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Depression should be considered ‘critical’ comorbidity in PsA

Patients with psoriatic arthritis who also have depression were more likely to be on medications for PsA, had fewer swollen joints and lower disease activity via body surface area but also reported higher RAPID3 scores, according to research presented at the American College of Rheumatology/Association of Rheumatology Professionals Annual Meeting.

“This discrepancy is likely a manifestation of how depression could affect the way patients experience their PsA despite apparent improvement in skin and join symptoms,” Rebecca Haberman, MD, a rheumatology fellow at NYU School of Medicine, and colleagues wrote in the study abstract.

Among 436 patients with PsA recruited at the NYU Psoriatic Arthritis Center, the mean age was 47 years, with 54% of patients being men and 74.1% white.

Depression was defined by an established diagnosis and/or the use of antidepressant medications. A total of 85 patients (19.5%) had depression, 68 patients (15.6%) had anxiety and 21 had ADHD (4.8%).

Most patients with depression (71%) were taking an antidepressant.

Patients with PsA and depression were more likely to be on one or more medications for PsA compared with patients without depression (80% vs. 65%; P = .01). Those with PsA and depression also had a trend toward higher rates of biologic use compared with patients with PsA alone (47.5% vs. 40.4%), according to researchers.

Patients with depression had a similar tender joint count to their peers without depression, but had a trend toward fewer swollen joints and concomitant higher RAPID3 scores. These findings persisted when matched with propensity scores to adjust for age, sex, comorbidities and medication use.

Psoriasis activity measured by body surface area was lower in those who with depression, at 1.4% vs. 3.03%, and these differences held over subsequent visits (P = .001).

Although further research is needed to understand whether modulation of psychiatric comorbidities can improve PsA outcomes, depression should be considered a “critical” comorbidity in PsA care, according to researchers. – by Abigail Sutton

Reference:

Haberman R. The paradoxical effect of depression on psoriatic arthritis outcomes in a combined psoriasis-psoriatic arthritis center. Presented at: American College of Rheumatology/Association of Rheumatology Professionals Annual Meeting; Nov. 9-13, 2019; Atlanta.

Disclosure: Haberman reports no relevant financial disclosures. Please see the study for all other authors’ financial disclosures.