Patients with high psychosocial burden less likely to achieve sustained RA remission
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Mental health and psychosocial well-being are associated with achieving sustained rheumatoid arthritis remission and treatment response, according to data published in Arthritis Care & Research.
“Our results suggest that psychosocial well-being and illness perceptions, from as early as treatment initiation, are associated with the probability of achieving sustained remission in early RA, and that the relationship between disease activity and psychosocial factors is complex and disease-phase specific,” Michaël Doumen, MD, of the Skeletal Biology and Engineering Research Center at KU Leuven in Belgium, and colleagues wrote. “These results are in line with previous studies that have shown an association between mental health in early RA and the response to treatment.”
To assess the effects of mental health and negative illness preceptors on patients with RA, the researchers conducted a post-hoc analysis of the 2-year randomized controlled CareRA-trial. The researchers defined remission as a DAS28-C-reactive protein score of less than 2.6 from weeks 16 to 104.
The post-hoc analysis assessed 379 participants between January 2009 and May 2013 who completed the Short Form 36 (SF-36), the Revised Illness Perception Questionnaire (IPQ-R) and the Utrecht Coping List (UCL) at baseline and at week 16, to determine psychosocial variables. The researchers compared time to first loss of remission using Cox proportional hazards regression and analyzed directionality of associations between psychosocial indicators and DAS28-CRP with cross-lagged panel models (CLPM).
According to the researchers, 33% of the assessed patients sustained DAS28-CRP remission. Of these patients in remission at week 16, the researchers identified two subgroups: A low-psychosocial-burden group (80%) and high psychosocial-burden group (20%), with the former retaining remission for a longer period (HR = 0.51; 95% CI, 0.35-0.73), compared with the latter group. Additionally, temporal relationships between psychosocial well-being and DAS28-CRP as presented in the CLPM were, “complex, bidirectional and disease-phase dependent,” with better psychosocial well-being predicting lower future disease activity and worse psychosocial well-being predicting higher future disease activity.
“Interestingly however, this relationship appeared to function differently during the earliest disease stages, with higher disease activity at baseline being associated with better well-being after 4 months in our study,” Doumen and colleagues wrote. “While somewhat counterintuitive, this suggests a stronger beneficial effect of treatment on psychosocial well-being in those patients who initially had the highest disease burden.”
The researchers also noted that approximately 20% of patients in DAS28-CRP or Clinical Disease Activity Index showed worse psychosocial outcomes even after 4 months of remission, suggesting that a higher psychosocial burden can still negatively affect patients with RA well into remission and “further underlines the need for a continued attention for psychosocial well-being, even when clinical treatment targets are met.
“Our observation of such subgroups among patients in remission further emphasizes that psychosocial unmet needs are frequent and relevant even when the disease appears well-controlled,” Doumen and colleagues wrote. “Therefore, future research should aim to develop tools to help clinicians to timely identify patients with such unmet needs in clinical practice.”
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