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RA patients awaiting biologic therapy experienced depression, anxiety
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High levels of depression and anxiety were reported by patients with active rheumatoid arthritis who were awaiting biologic therapy, according to study results.
“This is the first study of its kind in patients with high levels of active disease, and suggests that routinely assessing a patient’s moods and beliefs — separate to their physical state — would be useful in guiding patient management,” researcher Anne Barton, FRCP, professor of rheumatology and honorary consultant rheumatologist, University of Manchester, said in a press release. “As rheumatologists, we need to be aware that depression may occur more commonly in patients with severe rheumatoid arthritis than we realized.”
Anne Barton
Barton and colleagues conducted a study of 322 patients (mean age, 55.8 years; 73% women) with active rheumatoid arthritis (RA) awaiting anti-tumor necrosis factor (anti-TNF) therapy (adalimumab, infliximab, certolizumab, golimumab or etanercept) between November 2008 and January 2011. The patients had longstanding disease (median, 7.6 years) and high Disease Activity Score 28 (DAS28; mean, 6). Patients completed the Beliefs About Medicines Questionnaire (BMQ), Brief Illness Perception Questionnaire (BIPQ) and the Hospital Anxiety and Depression Scale (HADS).
Patients indicated a poor understanding of disease, with approximately half reporting above borderline HADS anxiety (51.1% greater than 7; 26.5% greater than 11) and HADS depression (47.3% greater than 7; 20.6% greater than 11) levels.
DAS28 had a “significant but weak” association with Brief IPQ dimension of illness (coef=0.08; 95% CI, 0.02-0.15) and a stronger association with construct of illness identity (coef=0.16; 95% CI, 0.09-0.23) but was not associated with BMQ or HADS scores.
Patient-reported visual analog scale had larger significant associations with BIPQ items and HADS depression. Higher tender joint count was associated with low illness coherence, and C-reactive protein or erythrocyte sedimentation rate correlated with three BIPQ items and HADS anxiety scores.
“By reporting individual DAS28 components, clinicians may be better able to assess the impact of therapies on each component, adjusting approaches according to patients’ needs,” the researchers concluded.
Disclosure: The researchers report no relevant financial disclosures.
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