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Objective Although mental disorder is one of the most common comorbidities of rheumatoid arthritis (RA) and is known as a critical influence on RA remission rates, there is little knowledge regarding a possible therapeutic strategy for depression or anxiety in a RA population. Most recently, clinical evidence of dietary improvement for depression has emerged in a general population, but the relationship between dietary habits and mental disorder has not been investigated in RA. The purpose of this study is to elucidate clinical associations between mental disorder (depression/anxiety), dietary habits and disease activity/physical function in patients with RA. Methods A cross-sectional study was performed with 267 female outpatients from the KURAMA database. Using the Hospital Anxiety and Depression Scale (HADS), we classified the participants into three groups by depression state, and their characteristics were compared. Using the 20-items on the self-reported food frequency questionnaire, we investigated the relationship between dietary habits and depression or anxiety, adopting a trend test and a multivariate standardized linear regression analysis for the HADS score of depression or that of anxiety as a dependent variable. Results According to the classified stage of depression, current disease activity (DAS28-CRP: 28-Joint RA Disease Activity Score-C-reactive protein) and the health assessment questionnaire disability Index (HAQ-DI) were significantly increased. Trend analyses revealed that the depression score was inversely associated with the consumption of three food (fish, vegetables and fruit) out of twenty as was the anxiety score with only fish intake. Furthermore, multiple linear regression analysis revealed that the depression score was negatively associated with frequent fish intake (≥ 3 times per week) (Estimate -0.53, p = 0.033), HAQ-DI score within normal range (Estimate -0.88, p ≤ 0.001) and MTX use (Estimate -0.60, p ≤ 0.023). For the anxiety score, multivariate analysis showed similar but not significant associations with variables except for HAQ-DI score. Conclusions In a RA population, both depression and anxiety had a significant and negative association with HAQ-DI score, and depression rather than anxiety had negative association with frequent fish intake. Modification of dietary habits such as increased fish consumption may have a beneficial effect on the depression state in RA patients.

Objective. Pain is one of the main symptoms of patients with rheumatoid arthritis (RA). Pain in RA is caused by specific physical changes, such as joint destruction, and is therefore used as a disease activity marker. Although pain can also be influenced by emotional factors, neither the effect of emotional health nor the indirect effect of the physical state mediated by emotional health on pain has been quantified.Methods. A total of 548 patients with RA participated. Emotional health was assessed using the Hospital Anxiety and Depression Scale (HADS). Measures routinely used in practice were used to evaluate the physical state and pain. To quantify the effects of the physical state on emotional health, and the effects of both physical and emotional health on pain, we used structural equation modeling, with emotional health, physical state, and pain as latent variables.Results. The prevalence of anxiety and depression (HADS score ≥8 for each) among patients with RA was 18.7% and 29.4%, respectively. Emotional health was significantly influenced by the physical state (β = 0.21). Pain was affected by physical (β = 0.54) and emotional health (β = 0.29). The effect of the physical state on pain was mediated by emotional health, with this mediation effect (β = 0.06) accounting for 10.2% of the total effect.Conclusion. The magnitude of pain in RA is determined by the mediation effect of emotional health as well as the direct physical state. Our findings suggest that emotional factors should be taken into account when assessing RA disease activity.

Background The management of anxiety and depression symptoms in rheumatoid arthritis (RA) patients is vital. Previous study findings on this topic are conflicting, and the topic remains to be thoroughly investigated. This study aimed to clarify the association of RA disease activity with anxiety and depression symptoms after controlling for physical disability, pain, and medication. Methods We conducted a cross-sectional study of RA patients from the Kyoto University Rheumatoid Arthritis Management Alliance cohort. We assessed patients using the Disease Activity Score (DAS28), Health Assessment Questionnaire Disability Index (HAQ-DI), and Hospital Anxiety and Depression Scale (HADS). Anxiety and depression symptoms were defined by a HADS score ≥ 8. We analyzed the data using multivariable logistic regression analyses. Results Of 517 participants, 17.6% had anxiety symptoms and 27.7% had depression symptoms. The multivariable logistic regression analysis demonstrated that DAS28 was not independently associated with anxiety symptoms (odds ratio [OR] [95% confidence interval; CI] 0.93 [0.48–1.78]; p = 0.82) and depression symptoms (OR [95% CI] 1.45 [0.81–2.61]; p = 0.22). However, DAS28 patient global assessment (PtGA) severity was associated with anxiety symptoms (OR [95% CI] 1.15 [1.02–1.29]; p = 0.03) and depression symptoms (OR [95% CI] 1.21 [1.09–1.35]; p < 0.01). Additionally, HAQ-DI scores ≤ 0.5 were associated with anxiety symptoms (OR [95% CI] 3.51 [1.85–6.64]; p < 0.01) and depression symptoms (OR [95% CI] 2.65 [1.56–4.50]; p < 0.01). Patients using steroids were more likely to have depression than those not using steroids (OR [95% CI] 1.66 [1.03–2.67]; p = 0.04). Conclusions No association was found between RA disease activity and anxiety and depression symptoms in the multivariable logistic regression analysis. Patients with high PtGA scores or HAQ-DI scores ≤ 0.5 were more likely to experience anxiety and depression symptoms, irrespective of disease activity remission status. Rather than focusing solely on controlling disease activity, treatment should focus on improving or preserving physical function and the patient’s overall sense of well-being.

