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Randomized Controlled Trial
. 2016 Feb;55(2):268-78.
doi: 10.1093/rheumatology/kev306. Epub 2015 Sep 8.

Symptoms of depression and anxiety predict treatment response and long-term physical health outcomes in rheumatoid arthritis: secondary analysis of a randomized controlled trial

Faith Matcham  1 , Sam Norton  2 , David L Scott  3 , Sophia Steer  3 , Matthew Hotopf  4
Affiliations
Randomized Controlled Trial

Symptoms of depression and anxiety predict treatment response and long-term physical health outcomes in rheumatoid arthritis: secondary analysis of a randomized controlled trial

Faith Matcham et al. Rheumatology (Oxford). 2016 Feb.

Abstract

Objective: The aim of this analysis is to examine the longitudinal impact of symptoms of depression/anxiety on treatment response, long-term disease activity and physical disability in RA.

Methods: Secondary analysis of clinical trial data was performed. Data were collected at baseline and at 6-monthly intervals for 2 years. The EuroQoL (EQ-5D(TM)) indicated depression/anxiety symptom severity. Our primary outcomes of interest were (i) DAS-28 and (ii) physical disability measured via the HAQ. Secondary outcomes were: tender and swollen joint counts, patient global assessment, ESR and odds of reaching clinical remission. Multilevel models were used to assess the impact of baseline and persistent depression/anxiety on outcomes over 2 years.

Results: Data from 379 patients were included. After adjusting for covariates, baseline depression/anxiety symptoms were associated with increased DAS-28 outcomes and increased tender joint counts. Persistent depression/anxiety symptoms were associated with increased DAS-28 scores, HAQ scores, tender joint counts and patient global assessment of disease activity, and reduced odds of reaching clinical remission. Patients with symptoms of depression/anxiety at baseline also showed a 50% reduction in prednisolone treatment effect, in comparison with patients with no symptoms of depression/anxiety at baseline.

Conclusion: Baseline and persistent symptoms of depression/anxiety are associated with poorer health outcomes over time, as well as reduced treatment response. Mental health should be routinely measured both in clinical practice and in research, and managed alongside rheumatological disease to optimize health outcomes. Further research is required to examine whether treatment of mental disorders can improve rheumatological outcomes.

Keywords: HAQ; anxiety; depression; disease activity; joint erosion; longitudinal; pain; remission; rheumatoid arthritis (RA).

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Figures

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Fig. 1
Estimated unadjusted mean outcomes by baseline depression/anxiety (with standard error bars) for DAS-28/ HAQ
F<sc>ig</sc>. 2
Fig. 2
Estimated unadjusted mean outcomes by depression/anxiety persistence (with standard error bars) for DAS-28/ HAQ
See this image and copyright information in PMC

References

    1. Matcham F, Rayner L, Steer S, Hotopf M. The prevalence of depression in rheumatoid arthritis: a systematic review and meta-analysis. Rheumatology 2013;52:2136–48. - PMC - PubMed
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    1. Norton S, Sacker A, Young A, Done J. Distinct psychological distress trajectories in rheumatoid arthritis: findings from an inception cohort. J Psychosom Res 2011;71:290–5. - PubMed

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