Background Rheumatoid arthritis (RA) patients can cause joint swelling and tenderness, and affect the patient's mental health. Previous studies showed that 13–47% of RA patients suffered from anxiety and/or depression. Hospital anxiety and depression scale (HADS) is usually used to evaluate patients' mental health, which consists of 14 items divided into an anxiety subscale (HADS-A) and a depression subscale (HADS-D). Disease activity score in 28 joints (DAS28) is one of the most used tool to assess RA patients' disease activity. Both HADS and DAS28 assessments were commonly led by health professionals with paper questionaire. This study applies the mobile platform of Smart System of Disease Management (SSDM) for evaluating DAS28 and HADS by RA patients.
Objectives The purpose of this study is to describe the morbidity of mental comorbidity in Chinese patients with RA and analyze the potential association among DAS28 and HADS.
Methods SSDM is a mobile application includes physicians' and patients' interfaces. The patient's terminal system includes self-assessment (DAS28, HADS), lab test results and medication management. After data entry, patients can synchronize data to the mobile terminal of their authorized rheumatologist. A cohort study was conducted with patients who were diagnosed with RA in tertiary hospital across China. All participants self-assessed both DAS28 and HADS with SSDM at least one time. Descriptive statistics were performed for patient and disease characteristics, assuming normality for DAS28 distribution and the level of disease activity was analyzed using Pearson's statistics. One-way analysis of variance was employed to explore for difference between sub-groups. Bivariate correlation and linear logistic analysis were employed to explore for potential correlation between DAS28 and HADS.
Results From June 2016 to January 2017, 230 patients (male 66, female 164) from 12 hospitals performed 311 times HADS and 517 times DAS28 self-assessment. The mean (±SD) age was 34.17±13.11 (11–71) years, with the median disease duration of 24.70 (0–572) months. As the standard of HADS score higher than 10, 31% and 37% patients could be diagnosed as anxiety and depression respectively. According to the DAS28 assessment results, the proportion of patients with remission, low disease activity, moderate activity and high activity were 18%, 19%, 46% and 18% respectively. Bivariate correlation showed that DAS28 was positively correlated with HADS, p<0.001. Both HADS-A and HADS-D showed linear regression association with DAS28 score, the regression equation as “HADS-A = 5.962 + 0.435*DAS28” and “HADS-D = 6.379 + 0.694*DAS28” respectively, p<0.001.
Conclusions DAS28 was positively correlated with HADS. SSDM is an effective mobile interface to serve for RA patients performing self-management of both disease activity and mental health as well as to supply physicians with valuable data.
Disclosure of Interest None declared