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

Abstract

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.