Background/Purpose: Rheumatoid arthritis (RA) is frequently associated with different comorbidities. Depression and fatigue are common in RA patients with a prevalence of 17-39-%⁽¹⁾ and 40%⁽²⁾ respectively. However, the factors that determine these comorbidities, especially their association with disease activity have been little studied.

We studied these two comorbidities: depression and fatigue in patients with RA, according to clinical activity, and the association between them.

Methods: Patients with RA (ACR/EULAR criteria, 2010) who agreed to participate in this study were included consecutively in the Rheumatology Department during a period of 3 months.

Demographic variables (age, sex, BMI), years of disease duration, treatment, physical examination (TJC28, SJC28), patient (PATGL) and physician (PhyGL) global assessment, and laboratory tests (ESR, CRP) were collected. Patients completed 2 one-dimensional questionnaires: PHQ-9 for depression (0-27; cut-off point>10) and FACIT-F for fatigue (0-52; lower scores indicate more fatigue) and the multidimensional health assessment questionnaire (MDHAQ) which includes a query for depression in the checklist review of 60 symptoms (ROS60) and one for fatigue measured in VAS of 0-10 (VAS_Fatigue). EULAR composite indices for clinical activity (DAS28-ESR and CRP, CDAI, SDAI) and self-reported clinical activity index with RAPID3 = function (FN) + pain (PN) + VGP were calculated.

Patients were compared in two groups according to disease activity (DAS28-ESR). Group 1: > 3.2 = moderate or high activity, and group 2: ≤3.2 = low activity or remission.

A bivariate statistical analysis was performed to compare groups (U Mann Whitney-test for quantitative variables and Chi²-test for categorical). Finally, Spearman’s Rho correlation was done.

Results: A total of 75 patients with RA were studied with a median of 14 years (IQR: 8-24) of disease duration, 84% women, with a median age of 63 (36-88) years and a BMI median of 24.22 (IQR: 22-27.4) and 64% with DMARDb treatment. 19 patients had moderate or high activity and 56 patients with low activity or remission. The clinical variables: TSC, SJC, laboratory tests (ESR, CRP) and all self-reported variables in MDHAQ (PN, FN, PTGL, self-RADAI, VAS_Fatigue, ROS60), PhyGL, FACIT-F and PHQ-9 showed significant differences between the two groups, with higher scores in patients of group 1. Also in the composite indices, as we expected (Table 1).

FACIT-F scores showed a very good negative correlation with VAS_Fatigue (r = -0.802; p < 0.0001), PHQ-9 (r = -0.850; p < 0.0001) and ROS60 (r = -0.766; p < 0.0001) and almost good with the rest of the variables (table 2). PHQ-9 scores showed high positive correlation with all the variables studied, remarkable in VAS_Fatigue (r= 0.721; p < 0.001) and in ROS60 (r = 0.717; p < 0.001) (Table 2).

Conclusion: In RA patients with a higher burden of disease (clinical, biological and self-reported) were observed high scores for fatigue and depression with a strong association to each other. These two comorbidities should be routinely studied in the follow-up of active RA patients.

References
1.Matcham F, et al. Rheumatology (Oxford) 2013.
2.Tournadre A, et al. Joint Bone Spine. 2019.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/depression-and-fatigue-two-forgotten-associated-comorbidities-in-patients-with-rheumatoid-arthritis/