NEW YORK (Reuters Health)—Rheumatoid arthritis patients with depression and anxiety symptoms may have worse outcomes and poorer response to prednisolone, a secondary analysis of the CARDERA trial has found.
“The strength of association between depression/anxiety and disease activity outcomes and treatment response warrants routine screening,” the study’s lead author Faith Matcham at King’s College London in the U.K. told Reuters Health by email.
The analysis, online Sept. 8 in Rheumatology, included 379 of the CARDERA trial’s 467 patients from 42 centers in England and Wales, with two years of follow-up data.
One of the five health domains assessed in the EuroQoL EQ-5DTM questionnaire touches on depression and anxiety symptoms, giving the researchers a measure of severity from baseline through the end of the study.
The researchers compared patients with no depression or anxiety symptoms to those with moderate and severe symptoms, examining their rheumatoid arthritis outcomes according to the DAS28 (disease activity score of 28 joints) and the HAQ (Health Assessment Questionnaire).
After adjusting for variables such as disease duration and baseline HAQ and DAS28 scores, patients with extreme depression and anxiety symptoms at baseline had significantly increased DAS28 scores during follow-up than did those with no baseline depression or anxiety symptoms (standardized mean difference, 0.42).
Baseline depression and anxiety symptoms were linked to a 50% drop in the effect of prednisolone treatment, Matcham and colleagues report.
Differences in HAQ scores were not significant after adjusting for variables, however.
Individuals with depression and anxiety persisting beyond baseline did even more poorly. Compared with patients without such symptoms, they had significantly worse HAQ and DAS28 scores post-treatment even after adjusting for confounders.
“Depression and anxiety are easy and quick to measure and routine screening may identify which subgroups are at risk of much poorer RA outcomes. These patients could be deemed treatment failures on DMARDS, and may end up on biologics at considerable cost. Our data suggests that RA services may get better outcomes if they were able to provide better management for mental disorders and screening is the first crucial step,” Matcham said.
Past research has found nearly more than 16% of rheumatoid arthritis patients screen positive for both depression and anxiety, she and her colleagues note in their report.
Dr. Masayo Kojima from Nagoya City University Graduate School of Medical Sciences in Japan, who was not involved in the research, led a 2009 study on depression, inflammation and pain in rheumatoid arthritis patients, and he echoes the call for mental health screening.
“I believe doctors should check their patients’ mental status routinely. It is necessary at least to have effective communication with their patients,” Dr. Kojima told Reuters Health by email.
Matcham and her colleagues are now studying a more diverse patient population and measuring their depression and anxiety with more rigorous methods, the researcher said.