Symptoms of depression and anxiety predict treatment response and long-term physical health outcomes in rheumatoid arthritis: secondary analysis of a randomized controlled trial

Abstract

Objective. The aim of this analysis is to examine the longitudinal impact of symptoms of depression/anxiety on treatment response, long-term disease activity and physical disability in RA.Methods. Secondary analysis of clinical trial data was performed. Data were collected at baseline and at 6-monthly intervals for 2 years. The EuroQoL (EQ-5DTM) indicated depression/anxiety symptom severity. Our primary outcomes of interest were (i) DAS-28 and (ii) physical disability measured via the HAQ. Secondary outcomes were: tender and swollen joint counts, patient global assessment, ESR and odds of reaching clinical remission. Multilevel models were used to assess the impact of baseline and persistent depression/anxiety on outcomes over 2 years.Results. Data from 379 patients were included. After adjusting for covariates, baseline depression/anxiety symptoms were associated with increased DAS-28 outcomes and increased tender joint counts. Persistent depression/anxiety symptoms were associated with increased DAS-28 scores, HAQ scores, tender joint counts and patient global assessment of disease activity, and reduced odds of reaching clinical remission. Patients with symptoms of depression/anxiety at baseline also showed a 50% reduction in prednisolone treatment effect, in comparison with patients with no symptoms of depression/anxiety at baseline.Conclusion. Baseline and persistent symptoms of depression/anxiety are associated with poorer health outcomes over time, as well as reduced treatment response. Mental health should be routinely measured both in clinical practice and in research, and managed alongside rheumatological disease to optimize health outcomes. Further research is required to examine whether treatment of mental disorders can improve rheumatological outcomes.

The Impact of Adequate Psychopharmacotherapy on the Efficiency of Treatment in Patients With Rheumatoid Arthritis

“…В недавней работе 2016 г. F. Matcham и соавт. [7] сделали те же выводы, а также показали, что депрессия снижает ответ на ГК у больных РА. Проведенное нами исследование также демонстрирует, что персистирую-щие ПР при отсутствии ПФТ способствуют менее зна-чимому снижению индексов воспалительной активно-сти РА, преимущественно за счет ЧБС и ООСЗ, а также уменьшают эффективность БПВП и ГИБП, которая оценивалась по критериям EULAR и динамике индекса SDAI.…”

“…К их числу от-носят женский пол, пожилой возраст, избыточную массу тела, курение, ряд молекулярных биомаркеров, антитела к применяемому ГИБП и некоторые другие [4]. Инте-ресно, что сопутствующие РА расстройства тревожно-депрессивного спектра (РТДС) и когнитивные наруше-ния (КН) в последние годы также рассматривают в каче-стве предикторов недостаточного ответа на терапию БПВП и ГИБП [5][6][7]. Как отмечено в систематическом обзоре A.M. Rathbun и соавт.…”

“…Fiest и соавт. [13], так же как и другие ученые, продемонстрировавшие в сво-их работах негативное влияние РТДС на активность и ис-ходы РА [7,14], указывают на необходимость проведения исследований для уточнения степени влияния адекватной ПФТ РТДС на эффективность терапии РА по примеру ра-бот, с успехом выполненных на группе больных сахарным диабетом (СД), ишемической болезнью сердца (ИБС) и депрессией [15].…”

Effects of psychosocial factors on monitoring treatment effect in newly diagnosed rheumatoid arthritis patients over time: response data from the tREACH study

“…Several previous studies have investigated the effects of psychosocial factors on DAS at subsequent visits. In a secondary analysis of a clinical trial in early RA, Matcham et al (12) found that both baseline and persistent symptoms of depression/anxiety symptoms, measured on a combined scale of the EuroQol 5 Dimensions (EQ-5D), were associated with increased DAS28 scores over the first 2 years of follow-up. This is partly in agreement with our study, in which we found both baseline anxiety and depression scores to be associated with higher DAS at 3 months of follow-up, but not at later time-points (12).…”

“…Recent interest has been directed towards the influence of psychosocial factors. Several studies have reported significant associations between baseline levels of anxiety and/or depression and subsequent DAS or DAS components (10)(11)(12). However, the effects of psychosocial factors after treatment has been initiated on disease activity have not been extensively studied.…”