Impact and Prevalence of Depression and Anxiety in Rheumatoid Arthritis-A Cross-Sectional Study with Self-Reported...

Objective: This study aims to screen for depression and anxiety in a real-life sample of rheumatoid arthritis (RA) patients and to observe whether RA phenotype characteristics and RA disease activity measures are associated with depression and anxiety. Methods: This cross-sectional study from a tertiary rheumatology hospital in Romania screened all patients with diagnosed RA that came for their one month disease follow-up for depression and anxiety using the Patient Health Questionnaire-9 (PHQ9) and Hospital Anxiety and Depression Scale (HADS), self-reported questionnaires. The follow-up captured the date of RA diagnosis, pharmacological treatment, clinical examination, blood sampling, and functional and radiographic assessment. The cut-off for positive screening of depression was a PHQ9 of 10 or more and a HADS-depression (D) of over 10, and the positive cut-off for anxiety was a HADS-anxiety (A) of over 10. Results: According to the medical histories, the prevalence of depression and anxiety in the 209 patients included was 10% and 8.1%, respectively, while the likely depression diagnosis according to PHQ was 34.4% and that according to HADS-D was 14.8%, while the likely anxiety diagnosis using the HADS-A was 32.5%. The subgroup of patients that positively screened for depression using the self-reported questionnaires PHQ9 and HADS-D had significantly higher DAS28, disease activity class, tender joint count, swollen joint count, patient global assessment, and functional stage, with some particularities regarding ESR and radiographic stage, which were higher just in the HADS-D of more than 10 subgroup, and glucocorticoid use, which was higher just in the PHQ9 over 10 subgroup. Regarding patients with a HADS-A of more than 10, they were more frequently women and had higher tender joint count and functional stage. Conclusions: Depression and anxiety are highly prevalent and underreported in the RA population and are associated with higher levels of pain, physical disability, and disease activity.