Background Psoriasis makes stress in patients and stress could play a role on the onset and exacerbation of psoriasis. Psoriasis and psoriatic arthritis (PsA) are associated with a variety of psychological problems, mainly anxiety and depression, although most of patients suffer from both anxiety and depressive symptoms of limited and equal intensity accompanied by at least some autonomic features and excluding severe anxiety and depressive symptoms (mixed anxiety-depressive disorder or MADD).
Objectives The aim of this study was to describe the prevalence of MADD in clinical practice among PsA patients from our registry on treatment with biological therapy (bDMARDs) and to analyze their possible relation with characteristics of the disease or treatments in these patients.
Methods We included all PsA patients (met CASPAR criteria) following treatment with bDMARDs and included in our regional registry (reference population 2.055.000). Was recorded the history of attending a mental health consultation since PsA diagnoses and before starting biologics therapy and if they were diagnosed as a mixed of anxiety and depression disorder (F41.2, ICD-10) and treated by non severe anxiety and depressive symptoms. We used for this analysis sex, age, disease duration, current bDMARDs with or without current co-medication with csDMARDs (methotrexate or leflunomide or sulfasalazine) and HLA-B27 status. Continuous variables were reported as mean ± standard deviation. Categorical variables were reported as percentages and frequencies. All analyses were performed using SPSS software. Differences were considered statistically significant if p<0.05 (two-tailed).
Results We have registered 604 PsA patients who have been treated with bDMARDs. Three-hundred and twenty nine (54.5%) patients were men, mean age was 53.3±12.6 years and disease duration of PsA was 12.4±8.7 years. MADD was diagnosed in 99 patients (16.4%), and was more frequent in women than in men (21.1% vs 12.5%, p=0.004), with no differences in age of diagnosis and disease duration of PsA, nail disease, dactylitis, uveitis or HLA-B27. MADD was more prevalent in patients with enthesitis (31.9% vs 12.0%, p<0.0001) and PsA with axial involvement was associated with MADD (p=0.003). Etanercept (42%) and adalimumab (36%) were bDMARDs more used -56.2% with associated csDMARDs - and 67.9% of patients remained in the first biologic with a mean follow-up of 4.9 years. Infliximab was most used bDMARDs in patients with previous MADD (p=0.001).
Conclusions Mixed anxiety-depressive disorder was more prevalent in women with PsA in our registry. It was associated more frequently with the axial disease, enthesitis and most use of infliximab like bDMARDs established in these patients.
McDonough E, Ayearst R, Eder L, Chandran V, Rosen CF, Thavaneswaran A, Gladman DD. Depression and anxiety in psoriatic disease: prevalence and associated factors. J Rheumatol. 2014;41(5):887–96.
Acknowledgements The authors are grateful for the support of the members of the Galician Society of Rheumatology (SOGARE).
Disclosure of Interest None declared