Study: Depression, Anxiety Reduce Likelihood of Achieving Minimal Disease Activity in PsA Patients

A recently published study in Arthritis Care & Research found anxiety and depression symptoms reduced the possibility of achieving sustained minimal disease activity in psoriatic arthritis (PsA).

“The number of comorbidities may be variable in PsA patients, but around 50% of patients are afflicted by at least one comorbidity,” the study investigators wrote. “Anxiety and depression are important comorbidities that have hitherto been less addressed. Emotional well-being is now strongly recommended to be included in the updated PsA Core Domain Set for randomized controlled trials and longitudinal observational studies.”

“Both depression and anxiety were identified as key domains of health when developing the PsA impact of disease [PsAID] questionnaire, a questionnaire that is used to calculate a score reflecting the impact of PsA from the patients’ perspective,” they stated. “In clinical practice, one aims to treat disease to attain a state of minimal disease activity [MDA] or, ideally, remission to improve long-term outcomes. Coates et al have defined criteria for MDA in PsA. Currently, there are few publications reporting the relationship between mental health and achieving MDA.”

In order to determine if there was a link between depression and anxiety and achieving sustained minimal disease activity in PsA, investigators observed 743 adult patients at the University of Toronto Psoriatic Arthritis from 2008 to 2017.

Depression or anxiety were defined as a 38 or lower on the Mental Component Summary score of the SF‐36 questionnaire, 56 or lower on the Mental Health sub‐scale score, or a diagnosis or treatment for either anxiety or depression from a rheumatologist.

The number of study participants that had anxiety or depression was 331 based on the first definition, 364 based on the second, and 211 based on the third.

Study results showed 45.36% (337) participants failed to achieve sustained MDA. Also, both depression and anxiety were found to be linked to a decreased possibility of achieving sustained MDA,with ORs of 0.3 (P < .0001), 0.34 (P < .0001) and 0.47 (P < .0001) based on the 3 definitions, respectively.

Additionally, other factors associated with a decreased likelihood of achieving sustained MDA were the Charlson comorbidity index and the presence of fibromyalgia.

“We demonstrate that the presence of depression/anxiety, regardless of the method used to define it, is associated with a lower probability of achieving sustained MDA in PsA patients,” the study investigators concluded, “Comprehensive management of PsA should therefore include measures for addressing anxiety and depression so that more patients achieve a state of MDA.”

Reference:

1. Wong A, Ye JY, Cook RJ, Gladman DD, Chandran V. Depression and anxiety reduce the probability of achieving a state of sustained minimal disease activity in patients with psoriatic arthritis. Arthritis Care & Research. n/a(n/a). doi:https://doi.org/10.1002/acr.24593