Background Significant evidence in the scholarly literature suggests that depression is a common comorbidity among patients with rheumatoid arthritis (RA) (1) Comorbid depression in RA patients is especially troublesome because it often goes unrecognized and untreated (2) often because rheumatologists and their patients seldom communicate about depression (3). In addition, evidence of depression in RA patients is limited in Asia studies.

Objectives To determine the prevalence of depression among patients with RA and explore the relationships between depression and an array of variables.

Methods Cross-sectional online survey (n=500) of RA patients including the Patient Health Questionnaire [PHQ-9] (4) to measure the presence and severity of depressive symptoms were performed. The survey contained patient demographic, clinical characteristics such as functional impairment as assessed using the Japanese version of the Stanford Health Assessment Questionnaire (J-HAQ score), and the participant's current medical treatment. Ordered logistic regression was used to identify the determinants of depression conditions among survey respondents.

Results The mean age of the 500 patients with RA was 54.3 years old and 67% were female. While only 25 (5%) of the population studied had been officially diagnosed with depression, 176 (35%) had PHQ-9 scores indicating depression was present. Comorbidity conditions, except for migraine and heart conditions, were not different between patients with depression and those without. Logistic regression analysis revealed a negative correlation between the prevalence of depression and younger age with odds ratio (OR) of 0.96 (95% confidence interval (CI); 0.93–0.98), higher education (OR, 0.60; 95% CI, 0.36–0.98 for a bachelor's degree or higher) and an income level of 0.8–1.6 million yen (OR, 0.45; 95% CI, 0.22–0.91). Positive correlations with depression was found in RA patients with high J-HAQ score (OR, 1.99; 95% CI, 1.47–2.71). Patients treated with biologic monotherapy were significantly less likely to have depression compared to those treated with non-biologic anti-rheumatic drugs (OR, 0.36; 95% CI, 0.17–0.75)

Conclusions It is a potential risk of under-diagnosis and under-reporting of Depression in patients with RARA patients are more likely to experience depression if they are younger, have greater functional impairment, or whose treatment regimen includes pain medications without biologic drugs.

References

1. Dickens C et al. (2002). Psychosom Med. 64(1), 52–60.

2. Nagyova I et al. (2005) Patient Educ Couns. 58(1), 55–62.

3. Sleath B et al. (2008) Arthritis Rheum. 59(2), 186–91.

4. Suzuki K et al. (2015) PLoS One. 10(3), e0119147.

References

Acknowledgements None.

Disclosure of Interest R. Sruamsiri Employee of: Janssen Pharmaceutical KK, Y. Kaneko Paid instructor for: YK has received lecture fees from AbbVie, Eisai Pharmaceutical, Chugai Pharmaceutical, Bristol Myers Squibb, Astellas Pharmaceutical, Mitsubishi Tanabe Pharma Corporation, Pfizer, Janssen, and UCB., J. Mahlich Employee of: Janssen Pharmaceutical KK