Underrecognized depressive and anxiety symptoms in inflammatory arthritis: implications for systematic screening...

Depression and anxiety are common comorbidities in patients with inflammatory arthritis (IA), including rheumatoid arthritis (RA), axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA). Despite their clinical relevance and impact on disease outcomes, these mental health conditions remain frequently underrecognized in routine rheumatology practice. To evaluate the prevalence of depression and anxiety symptoms in patients with IA in a real-world clinical setting and to compare the utility of different patient-reported questionnaires for their identification. Cross-sectional, real-world observational study. Patients with RA, axSpA, and PsA were evaluated. Depression and anxiety symptoms were assessed using the PHQ-9 and GAD-7, along with specific items of the Multidimensional Health Assessment Questionnaire (MDHAQ). A total of 255 patients were included (RA n = 105, PsA n = 60, axSpA n = 90), with mean ages 59, 47, and 42 years, respectively. Across all groups, the prevalence of depression symptoms identified using PHQ-9 were more frequently observed than reflected in prior routine clinical records .In RA, depressive symptoms prevalence increased from 8.6%(n = 9) to 24.8% (n = 26); in PsA, from 5% (n = 3) to 18.3%(n = 11); and in axSpA, from 14.4% (n = 13) to 21.1%(n = 19). A similar pattern was observed for anxiety symptoms. When assessed using GAD-7 the prevalence increased from 4.9% (n = 5) to 20% (n = 21) in RA, from 5.1% (n = 3) to 16.7% (n = 10) in PsA, and from 7.8% (n = 7) to 12.2% (n = 11) in axSpA when evaluated. No significant differences in median PHQ-9 or GAD-7 scores were observed between the groups. MDHAQ mental health items showed strong correlations with PHQ-9 and GAD-7 composite scores. Depression and anxiety symptoms are underrecognized yet highly prevalent in patients with inflammatory arthritis. They can be effectively identified using dedicated screening questionnaires such as the PHQ-9 and GAD-7. Mental health items in the MDHAQ may represent the first step in identifying patients who require further evaluation for psychiatric disorders.