Background Rheumatoid arthirtis (RA) and adult juvenile idiopathic arthirtis (AJIA) is associated with a significant impact on psychological well-being.^1-2 UK guidelines for the management of RA^3-5 state that psychological interventions should be offered to people with RA to help them adjust to living with their condition and manage their psychological well-being. Three in four rheumatology units in the UK however, rate their overall provision of psychological support as inadequate.⁶

Objectives To establish levels of anxiety and depression in people with RA or AJIA and how this relates to the prevalence of diagnosed mood disorders and receipt of psychological support.

Methods The 2018 National Rheumatoid Arthirtis Society (NRAS) ‘Emotional Health and Well-being Matters’ survey was designed by patients and researchers. This included a questionnaire designed to capture self-reported comorbidities, receipt of psychosocial support and the Hospital Anxiety and Depression Scale (HADS).⁷ Participants were recruited by NRAS via their social media platforms, membership and non-membership lists and in newsletters and forum. The survey was open from May-July 2018. Recruitment was focused on those diagnosed with RA or AJIA aged 18 years and over and living in the UK.

Results A total of 1565 people with RA and 55 AJIA completed the survey. Although mean scores on the HADS were within the normal range in both populations, over 25% of the samples were experiencing clinical levels of anxiety or depression. Over half of those reporting clinical levels of anxiety or depression had never received a formal diagnosis. Most concerning however, was that 1 in 2 respondents with RA and 1 in 3 AJIA who had either clinical levels or a formal diagnosis of anxiety or depression had never received any psychological support.

Conclusion This survey indicates that despite meeting the criteria for anxiety or depression a majority of people with RA and AJIA have not been formally diagnosed with a mental health condition and many are not receiving the support they should. It is therefore an imperative for rheumatology services to routinely measure anxiety and depression in order to intervene before the individual is in crisis. Acting early by sign-posting and referring on to specialist services has the potential to improve a person’s physical and psychological well-being.

References [1] Packham JC, Hall MA, Pimm TJ. Long−term follow−up of 246 adults with juvenile idiopathic arthritis: predictive factors for mood and pain. Rheumatology 2002; 41(12):1444-1449.

[2] Covic T, Cumming SR, Pallant JF, Manolios N, Emery P, Conaghan PG et al. Depression and anxiety in patients with rheumatoid arthritis: prevalence rates based on a comparison of the Depression, Anxiety and Stress Scale (DASS) and the hospital, Anxiety and Depression Scale (HADS). BMC Psychiatry 2012; 12(1):6.

[3] National Institute for Health and Care Excellence. Rheumatoid arthritis in adults: management NG100. 2018. London, NICE.

[4] Luqmani R, Hennell S, Estrach C, Birrell F, Bosworth A, Davenport G et al. British Society for Rheumatology and British Health Professionals in Rheumatology guideline for the management of rheumatoid arthritis (the first two years). Rheumatology 2006; 45(9):1167-1169.

[5] Luqmani R, Hennell S, Estrach C, Basher D, Birrell F, Bosworth A et al. British Society for Rheumatology and British Health Professionals in Rheumatology guideline for the management of rheumatoid arthritis (after the first 2 years). Rheumatology 2009; 48(4):436-439.

[6] Dures E, Almeida C, Caesley J, Peterson A, Ambler N, Morris M et al. A survey of psychological support provision for people with inflammatory arthritis in secondary care in England. Musculoskeletal Care 2014; 12(3):173-181.

[7] Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica 1983; 67(6):361-370.

Disclosure of Interests None declared