Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: Depression and anxiety disorders are common in RA patients, with the most recent prevalence estimates indicating that 16.8% of RA patients have a diagnosis of depression and 25.1% of RA outpatients have screened positive for anxiety (1,2). In RA patients, depression and anxiety have been shown to be associated with increased pain, fatigue, reduced quality of life, and increased healthcare utilization use. Our aim was to examine the longitudinal impact of depression and anxiety on RA disease activity and functional status in a cohort of RA patients with established disease.
Methods: Data from a prospective longitudinal RA cohort study were analyzed and included joint exams, serological analyses, and patient reported measures. The Mental Health Index-5 (MHI-5), a validated scale that screens for depression and anxiety, was collected annually for two years. At baseline, univariate analyses were performed using MHI-5 as a dichotomous variable (scale 0-100, ≤65 positive for mood/anxiety disorder) to study the association between depression/anxiety with age, gender, ethnicity, seropositivity, education, social support (Berkman Social Network Index), disease duration, disease activity measures (DAS28-CRP3, RADAI, CRP), and functional disability (MHAQ). To examine the association between MHI-5 and outcomes of disease activity and functional disability, linear repeated mixed model analyses were performed where the predictor variable, MHI-5 mood/anxiety disorder, was lagged by one year in relation to the outcomes.
Results: Of 992 participants analyzed, the average age was 57 (±13.6) years, most were female (82.6%), with an average disease duration of 13.8 (±11.9) years. Univariate analyses showed that MHI-5 scores were associated with DAS28-CRP3 (p<0.0001), MHAQ (p<0.0001), education (p=0.04), and social support (p=0.0006). The linear repeated mixed model analyses indicated that MHI-5 mood/anxiety disorder predicted worse DAS28-CRP3 (p=0.0002), worse RADAI scores (p<0.0001), and worse MHAQ scores (p<0.0001) one year later. MHI-5 score did not predict worse CRP levels overtime (p=0.48) (Table 1). Lower education also predicted worse DAS28-CRP3 (p=0.03), RADAI (p=0.0007), and MHAQ (p=0.0002) scores.
Conclusion: Symptoms of depression and anxiety defined by the MHI-5 score, predict worse disease activity and functional disability in RA patients. Ongoing monitoring and treatment of a patient’s mental health is important and may impact long-term RA outcomes.
1. Matchum F et al. The prevalence of depression in rheumatoid arthritis: a systematic review and meta-analysis. Rheumatology 2013;52:2136-48.
2. Spitzer RL et al. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med 2006;166:1092-7.
|Table 1. Using MHI-5 mood/anxiety disorder to Predict Disease Activity and Functional Disability a year latera|
|Primary Outcomes||β estimate (SE)||P-value|
|Higher DAS28-CRP3||0.37 (0.10)||<0.0001|
|Higher CRP||1.11 (1.56)||0.48|
|Higher RADAI score||0.56 (0.14)||<0.0001|
|Higher MHAQ score||0.13 (0.03)||<0.0001|
|aPrimary outcome models adjusted for age, gender, seropositivity, education, and social support|
To cite this abstract in AMA style:Iannaccone C, Mahmoud TG, Cui J, Weinblatt M, Shadick N. Symptoms of Depression and Anxiety Predict Worse Disease Activity and Functional Disability in a Cohort of Established Rheumatoid Arthritis Patients [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/symptoms-of-depression-and-anxiety-predict-worse-disease-activity-and-functional-disability-in-a-cohort-of-established-rheumatoid-arthritis-patients/. Accessed December 11, 2018.
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