Background/Purpose: Giant cell arteritis (GCA) is the most common primary vasculitis affecting patients aged above 50 years. Its clinical manifestations such as headache, jaw claudication and blindness, as well as its treatment with high doses of glucocorticoids (GCs) can have an impact on patients’ mental health. Hospital Anxiety and Depression Scale (HADS) is a validated patient-reported outcome tool to assess anxiety and depression. We aimed to explore GCA-specific and non-specific contributive factors to mental status using HADS.

Methods: HADS questionnaires were prospectively collected from patients with biopsy- or imaging-proven GCA evaluated from July 2018 to January 2020 in the Vasculitis clinic of a tertiary centre. HADS-A and HADS-D ≥8 defined possible and HADS-A and HADS-D ≥11 defined probable anxiety and depression, respectively. A cross-sectional analysis comparing different clinical and demographic features of GCA patients with HADS scores ≥8 or < 8 and ≥11 or < 11 was performed. Univariate analysis was performed using T-student, Chi-Square, Mann-Whitney and Fischer’s exact tests, as appropriate. Binary logistic regression was used to identify independent predictors of HADS ≥8 and HADS ≥11. Association between values of HADS and age was assessed using Spearman's correlation coefficient.

Results: We included 72 patients with GCA, 52 (72.2%) females, with a mean ± SD age of 78.3 ± 7.7 years. Patients presented a mean ± SD HADS-A of 8.2 ± 4.6 and mean ± SD HADS-D of 7.9 ± 5.0. Possible and probable anxiety was observed in 35 (48.6%) and 22 (30.6%) patients, respectively; possible and probable depression was observed in 35 (48.6%) and 24 (33.3%) patients, respectively. Table 1 shows the differences between patients with HADS ≥8 and < 8, and HADS ≥11 and < 11. Patients with HADS ≥8 were more frequently under GC treatment and all patients with HADS ≥11 were on GCs. Patients with HADS-A ≥8 had higher levels of ESR and lower prevalence of diabetes mellitus, whereas HADS-D scores of ≥8 or ≥11 were associated with older age. Multivariate analyses adjusted for sex, age, disease duration > 1 year and treatment with GCs showed that only GC therapy was an independent predictor of HADS-A ≥8 (OR 10.40 95%CI: 1.15-94.23) and age was an independent predictor of HADS-D ≥8 (OR 1.20 95%CI: 1.08-1.34). Multivariate analysis adjusted for age, sex and treatment with GCs showed that older age was also an independent predictor of HADS-D ≥11 (OR 1.12 95%CI: 1.03-1.22); no independent predictors were identified for HADS-A ≥11. Moreover, age and scores of HADS-D and HADS-A showed correlation (r=0.53, p< 0.001 and r=0.26, p=0.03; respectively).

Conclusion: In our cohort, around half the patients with GCA showed possible anxiety and depression. Older patients had more depression and patients under GCs were more likely to present anxiety. Although these results require replication, they highlight the importance of including the evaluation of mental health as part of the disease management in GCA, particularly in the most elderly patients under GC treatment.

Table 1: Results of univariate analysis comparing patients with HADS ≥8 and HADS < 8 and HADS ≥11 and HADS < 11.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/risk-factors-for-anxiety-and-depression-in-patients-with-giant-cell-arteritis/