Background Depression is more common among rheumatoid arthritis (RA) patients than in the general population. Depressive symptoms (DS) may increase work disability (WD), and also reduce treatment adherence in RA.
Objectives Our aim was to investigate the impact of DS on cumulative work disability (WD) in early RA.
Methods In the NEO-RACo trial, 99 patients with active early RA, whose therapy was aimed at strict remission, were treated with a triple combination of conventional synthetic DMARDs and low-dose prednisolone for 2 years, and randomized to receive either infliximab or placebo for the initial 6 months. The patients were from 18 to 60 years of age, and working or available for work. DS were evaluated at baseline, 8, 12 and 24 months with the depressive symptoms question from the 15D instrument for measuring health-related quality of life, and converted into population weighed utility values. Data on WD days per person-year were collected. Patients were divided into three groups based on DS Utility Area Under the Curve (AUC) 0–24 months (0 to 1) and mean WD days per group were calculated. Factors associated with DS Utility AUC 0–24 months were evaluated with Spearman correlation. A multivariate forward stepwise Poisson regression model was used to evaluate predictors of WD due to significant colinearity.
Results Data on WD days were available for all patients. In patients with no DS (n=44, utility AUC 1.0) during the follow-up, mean WD days per person-year were 7.7 (95% Confidence Interval 3.6 to 11.8), in patients with mild to moderate DS (n=34, utility AUC 0.870 to <1.0) mean WD days per person-years were 72.1 (CI 13.1 to 131.0), and respective figures for patients with severe DS (n=32, utility AUC <0.870) were 71.5 (CI 28.0 to 114.9). Following factors were associated with DS Utility AUC 0–24 months: Patient's Global Assessment AUC 0–24 months -0.46 (95% CI -0.60 to -0.29), p<0.001 and Physician's Global Assessment AUC -0.30 (-0.47 to -0.11), p=0.002, Pain (Visual Analogue Scale) AUC 0–24 months -0.38 (-0.54 to -0.19), p<0.001 and Health Assessment Questionnaire AUC 0–24 months -0.39 (-0.54 to -0.21), p<0.001. In the presence of any DS during the follow-up (utility <1.0), the risk for WD was elevated with an unadjusted Rate Ratio (RR) of 9.36 (CI 4.45 to 19.68). After adjusting for sex, age, and DAS28 AUC 0–24 months the RR was 6.42 (CI 2.95 to 13.97), p<0.001. With forward stepwise selection, and age, sex, baseline DS, treatment group, baseline DAS28, and rheumatoid factor included in the model, only age, baseline DS and treatment group remained as significant predictors of WD.
Conclusions Depressive symptoms, measured with the depressive symptoms question from the 15D, are associated with an increased likelihood of work disability in early RA.
Leirisalo-Repo M, Kautiainen H, Laasonen L, et al. Infliximab for 6 months added on combination therapy in early rheumatoid arthritis: 2-year results from an investigator-initiated, randomised, double-blind, placebo-controlled study (the NEO-RACo Study). Ann Rheum Dis 2013 Jun;72(6):851-857.
Acknowledgements The authors would like to thank all participating patients, study nurses, and co-investigators.
Disclosure of Interest None declared
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.