Background Depression and anxiety are reported to predict poorer treatment outcomes in rheumatoid arthritis (RA).1 Whether this can be confirmed in larger prospective observational studies using various remission criteria remains to be explored.
Objectives To investigate the predictive value of baseline depression/anxiety on the likelihood of achieving remission in RA as well as the associations between baseline depression/anxiety and the components of the remission criteria at follow-up.
Methods From the prospective, multi-center NOR-DMARD study we included RA patients starting first-time tumour necrosis factor inhibitors (TNFi) and DMARD naïve RA patients starting methotrexate (MTX) between year 2006 and 2012. The following two criteria for depression/anxiety were assessed: 1) the Medical Outcomes Survey Short Form-36 (SF-36) Mental Health subscale (MH)≤56 and 2) the SF-36 Mental Component Summary score (MCS)≤38.2 The predictive value of baseline depression/anxiety on remission after 3 and 6 months treatment was explored in prespecified logistic regression models adjusted for age, sex, disease duration and smoking and the associations between baseline depression/anxiety and the different components of the remission criteria at follow-up in prespecified multiple linear regression models adjusted for age, sex, disease duration and smoking.
Results A total of 1450 RA patients were included (mean (SD) age 54.4 (13.5) years, median (25th-75th percentile) disease duration 0.4 (0.0–5.0) years, 68.7% females and 28.6% current smokers). According to the SF-36MH≤56/SF-36MCS≤38 criteria 18.1/29.9% of the patients were depressed/anxious at baseline, respectively. Lower percentages of patients with versus without baseline depression/anxiety achieved remission at 3 and 6 months treatment (unadjusted analyses, figure). Baseline depression/anxiety negatively predicted remission after 3 and 6 months (adjusted analyses, table 1 and 2).
The findings were confirmed in separate subgroup analyses of TNFi/MTX treated patients. Baseline depression/anxiety were associated with increased patient's and evaluator's global assessment and 28 tender joint count at 3 and 6 months, but not with level of acute phase reactants or 28 swollen joint count.
Conclusions Depression and anxiety may reduce likelihood of remission based on composite scores in RA and should be taken into account in individual patients when making a shared decision on a treatment target.
Matcham et al.Rheumatology. 2016;55(2):268–78
Matcham et al.BMC musculoskel disorders. 2016;17:224.
Disclosure of Interest B. Michelsen: None declared, E. Kristianslund: None declared, K. Fageli: None declared, E. Lie Consultant for: Hospira, Pfizer, UCB, Speakers bureau: AbbVie, Celgene, H. Hammer Consultant for: AbbVie, Pfizer, UCB, Roche, MSD, BMS and Novartis., Speakers bureau: AbbVie, Pfizer, UCB, Roche, MSD, BMS and Novartis., G. Haugeberg: None declared, T. Kvien Consultant for: AbbVie, Biogen, BMS, Boehringer Ingelheim, Celltrion, Eli Lilly, Epirus, Janssen, Merck-Serono, MSD, Mundipharma, Novartis, Oktal, Orion Pharma, Hospira/Pfizer, Roche, Sandoz and UCB, Speakers bureau: AbbVie, Biogen, BMS, Boehringer Ingelheim, Celltrion, Eli Lilly, Epirus, Janssen, Merck-Serono, MSD, Mundipharma, Novartis, Oktal, Orion Pharma, Hospira/Pfizer, Roche, Sandoz and UCB