Factors associated with anxiety and depression in rheumatoid arthritis patients: a cross-sectional study

Abstract

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.

The impact of depression and anxiety on pain reported by patients with rheumatoid arthritis undergoing treatment

“…We also confirmed the studies that showed the association of depression and anxiety with physical dysfunction (Jamshidi et al, 2020;Uda et al, 2021), being described that the association of moderate to severe depression with physical dysfunction is independent of disease activity (Isnardi et al, 2021).…”

“…In women with RA, an association of depression with all components of the Clinical Disease Activity Index was observed, which also does not include laboratory markers of inflammation (Sautner, Puchner, Akin, &Pieringer, 2020). However, some authors have not demonstrated an association between depression and disease activity when assessed using the DAS-28 (Jamshidi et al, 2016;Juáres-Rojop et al, 2020;Uda et al, 2021). Others showed a significant association of depression only with subjective components of the DAS-28, such as the number of painful joints and global health assessment, both in cross-sectional studies (Michelsen et al, 2017) and after one year of treatment (Boer, Huizinga, & van der Helm-van Mil, 2019).…”

Anxiety and depression in rheumatoid arthritis patients: prevalence, risk factors and consistency between the Hospital Anxiety and Depression Scale and Zung’s Self-rating Anxiety Scale/Depression Scale

“…One previous study indicated that depression and anxiety rates are 50.3 and 25.3% in RA patients, respectively [ 12 ]. In another study, 17.6% of RA patients had anxiety and 27.7% of RA patients had depression [ 26 ]. Partly in line with these studies, we reported that the anxiety and depression rates were 29.4 and 29.4% according to the SAS/SDS questionnaire and 36.9% and 36.3% according to the HADS questionnaire, respectively, which were notably higher than those in HCs.…”

Prevalence, Severity, and Measures of Anxiety in Rheumatoid Arthritis: A Systematic Review

“…17 The inclusion and measurement of clinical variables varied considerably across the studies. The following variables were found to be associated with higher levels of anxiety: greater disease activity, 26,27,30,31,34,36,41,47,50,52 greater functional disability, 15,19,22,28,30,40,45,46,51 longer disease duration, 30,46,52,56 pain, 19,22,27,28,31,43,45,46,55 fatigue, 31,33 use of medication for pain, 26 use of anti-tumor necrosis factor medications, 57 rheumatoid factor seropositivity, 52 presence of nodules, 52 inflammation measured by erythrocyte sedimentation rate, 26 lower levels of immunoglobulin A, 56 and overall worse physical health. 26 In relation to other comorbid psychiatric conditions, 27 studies examined an association between anxiety and depression, with 14 of those reporting depression to be significantly associated with anxiety.…”