Session Information
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: Anxiety and depression (A&D) are important comorbid conditions that affect patients with rheumatoid arthritis (RA). It is not known whether they impact on disease outcome in early RA (eRA). The aim of this study was to understand if A&D are: 1) associated with disease activity (DAS28) or disability at time of eRA diagnosis, 2) predictors of DAS28 and disability after 12 months of treatment.
Methods: An inception cohort of eRA patients was studied. At baseline, patients completed a detailed questionnaire recording self-rated quality of life (EQ5D) and disability (modified health assessment questionnaire (HAQ)). A categorical variable for level of anxiety and depression (A&D) was created from the EQ5D (0=none, 1=moderate, and 2=extreme levels of self-reported A&D). Disease activity (DAS28), DAS28 remission (<2.6), and HAQ were recorded at baseline and at 12 month review. Associations with A&D were explored: 1) at baseline using simple descriptive statistics, and 2) with 12-month outcomes using age and gender adjusted logistic regression.
Results: At baseline, 126 eRA patients had complete data. 36 (28.6%) patients reported moderate levels, and 14 (11.1%) extreme levels of A&D. Increasing A&D was significantly associated with elevated HAQ, and DAS28 at baseline (Table 1).
Age and gender adjusted logistic regression revealed that baseline A&D predicted a reduced likelihood of: 1) DAS28 remission (ORadj 0.38 [95%CI 0.18, 0.81]), and 2) good EULAR response (ORadj 0.41 [95%CI 0.13, 1.03]), at 12 months. No difference was observed in initial DMARD therapy. Baseline A&D was not significantly associated with mean change in DAS28 (ORadj 1.06 [95%CI 0.85, 1.32]), or minimal clinically significant improvement in HAQ (ORadj1.95 [95%CI 0.91, 4.20]). However, those reporting extreme level A&D at baseline were 5 times more likely to report HAQ above 1.0 at 12-months compared to without A&D (ORadj 5.78 [95%CI 1.72, 19.52]).
Conclusion: Anxiety and depression at diagnosis of eRA is a strong predictor of poor outcome (disease activity and disability) at 12 months. Whilst A&D predict reduced likelihood of good EULAR response, no significant associations were observed with absolute change in HAQ or DAS28 after 12 months of DMARD therapy. This suggests that patients with A&D may benefit from additional treatment, targeted to reduce A&D, combined with usual DMARD treatment in order to optimise outcomes. Understanding the impact of confounding effect of anxiety and depression is important when assessing DMARD response in eRA.
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Table 1 Disease characteristics at baseline by level of anxiety/depression. |
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Anxiety and depression |
P-value |
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None (n=76) |
Moderate (n=36) |
Extreme (n=14) |
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Mean age (SD) |
58 (15.0) |
55.7 (16.9) |
54.4 (16.2) |
0.287 |
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Female (%) |
47 (61.8%) |
30 (83.3%) |
10 (71.4%) |
0.031 |
|
Smoke (%) |
23 (30%) |
8 (22.2%) |
4 (28.6%) |
0.442 |
|
Obese (%) |
19 (25.0%) |
10 (27.8%) |
4 (28.6%) |
0.707 |
|
Rheumatoid factor positive (%) |
48 (63.2%) |
22 (61.1%) |
11 (78.6%) |
0.744 |
|
CCP positive (%) |
50 (65.8%) |
23 (63.9%) |
8 (57.1%) |
0.664 |
|
High CRP (>14 [median]) |
36 (49.3%) |
14 (40.0%) |
9 (64.3%) |
0.796 |
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Median DAS28 [IQR] |
4.8 [3.9, 5.5] |
4.8 [4.3, 5.9] |
6.4 [5.9, 7.4] |
0.046* |
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High DAS28 (>5.1) |
31 (40.8%) |
13 (36.1%) |
12 (85.7%) |
0.309 |
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Median HAQ [IQR] |
0.75[0.25, 1.25] |
1.25 [0.875, 1.5] |
2.0 [1.125, 2.125] |
0.000* |
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High HAQ (≥1.0) |
30 (39.5%) |
24 (66.7%) |
11 (78.6%) |
0.003 |
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High TJC (>6) |
34 (49.3%) |
13 (44.8%) |
9 (81.8%) |
0.564 |
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High SJC (>3) |
26 (37.7%) |
14 (48.3%) |
7 (63.6%) |
0.132 |
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High ESR (>33) |
40 (52.6%) |
18 (50.0%) |
9 (64.3%) |
0.880 |
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High Global VAS (>55) |
35 (46.1%) |
20 (55.6%) |
12 (85.7%) |
0.048 |
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Initiated triple DMARD therapy |
11 (14.5%) |
7 (19.4%) |
1 (7.1%%) |
0.536 |
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Table 2 Response at 12 months by level of anxiety/depression. |
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Anxiety and depression |
P-value |
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None (n=76) |
Moderate (n=36) |
Extreme (n=14) |
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Median DAS28 at 1yr |
2.3[1,7, 3.3] |
3.0[2.1, 3.5] |
3.5[2.0, 4.8] |
0.046 * |
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DAS28 remission (<2.6) |
47 (71.2%) |
14 (21.2%) |
5 (7.6%) |
0.008 |
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Good EULAR response |
53 (69.7%) |
19 (52.8%) |
6 (42.9%) |
0.025 |
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Median change in DAS28 (from baseline) |
2.2 [1.3, 3.1] |
2.3 [1.0, 3.0] |
2.7 [0.9, 4.7] |
0.697 |
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Median HAQ at 1yr |
0.25 [0.0, 0.75] |
0.5 [1.25, 1.0] |
1.0[0.75, 2.0] |
0.005 * |
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HAQ improvement (>0.25 above baseline) |
39 (51.4%) |
25(69.4%) |
9(64.3%) |
0.063 |
*Wilcoxon’s ranksum – any anxiety depression vs no anxiety depression
To cite this abstract in AMA style:
Zhao S, Hider S, Sparks C, Matcham F, Galloway J, Estrach C, Goodson N. Association Between Anxiety and Depression and Rheumatoid Arthritis Outcome: Results from an Inception Early Rheumatoid Arthritis Cohort [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/association-between-anxiety-and-depression-and-rheumatoid-arthritis-outcome-results-from-an-inception-early-rheumatoid-arthritis-cohort/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/association-between-anxiety-and-depression-and-rheumatoid-arthritis-outcome-results-from-an-inception-early-rheumatoid-arthritis-cohort/