Background the prevalence of stress-related depressive and anxiety disorders in rheumatoid arthritis (RA) patients (pts) is very high. Their associations with disease activity and chronic pain confirmed in several studies related to negative effects on the efficacy of rheumatoid arthritis treatment.
Objectives to determine the impact of anxiety and depressive disorders recovery on the efficacy of RA treatment.
Methods 125 RA pts were enrolled in this study. 86% RA pts were women with a mean age of 47.4±11.3. The disease activity was assessed by DAS28 score. 52% of RA pts had a high activity of disease (DAS28>5,1). 67% RA pts were taking prednisone in mean dose 5±2.7 mg/day. 80% RA pts were taking DMARDs: most of them - methotrexate (45%) and leflunomide (21%). All patients were taking NSADs. Psychiatric disorders were diagnosed in accordance with the ICD-10. Psychiatric scales used: Hospital Anxiety and Depression Scale, Hamilton Anxiety Rating Scale, Perceived Stress Scale.
Results depressive and anxiety disorders were diagnosed in 117 (93.6%) RA pts: depressive episodes had 46 (36,8%) patients, dysthymia - 41 (32,8%), adjustment disorders - 21 (16,8%), generalized anxiety disorder - 9 (7,2%). Stress events preceded the RA onset in 77,6% of pts. 44% RApts with anxiety/depressive disorders were successfully treated by antidepressants (sertraline or mianserine). 56% RApts refused from treatment of depression. Both groups of RApts (treated and not treated with antidepressants) received similar standard RAtreatment (low doses of prednisone, DMARDs and NSADs). Efficacy of RA treatment was evaluated in one year according EULAR response criteria (“good – moderate – none”) using DAS28-score improvement from baseline. “Good response” was detected in 50% pts received standard RA treatment and antidepressants and 23% pts received standard RA treatment without antidepressants (p=0,024). “Moderate response” was detected in 25,5% pts received standard RA treatment and antidepressants and 23% pts received only standard RA treatment without antidepressants (p=NS). “None response” was detected in 25,5% pts received standard RA treatment and antidepressants and 54% pts received only standard RA treatment without antidepressants (p=0,013). In a linear regression model the presence of antidepressant treatment (β = 0.22, p < 0.05) was independently associated with the “good response” for the RA-treatment.
Conclusions the results have confirmed the improvement of RA treatment efficacy after successful depressive and anxiety disorders recovery due to antidepressants course. It may be associated as with the patient’s compliance improvement, as with the direct anti-inflammatory and pain relieving effects of antidepressants.
Disclosure of Interest None Declared