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Do depression and anxiety reduce the likelihood of remission in rheumatoid arthritis and psoriatic arthritis? Data from the prospective multicentre NOR-DMARD study
  1. Brigitte Michelsen1,2,3,
  2. Eirik Klami Kristianslund1,
  3. Joseph Sexton1,
  4. Hilde Berner Hammer1,
  5. Karen Minde Fagerli1,
  6. Elisabeth Lie1,
  7. Ada Wierød4,
  8. Synøve Kalstad5,
  9. Erik Rødevand6,
  10. Frode Krøll7,
  11. Glenn Haugeberg3,8,
  12. Tore K Kvien1
  1. 1Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
  2. 2Department of Rheumatology, Hospital of Southern Norway Trust, Kristiansand, Norway
  3. 3Norwegian University of Science and Technology, Trondheim, Norway
  4. 4Department of Rheumatology, Vestre Viken/Drammen Hospital, Drammen, Norway
  5. 5Department of Rheumatology, University Hospital of Northern Norway, Tromsø, Norway
  6. 6Department of Rheumatology, St. Olavs Hospital, Trondheim, Norway
  7. 7Department of Rheumatology, Lillehammer Hospital for Rheumatic Diseases, Lillehammer, Norway
  8. 8Department of Rheumatology, Martina Hansens Hospital, Bærum, Norway
  1. Correspondence to Dr Brigitte Michelsen, Department of Rheumatology, Diakonhjemmet Hospital, Vinderen, N-0319 Oslo, Norway; brigitte_michelsen{at}


Objective To investigate the predictive value of baseline depression/anxiety on the likelihood of achieving joint remission in rheumatoid arthritis (RA) and psoriatic arthritis (PsA) as well as the associations between baseline depression/anxiety and the components of the remission criteria at follow-up.

Methods We included 1326 patients with RA and 728 patients with PsA from the prospective observational NOR-DMARD study starting first-time tumour necrosis factor inhibitors or methotrexate. The predictive value of depression/anxiety on remission was explored in prespecified logistic regression models and the associations between baseline depression/anxiety and the components of the remission criteria in prespecified multiple linear regression models.

Results Baseline depression/anxiety according to EuroQoL-5D-3L, Short Form-36 (SF-36) Mental Health subscale ≤56 and SF-36 Mental Component Summary ≤38 negatively predicted 28-joint Disease Activity Score <2.6, Simplified Disease Activity Index ≤3.3, Clinical Disease Activity Index ≤2.8, ACR/EULAR Boolean and Disease Activity Index for Psoriatic Arthritis ≤4 remission after 3 and 6 months treatment in RA (p≤0.008) and partly in PsA (p from 0.001 to 0.73). Baseline depression/anxiety was associated with increased patient’s and evaluator’s global assessment, tender joint count and joint pain in RA at follow-up, but not with swollen joint count and acute phase reactants.

Conclusion Depression and anxiety may reduce likelihood of joint remission based on composite scores in RA and PsA and should be taken into account in individual patients when making a shared decision on a treatment target.

  • rheumatoid arthritis
  • psoriatic arthritis
  • remission
  • depression
  • anxiety

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  • Contributors BM, EKK, JS, HBH, KMF, EL, GH and TKK were responsible for study design. AW, SK, ER, FK and TKK were responsible for data acquisition. BM analysed the data and wrote the manuscript. All authors critically revised the manuscript and approved the final version.

  • Funding The study was funded through a clinical research fellowship from Diakonhjemmet Hospital, originating from South-Eastern Health Authority. Data collection in NOR-DMARD was partly funded through unrestricted grants from Abbvie, BMS, MSD, Pfizer (Wyeth), Roche and UCB.

  • Competing interests HBH has received fees for speaking and/or consulting from AbbVie, Pfizer, UCB, Roche, MSD, BMS and Novartis. TKK has received fees for speaking and/or consulting from AbbVie, Biogen, BMS, Boehringer Ingelheim, Celgene, Celltrion, Eli Lilly, Epirus, Hospira, Merck-Serono, MSD, Mundipharma, Novartis, Oktal, Orion Pharma, Hospira/Pfizer, Roche, Sandoz and UCB and received research funding to Diakonhjemmet Hospital from AbbVie, BMS, MSD, Pfizer, Roche and UCB. All other authors have declared that no competing interests exist.

  • Provenance and peer review Not commissioned; externally peer reviewed.