Background Mental disorders such as anxiety and depression are highly prevalent in SLE patients,[1] yet their association with the underlying disease activity remains elusive and has been mostly evaluated at cross-sectional level.[2] This is further complicated by the often-increased rates of treatment non-adherence,[3] an important determinant of heightened lupus activity, among patients with depression.[4]

Objectives To examine the relationship between longitudinal changes in anxiety (ICD-10-CM F41.9), depression (ICD-10-CM F32.x) and disease activity levels in adult SLE patients. Second, to test the association between the aforementioned mental disorders with treatment adherence and sociodemographic factors.

Methods A prospective 6-month observational study of outpatients aged 18-65 years who fulfilled the EULAR/ACR 2019 classification criteria and had active disease ascertained by a SLEDAI-2K ≥3 and PGA (physician global assessment; scale 0–3) >1. Patients were enrolled by consecutive sampling technique during May-September 2021. Excluding criteria were overlap rheumatic diseases, active neuropsychiatric lupus, ongoing pregnancy or post-partum period, history of dementia or malignancy. Sociodemographic factors (age, disease duration, education level, working status) and comorbidities were collected. Anxiety and depression levels (assessed with the Hospital Anxiety and Depression Scale [HADS-A/D subscales]), disease activity (SLEDAI-2K, PGA), use of medications, and treatment adherence (Morisky Medication Adherence Scale-4 items scale) were monitored during the observation period.

Results Forty SLE patients (39 females) with an average [standard deviation] age 50.5 (10.3) years and disease duration 10.3 (7.0) years, were enrolled. Baseline SLEDAI-2K was 6.0 (2.0) driven predominantly from the musculoskeletal and mucocutaneous domains. The prevalence of anxiety (HADS-A >11) and depression (HADS-D >8) were 42.5% and 45.0%, respectively. During follow-up, disease activity was significantly reduced (average [SD] reduction in SLEDAI-2K: 1.90 [2.80], p<0.001), however, anxiety and depression levels remained unchanged (average [SD] change in HADS-A -0.05 [3.76] and HADS-D 0.53 [3.25], respectively, p>0.300 for both). Accordingly, Spearman’s non-parametric test showed that longitudinal changes in SLEDAI-2K were not significantly correlated with the corresponding changes in the HADS-A (rho = 0.13, p=0.417) or HADS-D (rho = -0.05, p=0.781) scores. Treatment non-adherence was found in 19 patients (47.5%) but did not correlate with anxiety and depression (p>0.500 for both). Notably, mental disorders were not significantly associated with comorbidities (including fibromyalgia) but unemployment status predicted the presence of anxiety (odds ratio 7.73, p-value 0.018).

Conclusion Anxiety and depression are frequent comorbidities in active SLE and do not correlate with short-term disease improvement, thus underscoring the need for adjunct treatment. Physician awareness in the detection of treatment adherence is necessary. Larger studies in early disease and with longer follow-up will be required to further explore the possible interaction between of mental disorder and lupus disease course.

References [1]Zhang L, et al. BMC Psychiatry. 2017;17(1).

[2]Tay SH, et al. Lupus. 2015;24(13):1392–9.

[3]Costedoat-Chalumeau N, et al. Clin Pharmacol Ther. 2018;103(6):1074–82.

[4]Alsowaida N, et al. Lupus. 2018;27(2):327–32.

Disclosure of Interests None declared