Background/Purpose:   Depression and anxiety are well known comorbidities in psoriasis (PsO) and psoriatic arthritis (PsA) with higher prevalence in PsA. Patients with PsA have a worse quality of life than PsO, and the presence of joint pain is associated with higher rates of depression¹. Previous studies suggested that disease control may reduce symptoms of depression in PsO². Minimal disease activity (MDA) is a desirable state when treating patients with PsA, giving better outcomes as a target overall³. To date, no study has evaluated the effect of depression/anxiety on MDA in PsA. The aim of the study was to 1) Compare depression/anxiety scores between patients with MDA to those not in MDA (NMDA) in PsA. 2) Assess the effect of disease related variables, treatment, and depression and anxiety scores on MDA state.

Methods:   PsA patients fulfilling the CASPAR criteria were recruited. Patients were assessed for depression/anxiety using the Hospital Anxiety and Depression Scale (HADS-A and HADS-D) and Penn State Worry Questionnaire (PSWQ). Medical history including previous diagnosis or treatment for depression and anxiety, and risk factors of depression was taken. Patients underwent joint and skin assessments and completed questionnaires on health and quality of life. We compared the HADS-D and HADS-A scores and the % of patients with normal (0-7), borderline (8-10) and abnormal (11-21) categories between patients with MDA to those with NMDA, and anxiety by using PSWQ scores and the % of patients in low (16-39), moderate (40-59) and high (60-80) worry categories. Data were analyzed using Mann Whitney, Fisher’s exact, Chi-square tests and logistic regression analyses.

Results:   100 PsA patients were recruited, 40 patients were in MDA (age 52±10.6 years, male 55%) and 60 patients in NMDA (age 52±10.6 years, male 55%). TJC68 and SJC66 were lower in MDA compared to NMDA group (P<0.001) with no significant difference in the other 5 items of MDA, the number of patients on DMARD, biological treatment, and depression and anxiety medications. The % of patients with normal, borderline and abnormal HADS-D scores were 95%, 5% and 0 in MDA group vs. 80%, 15% and 5% in NMDA (P=0.084), respectively. Mean HADS-D score was significantly lower in MDA compared to NMDA (2.5±2.4 vs. 4.22±3.4, P=0.009). The % of patients with normal, borderline and abnormal HADS-A scores were 92.5%, 7.5% and 0 in MDA vs. 76%, 17% and 7% in NMDA (P=0.078), respectively. Mean HADS-A score was lower in MDA compared to NMDA. The number of patients in low, moderate and high worry categories and the mean PSWQ scores were similar in both groups. Logistic regression analyses revealed significant relationship between lower TJC (B=0.508 (CI95% 0.37-0.7) P<0.001), lower HADS-D (B=0.841 (CI95% 0.71-0.99) P=0.043) and MDA state.

Conclusion:   This is the first study assessing the effect of depression and anxiety on MDA. We found lower depression scores in patients with MDA compared to those in NMDA and significant relationship between depression and MDA state. Our results suggest the importance of recognizing depression in PsA since psychological well-being may contribute to MDA state. References:

1. McDonough E. JRheumatol 2014
2. Roubille C. JRheumatol 2015
3. Coates L. Lancet 2015

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