Initial High Disease Activity in Rheumatoid Arthritis Linked to Depression

In patients with early rheumatoid arthritis (RA), initial high disease activity is associated with self-reported depression and its persistence, according to the results of the Ontario Best Practices Research Initiative (OBRI), a provincial prospective registry of patients with RA, published in The Journal of Rheumatology. 

The investigators sought to determine whether initial high disease activity or changes in disease activity contribute to the development of persistent depression among patients with early RA. Furthermore, they explored whether disease activity and depression are modifiable based on sex.

In the current study, depression was established by self-report among patients enrolled in the OBRI. The link between baseline disease activity, assessed by the Clinical Disease Activity Index (CDAI), and persistent depression was evaluated using multivariate regression models, and effect modification according to sex was examined.

A total of 469 patients with early RA were enrolled in the study. Overall, 73% of the participants were women and the mean patient age was 56.8±13.6 years. At baseline, the incidence of depression was 26%, and 23% of participants reported persistent depression. Compared with patients who did not report depression, patients who reported depression were significantly more likely to be women (84% vs 69%, respectively; P <.001) and to have a significantly greater mean number of comorbidities (4.1 vs 2.7, respectively; P <.0001).

The incidence of depression was considerably higher among participants with initial moderate or high CDAI scores (87%). Treatment patterns appeared to be reflective of this trend among participants who reported depression vs those who reported no depression, with greater prior use of conventional synthetic disease-modifying drugs (DMARDs; 68% vs 51%, respectively; P <.01) and current users of biologic DMARDs (11% vs 5%, respectively; P <.02).

A significant association was reported between high continuous CDAI scores and persistent depression (odds ratio [OR], 1.03; 95% CI, 1.01-1.04) in univariate analysis. Higher initial CDAI scores significantly increased the risk for persistent depression over follow-up (OR, 1.03; 95% CI, 1.01-1.05). Moreover, female sex and greater number of comorbidities were also positively associated with persistent depression (OR, 2.68; 95% CI, 1.33-5.39; and OR, 1.40; 95% CI, 1.24-1.59, respectively).

The investigators concluded that the high probability of depression and its persistence among women with early RA and active disease represents an area for targeted focus and screening. Future studies among individuals with early RA are warranted to determine whether intervening during the “window of opportunity” to control disease activity has the potential to mitigate the development and maintenance of adverse mental health outcomes. This study is the first of its kind to investigate which components of CDAI may be the most predictive of persistent depression among individuals with early RA.

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Reference

Kuriya B, Joshi R, Movahedi M, Rampakakis E, Sampalis JS, Bombardier C; Ontario Best Practices Research Initiative Investigators. High disease activity is associated with self-reported depression and predicts persistent depression in early rheumatoid arthritis: results from the Ontario Best Practices Research Initiative [published online May 15, 2018]. J Rheumatol. doi: 10.3899/jrheum.171195