Influence of Anxiety and Depression on the Swollen to Tender Joint Count Ratio: In Pursuit of a Phenotype of RA Patients with Somatic Complaints in a U.S. Veteran Population

Iris Navarro-Millan¹, Archana Jain¹, Rebecca Belsom¹, Angelo L. Gaffo², Shuo Yang³, Ted R. Mikuls⁴ and Jeffrey R. Curtis⁵, ¹Rheumatology, University of Alabama at Birmingham, Birmingham, AL, ²Rheumatology, Birmingham VA Medical Center, Birmingham, AL, ³Clinical Immunology/Rheumatology, University of Alabama at Birmingham, Birmingham, AL, ⁴Medicine, University of Nebraska Medical Center, Omaha, NE, ⁵Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: Comorbidity and rheumatoid arthritis (RA), Disease Activity

Session Information

Date: Tuesday, November 10, 2015

Title: Rheumatoid Arthritis - Clinical Aspects Poster Session III

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose:
The utilization of a
swollen (SJC) to tender joint count (TJC) ratio (STR = (SJC/TJC)) has been proposed
in the past to identify a phenotype of rheumatoid arthritis (RA) patients that
may have somatic complaints that do not reflect active RA. The influence of
comorbidities such as depression and anxiety concomitant with RA, may influence
the tender joint count and may be an important factor moderating the STR. To
evaluate the influence of anxiety and depression on the distributions of TJC,
SJC and the STR within the Veterans’ Affairs Rheumatoid Arthritis cohort
(VARA),

Methods: Four mutually exclusive RA patient
groups were identified: 1) RA without anxiety or depression; 2) RA and
depression only; 3) RA and anxiety only; 4) RA and Anxiety and Depression. We
used Kolmogorov-Smirnov test to determine differences in the distribution of
the STR by patient group.

Results: There were 2,170 RA patients within
VARA. Mean age was 63 ± SD 10.9, 90% were men with an overall STR median (IQR)
= 0.55 (0-1.30). The median (IQR) of the STR for the RA only group was 0.57
(0-1.4); RA + depression 0.55 (0-1.3), RA + anxiety 0.25 (0-1.0) and RA +
anxiety + depression 0.54 (0-1.0). When comparing the actual distribution of
the STR only RA + Anxiety compared to RA only was significantly different
(p-value = 0.029). There was no difference between the RA + Depression group or
the RA + Depression and Anxiety when compared to the RA only group (p-value =
0.17, 0.13, respectively) (Figure). The proportion of patients with STR ratio
<0.5 was 43% (RA only), 54%, (RA+Anxiety), 45% (RA+Depression), and 43%
(RA+both), p<0.038.

Conclusion: The distribution of the swollen to
tender joint count ratio (STR) appears to be influenced by different
comorbidities. While the tender joint count is part of many disease activity
metrics, our study suggest that the tender to swollen joint count ratio may
identify a phenotype of RA patients with less active disease with somatic
complaints. Typical RA disease activity metrics may be overestimated in such
patients.

Figure:
Distribution of Swollen to Tender Joint Count Ratio in RA patients with and
without concomitant anxiety and depression

Disclosure: I. Navarro-Millan, None; A. Jain, None; R. Belsom, None; A. L. Gaffo, None; S. Yang, None; T. R. Mikuls, None; J. R. Curtis, Roche/Genentech, UCB, Janssen, CORRONA, Amgen, Pfizer, BMS, Crescendo, AbbVie, 2,Roche/Genentech, UCB, Janssen, CORRONA, Amgen, Pfizer, BMS, Crescendo, AbbVie, 5.

To cite this abstract in AMA style:

Navarro-Millan I, Jain A, Belsom R, Gaffo AL, Yang S, Mikuls TR, Curtis JR. Influence of Anxiety and Depression on the Swollen to Tender Joint Count Ratio: In Pursuit of a Phenotype of RA Patients with Somatic Complaints in a U.S. Veteran Population [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/influence-of-anxiety-and-depression-on-the-swollen-to-tender-joint-count-ratio-in-pursuit-of-a-phenotype-of-ra-patients-with-somatic-complaints-in-a-u-s-veteran-population/. Accessed .

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