Background/Purpose: Although the complication of anxiety in rheumatoid arthritis (RA) patients is reported to be 1.2 times higher than in healthy controls and weakly correlated with disease activity, no new studies have been reported in the last ten years in Japan. During this period, treatment outcomes for RA have improved, and it is presumed that anxiety status has improved. In the present study, we investigated the relationship between anxiety state and disease activity and the activity of daily living (ADL) and depression in RA patients.

Methods: A total of 155 RA patients attending Showa University Hospital and Showa University Northern Yokohama Hospital outpatient clinics who agreed to participate in this study were included. Patient background included age, gender, disease duration, class, smoking history, prednisolone use, methotrexate use, rheumatoid factor, anti-CCP antibody, matrix metalloproteinase-3, simplified disease activity index (SDAI) for assessment of RA disease activity, the health assessment questionnaire (HAQ) for assessment of ADL, and the Center for epidemiologic studies depression scale (CES-D) and the Patient Health Questionnaire-9 (PHQ-9) for evaluation of depression. The State-Trait Anxiety Inventory (STAI) was used to assess anxiety status; the STAI includes state and trait anxiety, with cutoff values of 41 for men, 42 for women for state anxiety, 44 for men, and 45 for women for trait anxiety. The two groups were divided into two groups: those above the cutoff and those below the cutoff. The correlation between STAI and each item was examined cross-sectionally.

Results: The scores for state anxiety and trait anxiety were 39.0 ± 11.0 (points) and 39.5 ± 11.6 (points), respectively, with 64 (41.3%) and 51 (32.9%) of the subjects above the cutoff value. In the group with higher state anxiety, SDAI was 7.1 ± 9.0 vs. 4.2 ± 5.1 (p=0.001), patient VAS was 27.9 ± 28.7 vs. 15.8 ± 20.4 (p=0.003), CES-D was 14.6 ± 7.7 vs. 7.8 ± 5.5 (p=0.000), PHQ-9 was 5.6 ± 4.7 vs. 2.1 ± 2.1 (p=0.000), respectively. In the group with higher characteristic anxiety, SDAI was 8.4 ± 9.4 vs. 3.9 ± 5.0 (p=0.000), patient VAS was 33.0 ± 29.9 vs. 14.8 ± 19.4 (p=0.000), CES-D was 15.9 ± 7.9 vs. 8.0 ± 5.4 (p =0.000), PHQ-9 was 6.5 ± 4.8 vs. 2.1 ± 2.1 (p=0.000), and HAQ was 0.63 ± 0.69 vs. 0.33 ± 0.55 (p=0.004), respectively. On the other hand, there were no significant differences in the relationship between age, gender, prednisolone use, state anxiety, and HAQ. Concerning the CES-D, state anxiety was correlated with a correlation coefficient of 0.57 and trait anxiety with 0.65; about the PHQ-9, state anxiety was associated with a correlation coefficient of 0.54 and trait anxiety with 0.60.

Conclusion: The high rate of anxiety in RA patients was associated with disease activity, patient VAS, and depression, suggesting that controlling disease activity may be necessary from a bio-psycho-social perspective.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-cross-sectional-study-of-the-association-between-anxiety-state-and-various-factors-in-patients-with-rheumatoid-arthritis/