Depression and Anxiety Associated With Disease Activity, Functional Status in Early RA

depressed woman, sad woman, middle aged woman in pain
Researchers evaluated the frequency of depression and anxiety in early RA and explored the association its disease-related measures.

High disease activity in early rheumatoid arthritis (RA) is correlated with depression and anxiety, according to study results published in RMD Open. Depression and anxiety were also found to be more prevalent among patients with poor self-reported functional status.

The Scottish Early Rheumatoid Arthritis (SERA) inception cohort included patients with new-onset RA who received care at rheumatology centers in Scotland between 2011 and 2015. Baseline demographic and clinical data of patients were collected within 6 months of RA diagnosis, with follow-up visits conducted after 6 and 12 months.

The primary study outcome was depression and anxiety symptoms, measured using the Hospital Anxiety and Depression Scale. Exposures of interest included disease activity, functional status, and laboratory parameters. Disease activity was measured using the Disease Activity Score-28 (DAS28) and the patient global assessment visual analog scale (PGA-VAS); functional status was measured using the Health Assessment Questionnaire (HAQ). Erythrocyte sedimentation rate, C-reactive protein (CRP) levels, rheumatoid factor positivity, and anticyclic citrullinated peptides status were also recorded. Multivariable linear regression was performed to assess the relationship between anxiety and depression scores and various demographic and clinical variables.

The study cohort included 848 patients with RA (mean age, 58.27±13.71 years; mean DAS28 score, 4.95±1.41), among whom 70.0% were women. At 6 and 12 months, follow-up data of 691 and 618 participants with RA, respectively, were available for evaluation.

No significant differences in depression or anxiety symptoms were observed between patients who continued follow-up and those who dropped out of the study. The baseline prevalence of anxiety and depression was higher among patients with early RA vs healthy individuals (19.0% vs 1.7% and 12.2% vs 1.75; P =.0002 and P =.009, respectively). However, prevalence of anxiety and depression in early RA decreased to 13.4% and 8.1%, respectively, at 12 months. Depression and anxiety scores were significantly positively associated with DAS28 at baseline, 6 months, and 12 months (all P <.001).

Multivariable linear regression models showed that baseline anxiety was associated with younger age (P =.001) and higher HAQ score (P <.0001). Anxiety at the 6-month follow-up was negatively correlated with body mass index (P =.015) and positively associated with baseline anxiety (P <.0001), current HAQ score (P =.006), and higher current PGA-VAS score (P =.008). Similar associations were observed at 12 months.

Baseline depression was associated with younger age (P =.029), being single at the time of measurement (P =.022), and a higher current HAQ score (P <.001). Depression at 6 months was associated with higher baseline depression (P <.0001) and anxiety (P =.002) scores, higher current HAQ score (P <.0001), and greater current CRP levels (P =.009). The same associations persisted at 12 months. At 6 months only, men were more likely than women to have depression.

These results suggested that anxiety and depression were prevalent in early RA, particularly among those with greater disease activity and poorer self-reported functioning. Although anxiety and depression rates appeared to decrease during follow-up, they were still reported at rates higher than those observed in the general population.

The primary study limitation included the fact that more than 200 participants had been lost to follow-up by 12 months. In addition, data were only available at 6-month intervals, which prevented a more precise assessment of mood during all timepoints.

“Our study indicates that clinicians should be alert to neuro-psychiatric comorbidity in RA from the earliest stages of the disease,” the researchers wrote. “[I]t remains to be determined whether more intense screening and treatment for psychiatric comorbidities…can improve outcomes.”

Disclosure: The SERA cohort was supported by Pfizer Inc. Please see the original reference for a full list of authors’ disclosures.


Fragoulis GE, Cavanagh J, Tindell A, et al. Depression and anxiety in an early rheumatoid arthritis inception cohort. associations with demographic, socioeconomic and disease features. RMD Open. 2020 Oct;6(3):e001376.