Background/Purpose: Takayasu arteritis (TAK) is a chronic, granulomatous large-vessel vasculitis. As TAK has a chronic course, higher frequency rates of anxiety and depression are reported in these patients [Misra DP, et al. Rheumatol Ther. 2021 Sep;8(3):1073-93]. Fibromyalgia (FM) incidence in active TAK patients is higher [Alibaz-Oner F, et al. Intern Med. 2013;52(24):2739-42]. Data regarding the impact of anxiety, depression, and FM in adherence to treatment on TAK have not been previously reported. This study aimed to explore the impact of mental illness and fibromyalgia on adherence to treatment of TAK patients.

Methods: A cross-sectional study was designed for including patients who satisfy the 2022 ACR/ EULAR classification criteria for TAK. FM screening was made with the 2016FM criteria published by Wolfe. Patient Health Questionnaire-9 (PHQ-9) and General Anxiety Disorder-7 (GAD-7) were used to measure depression and anxiety severity. Impact on quality of life was measured by EuroQol-5D (EQ-5D) questionnaire. Patients completed the Morisky-Green Test (MGT) for treatment adherence. Disease activity was assessed by the National Institutes of Health (NIH) scale and the Indian Takayasu Clinical Activity Score (ITAS2010).

Data were described as percentages, mean ± standard deviation or median and interquartile range (IQR) according to its distribution. The assessment of normality was done by the Kolmogorov-Smirnov test. The Chi-square, Fisher test, Student’s t-test, or Mann-Whitney U test were used for comparisons as required. The correlation between MGT values and PHQ-9 or GAD-7 was evaluated by Spearman’s method. A value of p < 0.05 was considered statistically significant.

Results: Fifty-five TAK patients were invited. Two patients denied answering questionnaires, and one was excluded because of a lack of medical data therefore 52 patients were analyzed. Fifty (96%) female patients were included, and the mean age was 39±18. Remission was found in 28 (54%) patients, according to the rheumatology care provider. Activity according to NIH score was found in 16 (30%) patients and by ITAS2010 in 20 (38%) patients. Anxiety was found in 23 (44%) and depression in 30 (58%) patients. 16 (31%) patients have poor treatment adherence, 20 (38%) moderate, and 16 (31%) have high adherence rates. EQ-5D median score was 80 (67-90). 5 patients fulfilled FM 2016 criteria and all of them have depression or anxiety. There was a tendency for lesser MGT scores in mental illness-affected TAK patients [6 (5 -7) vs 7 (6.7-8), p=0.060]. Interestingly, a weak negative correlation between MGT and GAD7 score was found (Rho=-0.314, p=0.023). Higher treatment adherence has a positive significant correlation with better EQ-5D (Rho=0.357, p=0.009) and a negative correlation with the patient global assessment of disease activity (Rho= 0.311, p=0.025). Paresthesias are higher in patients with mental illness (46.9% vs 15%, p=0.018).

Conclusion: Higher treatment adherence scores were associated with a better quality of life and a better patient global assessment of disease activity. Despite anxiety and depression have a high prevalence, there was no great impact on the medication adherence rates. More studies regarding treatment adherence are needed.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/impact-of-anxiety-or-depression-status-and-fibromyalgia-on-adherence-to-treatment-of-patients-with-takayasu-arteritis/