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Background: Evidence suggests rheumatoid arthritis (RA) confers an increased risk of psychological morbidity, particularly anxiety and depression, which may affect the subsequent management and treatment adherence. 1,2 Few studies have studied psychological factors over time in RA patients. 3
Objectives: To evaluate the prevalence of anxiety and depression in RA patients following rituximab treatment.
Methods: 92 biologics-naïve RA patients [mean (SD) age 49.5 (9.9) years, 78 women; median (IQR) DAS28 5.67 (3.94–8.45); median (IQR) HAQ 1.87 (1.2–3.5)] were followed up for 27 months after commencing and continuing rituximab therapy (1, 2, 3 standard courses). Anxiety and depression, and health-related quality of life (HRQoL) were assessed at baseline, 3, 15 and 27 months using the Hospital Anxiety and Depression Scale (HADS) and the Short Form (SF-36 v.1) Health Survey questionnaire, respectively.
Results: Median anxiety and depression scores decreased significantly between baseline and 3 months and continued depress over the 27-month period – Table. The prevalence of depression cases decreased twice from baseline to 27 months (p<0.01), as did the prevalence of anxiety (p<0.01). Patients reported poor baseline HRQoL. SF-36 domain scores substantially rose after 15 and 27 months.
| Anxiety, depression, and quality of life | ||||
|---|---|---|---|---|
| Baseline | 3 months | 15 months | 27 months | |
| (n=92 ) | (n=92 ) | (n=53 ) | (n=14 ) | |
| Anxiety cases (HADS-A score ≥8), n (%) | 72 (78.3) | 48 (52.2) | 24 (45.3)* | 5 (35.7)** |
| Median (IQR) Anxiety score | 12.6 (10–15) | 8.2 (5–12)* | 6.4 (3–10)** | 5.5 (3–8)*** |
| Depression cases (HADS-D score ≥8), n (%) | 62 (67.4) | 50 (54.3) | 19 (35.8)* | 4 (28.6)** |
| Median (IQR) Depression score | 9.2 (7.8–9.6) | 5.6 (3–8)** | 4.5 (2–7)** | 3.6 (2–6)*** |
| Mean (SD) Mental Health score | 42.8 (15.2) | 51.2 (18.3) | 68.7 (11.2)* | 72.9 (10.5)** |
| Mean (SD) Physical Function score | 24.4 (8.3) | 32.5 (9.8) | 53.8 (10.5)* | 54.5 (9.3)* |
| Mean (SD) Social Function score | 48.2 (15.4) | 56.8 (25.5) | 59.8 (18.7) | 65.9 (9.2)* |
| Mean (SD) General Health score | 35.8 (11.2) | 48.7 (10.8) | 67.8 (8.6)** | 75.9 (12.6)** |
* p<0.05, ** p<0.01, *** p<0.001 differences between baseline and follow-up
Conclusion: Anxiety and depression levels decrease significantly in RA patients following commencement and continuity of rituximab. B cell-directed therapy for patients with RA helps achieve remission of both anxiety and depression, and improves HRQoL.
REFERENCES:
[1]McWilliams LA, Goodvin RD, Cox BJ. Depression and anxiety associated with three pain conditions: results from a nationally representative sample. Pain 2004;111:77–83.
[2]Garcia-Cebrian A, Gandhi P, Demyttenaere K et al. The association of depression and painful physical symptoms: a review of the European literature. Eur Psychiatry 2006;21:379–88.
[3]Overman CL, Bossema ER, van Middendorp H et al. The prospective association between psychological distress and disease activity in rheumatoid arthritis: a multilevel regression analysis. Ann Rheum Dis 2012;71:192–7.
Disclosure of Interests: Ilshat Gaisin Speakers bureau: Boehringer Ingelheim, KRKA, Berlin-Chemie Menarini, Sanofi, Larisa Ivanova Speakers bureau: Bayer, Novartis, KRKA, Nikolay Maximov Speakers bureau: Pfizer, KRKA, Anastasia Vedekhina: None declared, Dilara Yurk: None declared, Nuriya Garaeva: None declared