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Depressive symptoms are associated with achieving remission in PsA patients - an analysis from the RABBIT-SpA
Andreas Reich1,2, Anja Weiß1, Lisa Lindner1,2
1German Rheumatology Research Center (DRFZ Berlin), Epidemiology and Health Services Research, Charitéplatz 1, 10117, Berlin, Germany.
Background:
Depressive symptoms are common in psoriatic arthritis (PsA) and may influence treatment response. This study examined their association with achieving remission after starting a new systemic antirheumatic therapy, and tested whether this association differs by sex.
Methods:
Data from PsA patients in the ongoing prospective longitudinal observational cohort study RABBIT-SpA were analyzed. Depressive symptoms were assessed with the WHO-5 Well-Being Index (none/mild vs. moderate/severe). Outcomes included minimal disease activity (MDA) and Disease Activity in Psoriatic Arthritis (DAPSA) remission at 3 and 6 months. Logistic regression assessed the association between baseline well-being and remission, adjusted for confounders identified using directed acyclic graphs. A sex × well-being interaction term was included in each model to test whether this association differs by sex. Multiple imputation handled missing data.
Results:
Moderate/severe depressive symptoms were present in 29% of 1,888 patients (34% of women, 23% of men). In adjusted analyses, higher baseline well-being was associated with remission (OR per 10-point increase: 1.06-1.14 across outcomes and timepoints, reaching significance for MDA at 6 months and DAPSA remission at both timepoints). Interaction testing showed no evidence that this association differed by sex; all four 95% confidence intervals included 1 (p ≥ 0.29). Both sexes with moderate/severe symptoms achieved MDA and DAPSA remission less frequently than those with no/mild symptoms. Although disease activity improved in both groups over time, it remained higher in patients with moderate/severe symptoms.
Conclusions:
Depressive symptoms were associated with higher disease activity and less frequent remission in PsA, with no evidence that this effect differed by sex. Routine screening for depressive symptoms should be considered in PsA management to identify patients at risk of suboptimal treatment response.
Clinical Trial Number:
Not applicable.