Anxiety and depression are associated with a lower probability of achieving sustained minimal disease activity (MDA) in psoriatic arthritis (PsA), according to study results published in Arthritis Care & Research (Hoboken).
Patients with PsA were assessed every 6 to 12 months between 2008 and 2017. Researchers defined MDA as having met criteria for at least 2 consecutive visits and was determined using both participant-reported outcomes and physician assessment. The 3 definitions of depression/anxiety used for identification purposes included Medical Outcomes Study Short Form 36 (SF-36) mental component summary score of 38 or lower; SF-36 mental health domain score of 56 or lower; and a report by a rheumatologist of treatment for or diagnosis of depression/anxiety. To identify factors related to the achievement of sustained MDA, the researchers used a discrete time-to-event analysis.
A total of 743 adults with PsA (56% men; mean age at baseline visit, 50.2±13.2 years; mean age at PsA diagnosis, 38.3±13.8 years) were included in the study. Among the study participants, 45.36% did not achieve sustained MDA. Furthermore, 31% met the criteria for all 3 definitions of depression/anxiety (definition 1, 44.54%; definition 2, 48.99%; definition 3, 28.4%). Overall, depression/anxiety was associated with an approximately 60% to 75% lower likelihood of achieving MDA (definition 1, odds ratio [OR], 0.30 [0.22-0.39]; definition 2, OR, 0.34 [0.26-0.45]; definition 3, OR, 0.47 [0.35-0.65]; P <.0001 for all). Fibromyalgia and the Charlson comorbidity index were also associated with a lower likelihood of sustained MDA.
Limitations to the study included a lack of formal psychiatric assessment or specific anxiety/depression questionnaire, as well as an inability to include all individuals in the database due to incompatibility with inclusion criteria.
The study authors concluded that “the presence of depression/anxiety, regardless of the method used to define it, is associated with a lower probability of achieving sustained MDA in patients [with PsA].” They added, “Comprehensive management of PsA should therefore include measures for addressing anxiety and depression so that more patients achieve a state of MDA.”
Wong A, Ye JY, Cook RJ, Gladman DD, Chandran V. Depression and anxiety reduce the probability of achieving a state of sustained minimal disease activity in patients with psoriatic arthritis. Arthritis Care Res (Hoboken). Published online June 8, 2022. doi: 10.1002/acr.24593