Session Information
Date: Monday, October 22, 2018
Title: Spondyloarthritis Including Psoriatic Arthritis – Clinical Poster II: Clinical/Epidemiology Studies
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose:
Depression and/or anxiety are comorbidities associated with psoriatic arthritis (PsA) that may affect treatment response. We aimed to determine whether the presence of depression/anxiety is associated with lower probability of achieving minimal disease activity (MDA) in patients with PsA.
Methods:
Patients with PsA from a large cohort evaluated at 6-12-month intervals according to a standard protocol were studied. Those with a minimum number of 2 visits between 2008 and 2017 were eligible for this study. Given the lack of a formal psychiatric assessment, patients were classified as having depression/anxiety based on 3 definitions: 1) if they scored ≤ 38 on the Mental Component Summary of the SF-36 questionnaire (Definition 1); 2) if they scored ≤ 56 on the Mental Health subscale (Definition 2); and 3) if the physician reported a diagnosis of depression/anxiety in the PsA clinic protocol (Definition 3). The primary outcome was the achievement of sustained MDA, defined as meeting 5 of the 7 following; tender joint count ≤ 1, swollen joint count ≤ 1, tender entheseal points ≤ 1, Psoriasis Activity and Severity Index ≤ 1 or Body Surface Area ≤ 3%, patient pain visual analogue scale (VAS) ≤ 20, patient global disease activity VAS ≤ 20; Health Assessment Questionnaire ≤ 0.5, for at least two consecutive visits. Univariable and multivariable proportional odds discrete time to event analyses were conducted to identify predictors for sustained MDA.
Results:
743 patients were included in the study (Table 1). The total number of patients identified as having depression/anxiety according to the 3 definitions was: Definition 1- 331 (44.54%), Definition 2- 364 (48.99%), and Definition 3- 211 (28.39%). A total of 337 patients (45.35%) failed to achieve sustained MDA during follow-up. The presence of depression/anxiety was associated with reduced probability of achieving sustained MDA in the multivariable regression analysis (reduced model), (OR 0.29 p <0.0001 [Definition 1], OR 0.33 p <0.0001 [Definition 2] and OR 0.44 [Definition 3] p <0.0001). Male sex and daily alcohol intake was associated with a higher probability of achieving sustained MDA, whereas Charlson Comorbidity index reduced the probability. Similar results were observed when using the definitions 2 and 3 for anxiety/depression.
Conclusion:
The presence of anxiety/depression reduces the probability of achieving sustained MDA in PsA. Comprehensive management of PsA thus should include measures for addressing these comorbidities.
|
Table 1. Descriptive statistics of baseline demographic and disease features (N=743) |
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|
Demographics |
Statistics |
|
|
Age of PsA** |
38.3 |
(13.8) |
|
Age at baseline visit** |
50.2 |
(13.2) |
|
Sex (male)* |
419 |
(56%) |
|
Employed* |
457 |
(62%) |
|
Education ³ college* |
546 |
(73%) |
|
Married* |
484 |
(65%) |
|
Daily alcohol use* |
407 |
(55%) |
|
Disease features |
Statistics |
|
|
Active (swollen or tender) joints** |
5.8 |
(8.7) |
|
Damaged joints** |
5.8 |
(11.3) |
|
Body Surface Area affected by psoriasis** |
4.8 |
(11.5) |
|
PASI** |
4.0 |
(6.3) |
|
Pain score VAS** |
32.9 |
(27.4) |
|
HAQ** |
0.5 |
(0.6) |
|
Patient global assessment score VAS** |
4.3 |
(2.7) |
|
Sacroiliitis (NY crietria)* |
184 |
(30%) |
|
Arthritis Mutilans* |
75 |
(12%) |
|
Enthesitis* |
131 |
(18%) |
|
Charlson Comorbidity index** |
0.8 |
(0.9) |
|
Body Mass Index** |
21.3 |
(14.3) |
|
Obesity* |
211 |
(28%) |
|
Treatment with DMARDs* |
394 |
(53%) |
|
Treatment with biologics* |
200 |
(27%) |
|
*number of cases (%) ** mean (st.d) |
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|
Table 2. Univariable and Multivariable analyses for sustained MDA, adjusted by age, sex obesity, and smoking |
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|
Univariable analysis |
Multivariable analysis |
|||||
|
Full Model |
Reduced Model |
|||||
|
Variable |
Odds Ratio |
p-value |
Odds Ratio |
p-value |
Odds Ratio |
p-value |
|
Depression/anxiety (Def 1) |
0.284 |
<0.0001 |
0.299 |
<.0001 |
0.297 |
<0.0001 |
|
Charlson Comorbidity index |
0.694 |
<0.0001 |
0.734 |
<.0001 |
0.733 |
<0.0001 |
|
Daily alcohol intake |
1.958 |
0.0002 |
1.686 |
0.0050 |
1.754 |
0.0023 |
|
DMARDs |
0.771 |
0.0176 |
0.849 |
0.1468 |
||
|
Biologic treatment |
0.835 |
0.0946 |
1.017 |
0.8770 |
||
|
Married |
1.211 |
0.0961 |
1.132 |
0.2947 |
||
|
Sacroiliitis (NY criteria) |
1.243 |
0.103 |
||||
|
Damaged joint count |
1.005 |
0.3344 |
||||
|
Arthritis mutilans |
0.955 |
0.7973 |
||||
|
Adjusted for |
||||||
|
Smoking |
0.940 |
0.5598 |
1.011 |
0.9207 |
1.006 |
0.9607 |
|
Age |
0.994 |
0.1496 |
1.000 |
0.9977 |
1.001 |
0.9146 |
|
Obesity |
0.760 |
0.0152 |
0.907 |
0.4096 |
0.91 |
0.4243 |
|
Sex (male vs female) |
1.551 |
<0.0001 |
1.385 |
0.0037 |
1.409 |
0.0021 |
To cite this abstract in AMA style:
Wong Lam A, Ye JY, Gladman DD, Chandran V. Depression and Anxiety Reduce Probability of Achieving a State of Minimal Disease Activity in Patients with Psoriatic Arthritis [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/depression-and-anxiety-reduce-probability-of-achieving-a-state-of-minimal-disease-activity-in-patients-with-psoriatic-arthritis/. Accessed .« Back to 2018 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/depression-and-anxiety-reduce-probability-of-achieving-a-state-of-minimal-disease-activity-in-patients-with-psoriatic-arthritis/