Background/Purpose: Studies have shown an increased prevalence of psychologic disorders in rheumatic diseases, such as rheumatoid arthritis, systemic lupus erythematosus, and psoriatic arthritis, compared to the general population. Of note, the coexistence of anxiety and depression with rheumatic diseases has been linked to worse outcomes and increased health care utilization. Our aim was to examine the prevalence of anxiety and depression in a cohort of patients with rheumatic diseases on biologic infusions.

Methods: We conducted a retrospective study between 2013 and 2017 at two infusion centers affiliated with the University of Arizona Arthritis Center. We identified patients with rheumatic diseases on biological infusions for the concurrent diagnosis of anxiety and/or depression and examined hospitalizations. Statistical analysis by Fisher’s exact test using Baptista-Pike was performed with Prism Software and is represented using the odds ratio with the 95% confidence interval and p-value.

Results: Of the total 548 patients with rheumatologic diagnoses, 77% of the sample was female. The mean age was 63 years. 59.7% had rheumatoid arthritis , 12.9% had osteoporosis, 6% had systemic lupus erythematosus, 5% had psoriatic arthritis, 4% had ankylosing spondylitis, 1.2% had gout, 0.9% had mixed connective tissue disease, 1.2% had juvenile idiopathic arthritis, 1% had anti-neutrophil cytoplasmic antibodies vasculitis, 1.6% had osteoarthritis, 0.3% had Behcet’s disease, 0.5% had dermatomyositis, 0.5% had polymyositis, 0.8% had adult-onset still’s disease, and 0.3% had giant cell arteritis.

175 patients (31.9%) within the cohort had a diagnosis of anxiety and/or depression. 76 patients (13.8%) had depression, 99 (18%) had anxiety, and 42 (7.6%) had concurrent anxiety and depression. 90/332 (27.1%) with RA, SLE 15/34 (44.1%), osteoporosis 24/71 (33.8%), ankylosing spondylitis 10/29 (34.5%), psoriatic arthritis 7/25 (28%), vasculitis 4/9 (44.4%), others 24/51 (47%) had either depression or anxiety or both.

61/175 (34.9%) of patients with depression and/or anxiety had 1 or more hospitalization compared to 87/373 (23.3%) patients without any psychological diagnosis (OR 1.76, 95% CI [1.19-2.60], P = 0.004). 

Conclusion: The findings of this study show a high prevalence of anxiety and depression in our cohort of patients with rheumatic diseases. Although, patients with one or both of these psychiatric diagnoses had significantly higher rates of hospitalizations but this association needs to be further investigated by regression analysis. Given the high prevalence of anxiety and depression in the rheumatology patient population, an interdisciplinary team approach with rheumatologists, primary care physicians, psychiatrists, and psychologists to manage a patient’s mental health may play an important role in improving long-term rheumatic and psychiatric disease outcomes.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/prevalence-of-anxiety-and-depression-in-a-cohort-of-patients-with-rheumatic-diseases-on-biological-infusions/