Depression, Anxiety May Predict Worse Disease Activity in RA

Ongoing monitoring and treatment of RA patients' mental health is important and may impact long-term RA outcomes.

Depression and anxiety as defined by Mental Health Index-5 (MHI-5) score predicted worse disease activity and functional disability in patients with rheumatoid arthritis (RA), according to findings presented at the 2016 ACR/ARHP Annual Meeting, November 11-16, 2016 in Washington, DC.

Christine Iannaccone, from the Brigham and Women’s Hospital and Harvard Medical School in Boston, Massachusetts and colleagues recruited 992 participants (mean age 57 (±13.6) years, 82.6% women) to participate in a prospective, longitudinal RA cohort study that included serial joint exams, serological analyses, and patient-reported measures.

Participants were screened for depression and anxiety using the Mental Health Index-5 (MHI-5) once a year for 2 years. 

Univariate analyses were performed at baseline using MHI-5 as a dichotomous variable (scale 0-100, with a score ≤65 being defined as positive for mood/anxiety disorder) to study the association between depression/anxiety and age, gender, ethnicity, seropositivity, education, social support (Berkman Social Network Index), disease duration, disease activity measures (Disease Activity Score in 28 joints [DAS28]- C-reactive protein [CRP], Rheumatoid Arthritis Disease Activity Index [RADAI], CRP), and functional disability (MHAQ).

The researchers further examined the association between MHI-5 and RA disease activity and functional disability with linear repeated mixed model analyses.

The researchers found that depression and anxiety measured with MHI-5 were associated with disease duration and activity (DAS28-CRP3 (P <.0001)), with functional disability (MHAQ (P<.0001), education (P =.04), and social support (P =.0006).

Linear repeated mixed model analyses indicated that MHI-5 mood/anxiety disorder predicted worse DAS28-CRP (P =.0002), worse RADAI scores (P < .0001), and worse MHAQ scores ( P <.0001) one year later. MHI-5 score did not predict worse CRP levels over time (P =.48). Lower education also predicted worse DAS28-CRP (P =.03), RADAI (P =.0007), and MHAQ (P =.0002) scores.

“Ongoing monitoring and treatment of a patient’s mental health is important and may impact long-term RA outcomes,” the authors concluded.


Iannaccone C, Mahmoud TG, Cui J, Weinblatt M, Shadick N. Symptoms of depression and anxiety predict worse disease activity and functional disability in a cohort of established rheumatoid arthritis patients [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). Accessed November 28, 2016.