Depression, Anxiety Highly Prevalent in Patients With Rheumatoid Arthritis

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Patient mental health status, especially mood disturbances, should be addressed in routine practice to improve quality of life in rheumatoid arthritis.

Depression and anxiety were highly prevalent in patients with rheumatoid arthritis (RA), according to study results published in the International Journal of Rheumatic Diseases. The study findings also highlighted that better self-reported global health status was protective against both anxiety and depression symptoms.

Investigators conducted a prospective, cross-sectional study of patients enrolled in either the Siriraj Rheumatoid Arthritis Registry (SIRA) or the Thai Army Rheumatoid Arthritis Cohort (TARAC) between September 2016 and March 2018. Established at major hospitals in Bangkok, Thailand, the SIRA and TARAC cohorts comprised patients aged ≥18 years with a diagnosis of RA per the American College of Rheumatology criteria. At baseline, SIRA and TARAC enrollees provided sociodemographic and clinical information; patients were then followed-up prospectively through rheumatology clinic visits. The present analysis extracted depression and anxiety data from most recent visit, assessed using the Thai version of the Hospital Anxiety and Depression Scale (HADS). Anxiety and depression were defined as having a HADS score ≥8. Logistic regression was conducted to identify baseline factors associated with HADS score at follow-up.

Data from 464 patients were included in analysis. Mean age at most recent study visit was 59±11.4 years, median disease duration was 9.9 years (interquartile range, 5.1-16.6 years), and 85% were women. Nearly half (48%) of participants were unemployed. Mean HADS score for depression was 3.83±3.11; mean score for anxiety was 4.71±2.95. The overall prevalence rates for depression and anxiety were estimated at 12.5% and 14.5%, respectively. Increased disease activity was observed in patients with anxiety and depression, although this trend was not statistically significant.

In multivariate regression models, global health score (risk ratio [RR], 0.98; 95% CI, 0.96-0.99; P =.001) was negatively associated with depression. Anxiety was positively associated with the presence of functional disability (RR, 2.46; 95% CI, 1.33-4.54; P =.004) and being married (RR, 2.43; 95% CI, 1.25-4.73; P =.009), but negatively associated with disease duration 10 years or more (RR, 0.45; 95% CI, 0.25-0.80; P =.007) and global health score (RR, 0.97; 95% CI, 0.95-0.98; P <.001). Overall, patients who self-reported better global health were less likely to endorse depression and anxiety.

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These data underscore the significant burden of mood disorders in patients with RA. As a study limitation, investigators noted that the cross-sectional design prevented longitudinal analysis of mood symptoms, which may fluctuate over time with changing disease activity. Even so, given these results, mental health screenings may be an important component to clinical care for RA.


Katchamart W, Narongroeknawin P, Chanapai W, Thaweeratthakul P, Srisomnuek A. Prevalence of and factors associated with depression and anxiety in patients with rheumatoid arthritis: a multicenter prospective cross-sectional study. Int J Rheum Dis. 2020;23(3):302-308.