Background/Purpose:

To explore the effect of psychosocial factors on the Disease Activity Score (DAS) and its components in early arthritis patients three months after initiating treatment with DMARDs.

Methods:

Data were used from patients with recent-onset arthritis participating in a single-blinded clinical trial (Treatment in the Rotterdam Early Arthritis CoHort (tREACH))(1,2) in which three induction therapy strategies were compared: (A) combination therapy (methotrexate (MTX) + sulfasalazine + hydroxychloroquine) with glucocorticoids (GCs) intramuscularly; (B) combination therapy with an oral GC tapering scheme and (C) MTX with oral GCs similar to B. 

Data were collected on demographics, clinical and psychological characteristics, including questionnaire data on coping, fatigue, depression, social support, locus of control and physical activity. The effect of baseline psychological characteristics on the DAS three months after initiation of therapy were evaluated using a multivariate linear regression model corrected for treatment arm, baseline DAS, age, sex, Rheumatoid Factor and ACPA.  Separate analyses were performed for the DAS components: SJC (Swollen Joint Count), Ritchie Articular Index (RAI), ESR and patient self-report of general health (Visual Analogue Scale).

Results:

281 patients (91 men, 190 women; mean baseline DAS 3.4, median baseline HAQ 0.75) were included in the analysis. We found that passive coping with pain and higher anxiety scores at baseline were associated with higher levels of disease activity (DAS) at three months. Taking the individual components of the disease activity score at three months as an outcome, passive coping with pain was associated with higher levels of ESR, while anxiety was related to higher tender joint scores (RAI) and patient self-report of general health.

Conclusion:

Our results suggest that psychological factors, especially anxiety and coping style, are associated with disease activity in early arthritis patients three months after initiation of DMARD therapy. This was not explained by baseline levels of disease activity or initial type of DMARD treatment.

Table 1 Univariate and multivariate linear regression analysis of psychological factors on disease activity (DAS) at three months.

1.      Claessen et al. Use of risk stratification to target therapies in patients with recent onset arthritis; design of a prospective randomized multicenter controlled trial. BMC Musculoskelet Disord 2009;10:71.

2.      De Jong et al. Induction therapy with a combination of DMARDs is better than methotrexate monotherapy: first results of the tREACH trial. Ann Rheum Dis. 2013 Jan;72(1):72-8.