Introduction / objectives Management of anxiety and depression in rheumatoid arthritis (RA) patients is vital. Previous studies investigating this topic are conflicting, and this topic still has not been thoroughly investigated. This study aimed to clarify the association of disease activity with anxiety and depression after controlling for physical disability, pain, and treatment.Method We conducted a cross-sectional study of RA patients from the Kyoto University Rheumatoid Arthritis Management Alliance cohort. For assessments, we used the Disease Activity Score (DAS28), Health Assessment Questionnaire Disability Index (HAQ-DI), and Hospital Anxiety Depression Scale.Depression and anxiety were defined by a Hospital Anxiety Depression Scale score ≥8. We then performed multivariable logistic regression analyses. ResultsOf 517 participants, 17.9% had anxiety, and 28.2% had depression. The multivariable logistic regression analyses showed patients with DAS28-based non-remission had low association with anxiety (odds ratio [OR] [95% confidence interval {CI}], 0.93 [0.48-1.78]: p = 0.82) but slight association with depression (OR [95% CI], 1.45 [0.81-2.61]: p = 0.22). However, severity of the patient's global assessment (PtGA) on DAS28 was associated with anxiety (OR [95% CI], 1.15 [1.02-1.29]; p = 0.03) and depression (OR [95% CI], 1.21 [1.09-1.35]; p < 0.01). Additionally, HAQ-DI-based non-remission was associated with anxiety (OR [95% CI], 3.51 [1.85-6.64]; p < 0.01) and depression (OR [95% CI], 2.65 [1.56-4.50]; p < 0.01). Younger patients (OR [95% CI], 0.83 [0.68-1.01]; p = 0.07) and patients not treated with methotrexate (OR [95% CI], 0.67 [0 .40-1.13]; p = 0.13) tended to suffer from anxiety. Patients using steroids had a closer association with depression than those not using them (OR [95% CI], 1.66 [1.03-2.67]; p = 0.04).Conclusions Assessment of disease activity, PtGA, and HAQ-DI are important for assessing anxiety and depression in RA patients. Attention should be paid to improving PtGA and physical function.

Background Management of anxiety and depressive symptoms in rheumatoid arthritis (RA) patients is vital. Previous studies investigating this topic are conflicting, and this topic still has not been thoroughly investigated. This study aimed to clarify the association of disease activity with anxiety and depressive symptoms after controlling for physical disability, pain, and treatment.Methods We conducted a cross-sectional study of RA patients from the Kyoto University Rheumatoid Arthritis Management Alliance cohort. For assessments, we used the Disease Activity Score (DAS28), Health Assessment Questionnaire Disability Index (HAQ-DI), and Hospital Anxiety Depression Scale. Depression and anxiety were defined by a Hospital Anxiety Depression Scale score ≥8. We then performed multivariable logistic regression analyses.Results Of 517 participants, 17.9% had anxiety and 28.2% had depression. The multivariable logistic regression analyses showed that DAS28-based non-remission was not statistically associated with anxiety symptoms (odds ratio [OR] [95% confidence interval {CI}], 0.93 [0.48–1.78]: p = 0.82) and depressive symptoms (OR [95% CI], 1.45 [0.81–2.61]: p = 0.22). However, severity of the patient’s global assessment (PtGA) on DAS28 was associated with anxiety symptoms (OR [95% CI], 1.15 [1.02–1.29]; p = 0.03) and depressive symptoms (OR [95% CI], 1.21 [1.09–1.35]; p < 0.01). Additionally, HAQ-DI-based non-remission was associated with anxiety symptoms (OR [95% CI], 3.51 [1.85–6.64]; p < 0.01) and depressive symptoms (OR [95% CI], 2.65 [1.56–4.50]; p < 0.01). Patients using steroids had a closer association with depressive symptoms than those not using them (OR [95% CI], 1.66 [1.03–2.67]; p = 0.04).Conclusions As per the multivariable logistic regression analysis, there was no association between DAS28-based-non-remission and anxiety and depressive symptoms; however, the univariate analysis revealed such association. In the multivariate analysis, PtGA and non-remission on HAQ were associated with anxiety and depressive symptoms. Rather than focusing solely on controlling disease, activity and treatment should focus on improving or preserving physical function and patient's overall sense of well-being.

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BackgroundAlthough depression is one of the most common comorbidities of rheumatoid arthritis (RA) and is known as a critical influence on RA remission rates, there is little knowledge regarding a possible therapeutic strategy for depression in a RA population. Most recently, clinical evidence of dietary improvement for depression has emerged in a general population, but the relationship between dietary habits and depression has not been investigated in RA. The purpose of this study is to elucidate clinical associations between depression, dietary habits and disease activity/physical function in patients with RA.MethodsA cross-sectional study was performed with 267 female outpatients from the KURAMA database. Using the Hospital Anxiety and Depression Scale (HADS), we classified the participants into three groups by depression state, and their characteristics were compared. Using the 20-items on the self-reported food frequency questionnaire, we investigated the relationship between dietary habits and depression or anxiety, adopting a trend test and a multivariate standardized linear regression analysis for the HADS score as a dependent variable.ResultsClassification of the depressive state revealed that current disease activity and physical dysfunction (28-Joint RA Disease Activity Score-C-reactive protein (DAS28-CRP) as well as the health assessment questionnaire disability Index (HAQ)) were significantly increased according to the stage of depression. Trend analysis identified three of 20 foods, i.e., fish, vegetables and fruit, the consumption of which was inversely associated with the depression score. Furthermore, multiple linear regression analysis revealed that the depression score was negatively associated with frequent fish intake (> 3 times per week) (Estimate -0.53, p = 0.033) as well as remission of HAQ (Estimate -0.88, p ≤ 0.001). For the anxiety score, none of the dietary habits showed any correlation in the multiple regression analysis.ConclusionDepression state assessed by HADS score was significantly and independently associated with both fish intake frequency and remission of physical dysfunction in an RA population. Modification of dietary habits, such as that by increased fish consumption, may have a beneficial effect on the depression state in RA patients.