Session Information
Title: Rheumatoid Arthritis - Clinical Aspects (ACR): Comorbidities, Treatment Outcomes and Mortality
Session Type: Abstract Submissions (ACR)
Background/Purpose
Rheumatoid arthritis (RA) is a chronic disease with frequent psychological comorbidities, of which depression and anxiety are 2 common manifestations. We aimed to identify predictive factors of psychological distress in a large prospective cohort of very early RA patients.
Methods
ESPOIR (Etude et Suivi des POlyarthrites Indifférenciées Récentes ) is a multicentre, longitudinal and prospective cohort study of patients with early arthritis (< 6-month disease duration). The study sample comprised 641 patients with very early RA according to the 2010 ACR/EULAR RA criteria from the ESPOIR cohort. Psychological distress was assessed over 3 years by the Mental Health Inventory 5 questionnaire, at different timepoints (baseline, 6, 12, 18, 24 and 36 months). Logistic regression with a Generalized Estimating Equation (GEE) model was used to analyse the association of disease variables and risk of psychological distress.
Results
At baseline, 46.9% of RA patients were screened as positive for psychological distress. Over 3 years, psychological distress decreased significantly, with a prevalence of 25.8% at 36 months. The Health Assessment Questionnaire–Disability Index (HAQ-DI) score was the most important factor predicting psychological distress over 3 years (odds ratio 1.81 [95% confidence interval 1.13–2.91] to 3.66 [2.07–6.45]). On GEE analysis, other significant variables predicting psychological distress included female sex (p= 0.0117), low educational level (p=0.0047), family income (p= 0.0138 or 0.0385) and occupation of employee according to national classification of socio-professional categories (p= 0.0096). Low (< median) patient and physician global assessment of disease activity or DAS28-CRP ≤ 3.2 were protective for risk of psychological distress. Finally, risk of psychological distress was increased during the first year after diagnosis (OR 1.31 [1.04–1.72] to 1.95 [1.44–2.84]. Baseline biological and radiological variables and treatment regimen were not associated with distress.
Conclusion
Psychological distress in very early RA is frequent and the HAQ-DI score is a predictor of depression and anxiety in these patients. Psychological evaluation in patients with early RA is important for further individual psychiatric diagnosis and management.
Disclosure:
B. Combe,
Lilly, Merck, Novartis, Pfizer Inc, Roche-Chugai, and UCB,
2,
Lilly, Merck, Novartis, Pfizer Inc, Roche-Chugai, and UCB,
8;
N. Rincheval,
None;
R. M. Flipo,
None;
P. M. Goupille,
None;
J. P. Daurès,
None;
J. Boulenger,
None.
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