Background Depression is a frequent if not the most frequent comorbidity in patients with rheumatoid arthritis (RA) .
Objectives To investigate the prevalence of depressive symptoms in RA patients in a standardized manner in the clinical setting using two previously validated questionnaires and to test for clinical characteristics associated with depressive symptomatology.
Methods To assess depressive symptoms the validated 9 item version of the patient health questionnaire (PHQ-9) and the Beck-Depression Inventory II (BDI-II) were used. In addition, demographic background, RA disease activity according to DAS28, RA disease symptoms according to the RAID questionnaire, comorbidities and anti-rheumatic as well as anti-depressive treatment were recorded. Cut-off values for depressive symptomatology were PHQ-9≥5 or BDI-II≥14 (ie mild depressive symptoms or worse). Numbers for frequency of depressive symptomatology were derived by frequency analysis while factors independently associated to depressive symptomatology were investigated by odds ratios and 95% confidence intervals using multiple logistic regression analyses. IRB approval was obtained and all patients completed an informed-consent form prior to participation.
Results In 1004 RA-patients (75.1% female, mean age: 61.0±12.9 years, mean disease duration: 12.2±9.9 years, DAS28(ESR): 2.5±1.2) the prevalence of depressive symptoms was 55.4% according to predefined cut-offs (more restrictive cut-offs indicating moderate depressive symptoms at least, i.e. PHQ-9 ≥10 or BDI-II ≥20 still classified 22.8% of our patients as being depressed). Characteristics independently associated with depressive symptomatology were: age >60 years (OR=0.62 (95%CI: 0.46, 0.83)), DAS28(ESR) ≥3.2 (OR=1.52 (95%CI: 1.03, 2.27)), RAID score >5 (OR=8.28 (95%CI: 5.36, 12.80)) and presence of chronic pain (OR=2.55 (95%CI: 1.42, 4.57)). Only 11.7% of patients classified as having depressive symptoms received anti-depressive drug therapy.
Conclusions More than half of RA patients showed symptoms of depression, which were associated with age, RA disease activity, a high impact of RA symptoms on the life of patients and the presence of chronic pain. However, only a small number of RA patients were receiving appropriate anti-depressive therapy. These findings strongly suggest the need for better assessment of depression in routine rheumatologic care.
Dougados M, Soubrier M, Antunez A, et al. Prevalence of comorbidities in rheumatoid arthritis and evaluation of their monitoring: results of an international, cross-sectional study (COMORA). Ann Rheum Dis. 2013.
Disclosure of Interest M. Englbrecht Grant/research support from: Research grant for VADERA: Chugai Pharma Europe Ltd. and Roche Pharma AG, R. Alten Grant/research support from: Roche, Chugai, Speakers bureau: Roche, Chugai, M. Aringer Consultant for: Roche, Chugai, Speakers bureau: Roche, Chugai, C. Baerwald: None declared, H. Burkhardt Grant/research support from: Roche, Chugai, Consultant for: Roche, Chugai, N. Eby Consultant for: Fees from Roche Pharma AG for statistical analysis and manuscript preparation during the conduct of the study, J.-P. Flacke Employee of: Roche Pharma AG, G. Fliedner Consultant for: Roche, Chugai, Paid instructor for: Roche, Chugai, B. Gauger Employee of: Roche Pharma AG, U. Henkemeier: None declared, M. Hofmann Employee of: Chugai Pharma Europe Ltd., S. Kleinert Speakers bureau: Abbvie, Chugai, Pfizer, Roche, UCB, Medac, C. Kneitz Grant/research support from: Pfizer, Consultant for: AbbVie, Janssen, Pfizer, Berlin Chemie, Chugai, Roche, Speakers bureau: AbbVie, Janssen, Pfizer, Berlin Chemie, Chugai,Celgenge, Novartis, Roche, MSD, UCB, K. Krüger Employee of: Chugai Pharma Europe Ltd., R. Lüthje: None declared, C. Pohl: None declared, G. Schett Grant/research support from: Research grant for VADERA: Chugai Pharma Europe Ltd. and Roche Pharma AG, M. Schmalzing Consultant for: Chugai, Novartis, Roche, Speakers bureau: AbbVie, Actelion, BMS, Chugai, Genzyme, Janssen-Cilag, Novartis, Pfizer, Roche, UCB, A.-K. Tausche: None declared, H. P. Tony Grant/research support from: Roche Pharma AG, Consultant for: Abbvie, BMS, Chugai, Janssen, Lilly, Novartis, Roche, UCB, Speakers bureau: Abbvie, BMS, Chugai, Janssen, Lilly, Novartis, Roche, UCB, J. Wendler Consultant for: Roche, Chugai, Speakers bureau: Roche, Chugai