Background/Purpose: Psoriatic arthritis (PsA) affects approximately 30% of patients with psoriasis and has the potential to cause severe joint damage. Research into the prevalence of depression and anxiety in PsA patients, and the contribution of joint disease to mental health in psoriatic disease, is limited.  The objectives were: 1) To determine the prevalence of depression and anxiety in PsA patients and identify associated demographic and disease-related factors. 2) To determine if there is a difference between patients with PsA and those with psoriasis without PsA (PsC).

Methods: Consecutive patients attending PsA and PsC clinics were assessed for depression and anxiety using the Hospital Anxiety and Depression Scale (HADS). Patients with PsA satisfied CASPAR criteria and those with PsC had dermatologist confirmed psoriasis and PsA excluded by a rheumatologist. Patients underwent a clinical assessment according to a standard protocol and completed questionnaires assessing their health and quality of life. T-tests, ANOVA, univariate, and multivariate models were used to compare depression and anxiety prevalence between patient cohorts and determine factors associated with depression and anxiety.

Results: A total of 306 PsA and 135 PsC patients were assessed. The mean age of PsA and PsC patients was 53.8 and 52.4 years respectively. There were significantly more men in the PsA group (61.4% vs. 48% for PsC) and they were more likely to be unemployed (40% vs. 29.1%). The prevalence of both anxiety and depression was higher in PsA patients (36.6% and 22.2% respectively) compared to PsC (24.4% and 9.6%) (p = 0.012, 0.002). Factors associated with a higher likelihood of depression and/or anxiety included unemployment, female gender, and higher active joint count. Patient reported factors such as disability, pain, and fatigue were highly correlated with an increased likelihood of both depression and anxiety (p < 0.0001). In the univariate analyses, the protective factors for depression included having only PsC, drinking socially, and being employed. Factors associated with a higher odds ratio (OR) for depression included current smoking, a higher pain rating, higher patient reported physical disability, and a higher level of fatigue. In the multivariate reduced model, employment was protective for depression (OR 0.36) and a 1 unit increase on the fatigue severity scale (FSS) was associated with depression (OR 1.5).

Conclusion: The rate of depression and anxiety is significantly higher in PsA patients than in PsC patients. The factors most closely associated with higher rates of depression and anxiety are those in which patients express the negative effects PsA has on their quality of life, such as ratings of pain, disability and fatigue. The major limitation of this study is that it is not able to determine causation. Nonetheless, these results indicate the importance of addressing patients’ perceptions of their own health and functioning, as well as objective measures of disease severity, when treating depression and anxiety in psoriatic disease. A deeper understanding of these factors is important for planning and evaluating future treatments.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/depression-and-anxiety-in-psoriatic-disease-prevalence-and-associated-factors/