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THU0591-HPR The Longitudinal Impact of Persistent Depression on Physical Health Outcomes in Rheumatoid Arthritis
  1. F. Matcham1,
  2. S. Norton2,
  3. D.L. Scott3,
  4. S. Steer3,
  5. M. Hotopf1
  1. 1Psychological Medicine
  2. 2Psychology Department, King's College London
  3. 3Department of Rheumatology, King's College Hospital, London, United Kingdom


Background Depression is highly prevalent in RA and is associated with increased mortality, disability and healthcare costs [1, 2]. There is limited evidence assessing the longitudinal impact of depression on RA outcomes, particularly objectively-reported clinical outcomes.

Objectives To assess the impact of persistent depression on physical health outcomes over a 2-year follow-up period.

Methods A secondary data analysis of a clinical trial (CARDERA) was performed [3]. Depression and physical health outcomes were measured at baseline and 6-montly intervals for 2-years. Depression was measured using the EQ-5D, and patients were categorised into 4 groups: 1) never depressed; 2) depressed at <50% of time-points; 3) depressed at >50% of time-points; and 4) depressed at every time-point. Physical health outcomes were: Larsen score; tender joint count (TJC); swollen joint count (SJC); ESR; assessor and patient global assessments (AGA/PGA); HAQ; pain; and DAS-28.

Results Data was available for 379 patients. Patients' mean age was 54.1 (12.3), and 68.3% of the sample were female. In total, 25.9% were never depressed, 36.9% were depressed <50% of the time, 27.4% were depressed >50% of the time, and 15.8% were depressed at every time-point.

Table 1.

Fully adjusted multilevel models for physical health outcomes (effect size), with depression persistence as predictor variable

Conclusions Increasing persistence of depression over time tends to be associated with poor physical health outcomes, with discordance between subjectively and objectively measured outcomes. These findings have significant implications: mental health should be measured and monitored throughout the course of treatment [4]; DAS-28 scores may be inflated in depressed patients, which needs to be considered when making treatment decisions.


  1. Matcham F et al. The prevalence of depression in Rheumatoid Arthritis: A systematic review and meta-analysis. Rheumatology 2013; 52: 2136-48.

  2. Bruce T. Comorbid depression in rheumatoid arthritis: Pathophysiology and clinical implications. Current Psychiatry Reports 2008; 10: 258-64.

  3. Choy EHS et al. Factorial randomised controlled trial of glucocorticoids and combination disease modifying drugs in early rheumatoid arthritis. Ann Rheum Dis 2008; 67: 656-63.

  4. Rayner L et al. Embedding integrated mental health assessment and management in general hospital settings: feasibility, acceptability and the prevalence of common mental disorder. Gen Hosp Psychiatr (in press), doi: 10.1016/j.genhosppsych.2013.12.004.

Disclosure of Interest : None declared

DOI 10.1136/annrheumdis-2014-eular.2878

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