Depression in rheumatoid arthritis patients: Screening for a frequent yet underestimated comorbidity

Abstract

Aim of the workTo screen for depression and assess its frequency in rheumatoid arthritis (RA) patients and to study its relation to clinical parameters, patient-reported outcomes (PROs) and disease activity. Patients and methodsThis study included 200 consecutive adult RA patients. Clinical and laboratory investigations were performed. PROs including tender and swollen joint count, patient’s estimated pain, patient global assessment (PGA), validated Arabic version of the health assessment questionnaire (HAQ-A) as well as physician global assessment were considered. The disease activity score (DAS28) and simplified erosion narrowing score (SENS) were calculated. Patient health questionnaire-9 (PHQ-9) was used to detect depression. ResultsThe patients’ mean age was 41.3 ± 11.9 years and disease duration 6.6 ± 4.9 years, 79% were females and 21% males (F:M 3.8:1). Their mean DAS28 was 6 ± 1.7 and HAQ-A 1.9 ± 0.9. The mean PHQ-9 score was 7.6 ± 9.3. 45% of patients had depression; mild (3%), moderate (13%), moderate/severe (13%) and severe (16%) degrees. PHQ-9 significantly correlated with age, disease duration, morning stiffness, joint deformity, C-reactive protein, erythrocyte sedimentation rate and rheumatoid factor and negatively with disease modifying anti-rheumatic drugs usage (p = 0.002). All PROs and DAS28 significantly correlated with PHQ-9 (p < 0.0001). Logistic regression analysis showed that joint surgery (p = 0.004), steroid usage (p = 0.005), functional status (p < 0.0001) and joint damage (p < 0.0001) independently significantly increased the probability of depression occurrence. ConclusionDepression is common among rheumatoid arthritis patients. Periodic routine screening for depression in RA should be included in clinical practice to prevent poor outcomes and to adapt therapies to the specific situation of individual patients.