Background/Purpose:

Psoriatic arthritis (PsA) is a heterogeneous inflammatory arthritis affecting multiple clinical domains. Untreated, PsA has the potential for significant morbidity and disability. Psychiatric disorders have been described as a major comorbidity in PsA. Although anxiety and depression are known to co-occur in PsA, the prevalence of attention deficit hyperactivity disorder (ADHD) in this population has not been reported. Further, little is known about the impact of psychiatric disorders on disease severity and patient reported outcomes. The objective of this study was to characterize the prevalence and gender-driven differences of psychiatric disorders among PsA patients followed at a combined psoriasis-PsA clinic in the US.

Methods:

Two-hundred and fifty-three consecutive adult patients meeting CASPAR criteria for PsA were prospectively recruited at the New York University Psoriatic Arthritis Center and assessed for demographic characteristics, presence of psychiatric comorbidities, including anxiety, depression and ADHD. Diagnosis was defined by patients report and/or current use of psychiatric medications. Objective measures of disease severity included swollen and tender joint counts (SJC/TJC) and %body surface area (BSA) covered by psoriasis. A physician global assessment was recorded at the time of the visit, along with arthritis, skin and nail global scores. A RAPID3 score was also recorded. Data was analyzed with SPSS version 23. Associations between variables were evaluated by t-tests for continuous variables and chi-squared tests for categorical variables.

Results:

Participants were 54% male, had mean age 47 years, and majority were Caucasians (73.1%). A psychiatric diagnosis was reported in 27.8% of PsA patients: depression (18.7%), anxiety (14.7%), and/or ADHD (4.8%). When stratified by gender, female PsA patients had significantly higher prevalence of overall psychiatric diagnosis (34.5% vs 22.1%; p=0.028), depression (25% vs 13.2%; p=0.017) and use of antidepressants (22.2% vs 11.8%; p=0.048). Males had higher use of medications for bipolar disorder (9.1% vs 2.1%; p=0.037). While there were no significant differences in disease severity, female patients reported a significantly higher RAPID3 scores than males (12.09 vs 8.95; p=0.007). Intriguingly, male PsA patients (but not females) with any psychiatric diagnosis had a significantly lower SJC compared to those without these comorbidities (0.79 vs 1.82; p=0.14). Similarly, female PsA patients with psychiatric diagnosis has a lower %BSA affected with psoriasis (1.46 vs 2.40; p=0.054).

Conclusion:

We report, for the first time, a relatively high prevalence of ADHD in a cohort of PsA patients managed in a Psoriasis and PsA clinic. We further validate prior reports of significantly increased levels of depression and antidepressant use in female patients with PsA. Higher RAPID3 scores in women, independent of disease activity or presence of comorbidities, represents a significant gap in how patients perceive their disease symptoms. Further understanding of these gender-driven differences is needed to evaluate the impact on PsA disease burden, adherence and management.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/prevalence-of-depression-and-attention-deficit-hyperactivity-disorder-in-female-patients-at-a-combined-psoriasis-psoriatic-arthritis-center/