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Abstract Number: 1411

Psychological Distress over Time in Early Rheumatoid Arthritis: Results from a Longitudinal Study in an Early Arthritis Cohort

Bernard Combe1, Nathalie Rincheval2, René-Marc Flipo3, Philipe M. Goupille4, Jean-Pierre Daurès2 and JP Boulenger5, 1Immuno-Rhumatologie, Hôpital Lapeyronie, Montpellier, France, 2Institut Universitaire de Recherche Clinique, Montpellier, France, 3Rheumatology, Hopital R Salengro CHRU, Lille CEDEX, France, 4Rheumatology, Hopital Trousseau, Tours, France, 5CHRU Montpellier I University, La Colombiere Hospital, Montpellier, France

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: depression and psychological status, Early Rheumatoid Arthritis, Health Assessment Questionnaire

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Session Information

Session Title: Rheumatoid Arthritis - Clinical Aspects (ACR): Comorbidities, Treatment Outcomes and Mortality

Session Type: Abstract Submissions (ACR)

Background/Purpose

Rheumatoid arthritis (RA) is a chronic disease with frequent psychological comorbidities, of which depression and anxiety are 2 common manifestations. We aimed to identify predictive factors of psychological distress in a large prospective cohort of very early RA patients.

Methods

ESPOIR (Etude et Suivi des POlyarthrites Indifférenciées Récentes ) is a multicentre, longitudinal and prospective cohort study of patients with early arthritis (< 6-month disease duration). The study sample comprised 641 patients with very early RA according to the 2010 ACR/EULAR RA criteria from the ESPOIR cohort. Psychological distress was assessed over 3 years by the Mental Health Inventory 5 questionnaire, at different timepoints (baseline, 6, 12, 18, 24 and 36 months). Logistic regression with a Generalized Estimating Equation (GEE) model was used to analyse the association of disease variables and risk of psychological distress.

Results

At baseline, 46.9% of RA patients were screened as positive for psychological distress. Over 3 years, psychological distress decreased significantly, with a prevalence of 25.8% at 36 months. The Health Assessment Questionnaire–Disability Index (HAQ-DI) score was the most important factor predicting psychological distress over 3 years (odds ratio 1.81 [95% confidence interval 1.13–2.91] to 3.66 [2.07–6.45]). On GEE analysis, other significant variables predicting psychological distress included female sex (p= 0.0117), low educational level (p=0.0047), family income (p= 0.0138 or 0.0385) and occupation of employee according to national classification of socio-professional categories (p= 0.0096). Low (< median) patient and physician global assessment of disease activity or DAS28-CRP ≤ 3.2 were protective for risk of psychological distress. Finally, risk of psychological distress was increased during the first year after diagnosis (OR 1.31 [1.04–1.72] to 1.95 [1.44–2.84]. Baseline biological and radiological variables and treatment regimen were not associated with distress.

Conclusion

Psychological distress in very early RA is frequent and the HAQ-DI score is a predictor of depression and anxiety in these patients. Psychological evaluation in patients with early RA is important for further individual psychiatric diagnosis and management.


Disclosure:

B. Combe,

Lilly, Merck, Novartis, Pfizer Inc, Roche-Chugai, and UCB,

2,

Lilly, Merck, Novartis, Pfizer Inc, Roche-Chugai, and UCB,

8;

N. Rincheval,
None;

R. M. Flipo,
None;

P. M. Goupille,
None;

J. P. Daurès,
None;

J. Boulenger,
None.

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