48.0 (12.4) years, median (25^th-75^th percentile) disease duration 0.4 (0.0-5.0)/ 1.0 (0.1-6.8) years, 68.7/ 50.7% females and 28.6/ 28.6% current smokers). Similar percentages of RA and PsA patients reported to be moderately (40.7 vs. 40.7%)/ extremely (2.8 vs. 3.0%) depressed/ anxious at baseline (p=0.98). Baseline depression/ anxiety negatively predicted DAS28<2.6, SDAI≤3.3 and ACR/EULAR Boolean remission after 3 and 6 months treatment in RA (table 1). Corresponding findings in PsA were less consistent (table 2). In subgroup analyses of TNFi and methotrexate treated patients depression/ anxiety was found to be negatively predictive of remission at 6 months in RA, but not in PsA (table 1-2). Table 1

		Odds ratio (95%CI) for remission when depressed/ anxious at baseline (logistic regression analyses)
		All RA patients	RA patients treated with TNFi with or without methotrexate	DMARD naïve RA patients treated with methotrexate
After 3 months	DAS28ESR < 2.6	0.65 (0.48-0.86) p=0.003	0.42 (0.26-0.67) p<0.001	0.84 (0.57-1.23) p=0.36
	SDAI ≤ 3.3	0.62 (0.43-0.88) p=0.008	0.75 (0.44-1.26) p=0.28	0.51 (0.31-0.83) p=0.007
	ACR/EULAR Boolean	0.53 (0.35-0.79) p=0.002	0.83 (0.46-1.49) p=0.53	0.33 (0.18-0.61) p<0.001
After 6 months	DAS28ESR < 2.6	0.50 (0.36-0.67) p<0.001	0.48 (0.30-0.78) p=0.003	0.50 (0.33-0.75) p=0.001
	SDAI ≤ 3.3	0.46 (0.32-0.65) p<0.001	0.48 (0.28-0.81) p=0.007	0.43 (0.27-0.68) p<0.001
	ACR/EULAR Boolean	0.43 (0.29-0.64) p<0.001	0.51 (0.29-0.92) p=0.03	0.36 (0.21-0.61) p<0.001

Table 2

		Odds ratio (95%CI) for remission when depressed/ anxious at baseline (logistic regression analyses)
		All PsA patients	PsA patients treated with TNFi with or without methotrexate	DMARD naïve PsA patients treated with methotrexate
After 3 months	DAS28ESR < 2.6	0.73 (0.49-1.1) p=0.13	0.79 (0.42-1.48) p=0.46	0.67 (0.38-1.18) p=0.16
	SDAI ≤ 3.3	0.62 (0.39-0.97) p=0.04	0.61, (0.34-1.11) p=0.11	0.58 (0.27-1.22) p=0.15
	ACR/EULAR Boolean	0.52 (0.31-0.86) p=0.01	0.43 (0.22-0.85) p=0.02	0.64 (0.28-1.44) p=0.28
	DAPSA < 4	0.45 (0.28-0.72) p=0.001	0.44 (0.23-0.81) p=0.009	0.45 (0.21-0.95) p=0.04
After 6 months	DAS28ESR < 2.6	0.92 (0.60-1.41) p=0.69	0.93 (0.47-1.85) p=0.85	0.93 (0.52-1.65) p=0.80
	SDAI ≤ 3.3	0.69 (0.44-1.08) p=0.11	0.65 (0.33-1.27) p=0.21	0.81 (0.43-1.50) p=0.50
	ACR/EULAR Boolean	0.63 (0.39-1.03) p=0.07	0.81 (0.40-1.64) p=0.56	0.53 (0.26-1.05) p=0.07
	DAPSA < 4	0.66 (0.42-1.03) p=0.07	0.69 (0.36-1.34) p=0.28	0.67 (0.36-1.26) p=0.21

Conclusion: Baseline depression/ anxiety may reduce likelihood of remission in RA. Whether this also is the case in PsA needs to be explored in larger patient samples and using validated remission criteria. Depression and anxiety are factors with potential impact for disease outcome and should be considered in routine care and in treat-to-target strategies. 1 Matcham F, Norton S, Scott DL, et al. 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) 2016;55:268-78.

Disclosure: B. Michelsen, None; K. M. Fagerli, None; E. Lie, None; H. B. Hammer, None; G. Haugeberg, None; E. K. Kristianslund, None; T. K. Kvien, Biogen, BMS, Boehringer Ingelheim, Celltrion, Eli Lilly, Epirus, Hospira, Merck-Serono, Novartis, Orion Pharma, Pfizer, Sandoz and UCB, 9.

To cite this abstract in AMA style:

Michelsen B, Fagerli KM, Lie E, Hammer HB, Haugeberg G, Kristianslund EK, Kvien TK. Do Depression and Anxiety Reduce the Chance of Remission in Rheumatoid Arthritis and Psoriatic Arthritis? [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/do-depression-and-anxiety-reduce-the-chance-of-remission-in-rheumatoid-arthritis-and-psoriatic-arthritis/. Accessed .

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