Background/Purpose:  As many as 40% of people with rheumatoid arthritis (RA) experience significant symptoms of mood disorders. In addition to the pain, fatigue, and disability associated with RA, inflammatory mediators such as IL-1, TNF and IL-6 are thought to play a role in the aetiology of mood disorders. This study examined comorbid anxiety/depression in RA (both physician- and patient-reported), and its association with work and activity impairment.

Methods:  Data were drawn from the 2014 Adelphi RA Disease Specific Programme, a cross-sectional survey in the US and 5 European countries (France, Germany, Italy, Spain, UK). Physician-reported anxiety or depression was documented as a comorbid condition for each patient. In addition, patient-reported anxiety/depression was collected using the EQ-5D health status questionnaire: anxiety and depression were rated as “none,” “moderate,” or “extreme.” These 2 distinct markers for anxiety/depression in RA patients within the Adelphi survey were analyzed separately in univariate/multivariate analyses. Univariate analysis was initially used to identify any association between physician- and patient-rated anxiety/depression with patient-reported work productivity and activity impairment (WPAI) questionnaire scores. Controlling for patient age, gender, region, body mass index, physician-reported disease severity, number of flares (past 12 months), and physician-reported global health, multivariate regression analyses further examined the relationships between these markers and outcomes of interest.

Results:  Of the total 3,379 patients, 15.3% had physician-reported anxiety/depression as a comorbid condition. 38.4% of those who completed the EQ-5D question on anxiety and depression (n=1015) had self-reported anxiety/depression of at least moderate severity at the time of the survey. Multivariate analyses demonstrated that patient-reported anxiety/depression was significantly associated with overall work impairment (among employed patients) (coefficient [95% CI], 11.04 [4.23, 17.84]; P=0.002) and activity impairment (among all patients) (14.11 [10.69, 17.54]; P<0.001). Separate multivariate analysis demonstrate that physician-reported anxiety/depression was also borderline significantly associated with overall work impairment (6.80 [-0.01, 13.62]; P=0.050) and significantly associated with activity impairment (6.80 [2.89, 10.72]; P=0.001), respectively.

Conclusion:  Both physician-reported comorbid anxiety/depression, and patient-reported anxiety/depression during EQ-5D administration were independently and significantly associated with overall work impairment as well as activity impairment. Further research on optimal management of mood disorders in RA is warranted.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/physician-reported-and-patient-reported-anxiety-and-depression-in-rheumatoid-arthritis/