Background Depression and anxiety are frequent comorbidities in psoriatic arthritis (PsA). Still, the potential influence of depression/anxiety on achievement of remission remains unexplored.
Objectives To investigate the predictive value of baseline depression/anxiety on the likelihood of achieving remission in PsA, 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 observational NOR-DMARD study we included PsA patients starting first-time methotrexate/tumor necrosis factor inhibitors between year 2006 and 2012. The following criteria for depression/anxiety were assessed: 1) the Medical Outcomes Survey Short Form-36 (SF-36) Mental Health subscale (MH)≤56 and 2) SF-36 Mental Component Summary score (MCS)≤38.1 The predictive value of baseline depression/anxiety on remission at 3 and 6 months was explored in prespecified logistic regression models adjusted for age, sex, disease duration and smoking, and the associations between baseline depression/anxiety and the components of the remission criteria at follow-up in prespecified multiple linear regression models adjusted for age, sex, disease duration and smoking.
Results 805 PsA patients were included (mean (SD) age 48.0 (12.4) years, median (25th-75th percentile) disease duration 1.0 (0.07–6.8) years, 50.8% females, 28.6% current smokers). According to the SF-36MH≤56/SF-36MCS≤38 criteria 15.6/25.2% of the patients had depression/anxiety at baseline, respectively. Lower percentages of patients with vs. without baseline depression/anxiety achieved remission at 6 months (unadjusted analyses;figure). Patients with baseline depression/anxiety had consistently lower point estimates for achievement of remission at follow-up, but did not reach significance for all the analyses (adjusted analyses, table).
Baseline depression/anxiety was associated with increased patient's global assessment and joint pain at follow-up, but not with swollen joint count or levels of acute phase reactants.
Conclusions Depression and anxiety may reduce likelihood of remission based on composite scores in PsA. These observations support a focus on depression and anxiety as comorbidities in a treat-to-target strategy and may also reflect that patient reported outcome measures are part of all these composite measures used to define remission.
Matcham et al. BMC Musculoskelet Disord. 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