Background/Purpose:  Rheumatoid arthritis, is the leading cause of disability and chronic pain. Psychiatric disorders such as depression and anxiety adversely impact reported pain and may also be influenced by systemic inflammation. We conducted a comprehensive, longitudinal investigation to assess the association of depressive and anxiety disorders, including severity of symptoms, with subjective and physician-assessed indicators of arthritis severity among outpatients with recent onset inflammatory arthritis.

Methods: Data included 148 subjects (mean age = 57.7, 72% female) from a prospective longitudinal Early Arthritis Cohort (<12 months symptoms at baseline) from 2012 to 2015. Presence of anxiety or depressive disorder was indicated via self-report annually, and severity of psychiatric symptoms was assessed using the Patient Reported Outcomes Measurement Information System (PROMIS) scales each visit. Arthritis activity indicators included patient reported visual analogue scales for pain fatigue, and functional status (modified health assessment questionnaire; mHAQ), physician global disease activity, swollen 28 joint count, tender 28 joint count, Lansbury weighted joint count, erythrocyte sedimentation rate (ESR), c-reactive protein (CRP), and composite indices (DAS28ESR-3variable, Clinical Disease Activity Index (CDAI)). Patients were re-assessed at each visit (visit range = 1 thru 7 visits, median (IQR) months followed 18(11,22)). Linear regressions and bivariate and partial correlations (controlling for number of visits and presence of a current mood or anxiety disorder for symptom-based analyses) first examined the cross-sectional relationship between mental health variables and indicators of arthritis severity. Linear regressions controlling for number of visits examined the longitudinal relationship between change in mental health symptoms on indicators of arthritis severity. Only results significant at the 0.01 level are reported to adjust for multiple comparisons.

Results: The presence of a current mood or anxiety disorder was reported by 10.7% and 6.3%, respectively, of the cohort at any time. Fatigue was associated with both a mood disorder (Beta = 0.27, t (202) = 4.025, p < 0.001) and anxiety disorder (Beta = 0.197, t (197) = 2.814, p < 0.01). Increasing severity of anxiety and depressive symptoms were significantly associated with pain, fatigue, CDAI, tender joint count, mHAQ and the Lansbury index (r range = 0.156-0.514). Severity of depressive symptoms were associated with ESR, DAS28 and CRP. When controlling for the presence of a mood or anxiety disorder and number of visits, most associations remained statistically significant. Worsening of anxiety (Beta = 0.212, t (314) = 3.85, p < 0.001) and depressive symptoms (Beta = 0.207, t (314) = 3.75, p< 0.001) over time were significantly associated with CRP values.

Conclusion: Indicators of disease severity were impacted by mental health factors, particularly severity of chronic pain and fatigue. Severity of mental health symptoms were a better indicator of disease severity than the presence of a psychiatric disorder alone. These findings have important implications for screening, prevention, and treatment.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-impact-of-mental-health-on-indicators-of-disease-severity-among-patients-with-inflammatory-arthritis-a-cross-sectional-and-longitudinal-investigation/