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Rheumatoid Arthritis Linked With Depression and Anxiety

July 02, 2018

By Lorraine L. Janeczko 

NEW YORK—Early rheumatoid arthritis (RA) may be linked with depression and anxiety, according to research from the UK presented June 16 at the annual meeting of the European League Against Rheumatism in Amsterdam.

The findings are drawn from the Scottish Early Rheumatoid Arthritis (SERA) inception cohort of 848 newly diagnosed RA patients.

Dr. George Fragoulis of the University of Glasgow and colleagues recorded clinical, laboratory, and psychosocial data over time, including anxiety and depression scores (using the Hospital Anxiety and Depression Scale, with scores ranging from 0 to 21).

One year after RA diagnosis, the prevalence of anxiety dropped significantly, from 19.0% to 13.4% (p=0.004), and the prevalence of depression fell from 12.2% to 8.2% (p=0.01). Over the same period, disease activity also decreased.

"Anxiety and depression scores were correlated with DAS28 at all time points, including baseline (all p<0.0001)," the authors reported in the abstract for their presentation. Change in DAS28 (final-baseline) was correlated with change in depression and anxiety scores at months 6 and 12.

On multivariable analysis, anxiety score at baseline was associated with female gender, younger age and patient global assessment score (PGA), while anxiety scores at months 6 and 12 were linked with low BMI, PGA, and baseline anxiety score.

For depression scores, multivariable analysis indicated an association at baseline with PGA and at months 6 and 12 with PGA, CRP levels and baseline depression and anxiety scores.

"Intriguingly, C-reactive protein levels seem to be highly correlated with depression but not with anxiety," Dr. Fragoulis, who gave the oral presentation, noted by email. "This provides further support to compelling data linking inflammation and depression," he added in a press release.

"We might be able to identify characteristics and predict at an early stage which RA patients have or will develop depression/anxiety," Dr. Fragoulis said. "This could lead to earlier prevention and treatment and earlier management."

"The big remaining question," he observed, "is the direction of the relationship between RA and depression and anxiety: Is it only that RA causes depression and anxiety or might depression and anxiety contribute to a chronic inflammatory status and therefore affect RA per se?"

Going forward, Dr. Fragoulis said, "In collaboration with neuroscientists, we will try to identify whether biomarkers exist that correlate with the occurrence or development of depression and anxiety in RA patients."

Co-author Dr. Jonathan Cavanagh, also of the University of Glasgow, told Reuters Health by email, "There is a strong evidence base in the literature for these relationships. What is relatively new is the exploration of joint pathology, depression, and RA, focused on immune-mediated inflammatory changes."

Dr. Cavanagh said these results may also help researchers understand comorbidities in other immune-mediated inflammatory disorders.

The authors reported no conflicts of interest.


EULAR 2018.

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