Musculoskeletal Biology I, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK.
Department of Academic Rheumatology, Aintree University Hospital, Liverpool, UK.
Clin Rheumatol. 2020 Jan;39(1):217-225. doi: 10.1007/s10067-019-04734-8. Epub 2019 Sep 5.
In this systematic review and meta-analysis of psoriatic arthritis (PsA) studies, we pooled data from existing literature to (1) estimate the prevalence of mental health disorders in PsA patients and (2) compare disease activity in PsA patients with and without these comorbidities.
We searched PubMED, Web of Science, Scopus, PsycINFO and the Cochrane Library using a predefined protocol in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Where possible, meta-analysis was performed using random effects model. Prevalence estimates were pooled according to the severity of mental health disorders.
A total of 24 studies, amounting to 31,227 PsA patients, were included for review. Anxiety and depression were the only consistently reported mental health disorders, defined using a range of screening criteria/thresholds. Anxiety prevalence ranged from 4 to 61% with a pooled estimate of 33% (95%CI 17 to 53%) having at least mild anxiety and 21% (95%CI 14 to 29%) at least moderate. Depression prevalence ranged from 5 to 51%, with 20% (95%CI 8 to 35%) having at least mild and 14% (95%CI 8 to 21%) at least moderate. Only two studies compared disease activity according to the presence of mental health comorbidities; both reported higher disease activity and pain among those with comorbid anxiety and depression.
Anxiety and depression are highly prevalent among PsA patients. Studies of other mental health disorders were scarce. More studies are needed on the impact of these comorbidities on disease activity and long-term outcomes.Key Points• One in three patients with psoriatic arthritis has at least mild anxiety, while 1 in 5 reported at least mild depression.• PsA patients with anxiety and/or depression reported greater disease activity.• More research is needed on other mental health comorbidities, particularly sleep, suicide/self-harm and substance misuse.
本系统性综述和荟萃分析纳入了多项银屑病关节炎（PsA）研究，旨在汇总现有文献数据：(1) 评估 PsA 患者的心理健康障碍患病率；(2) 比较伴和不伴这些合并症的 PsA 患者的疾病活动度。
我们按照系统评价和荟萃分析的 Preferred Reporting Items（PRISMA）指南，使用预先制定的方案检索了 PubMED、Web of Science、Scopus、PsycINFO 和 Cochrane Library 中的数据。如有可能，我们使用随机效应模型进行荟萃分析。根据心理健康障碍的严重程度汇总患病率估计值。
共纳入 24 项研究，总计纳入 31227 例 PsA 患者。仅焦虑和抑郁为一致报告的心理健康障碍，其使用了一系列筛查标准/阈值进行定义。焦虑症患病率为 4%至 61%，汇总估计值为 33%（95%CI 17%至 53%）至少存在轻度焦虑，21%（95%CI 14%至 29%）至少存在中度焦虑。抑郁症患病率为 5%至 51%，20%（95%CI 8%至 35%）至少存在轻度抑郁，14%（95%CI 8%至 21%）至少存在中度抑郁。仅有两项研究根据合并症存在情况比较了疾病活动度；这两项研究均报告称，合并焦虑和抑郁的患者疾病活动度和疼痛更高。
焦虑和抑郁在 PsA 患者中患病率较高。其他心理健康障碍的研究较少。需要更多研究来了解这些合并症对疾病活动度和长期结局的影响。
三分之一的银屑病关节炎患者至少存在轻度焦虑，而五分之一的患者报告至少存在轻度抑郁。
伴有焦虑和/或抑郁的 PsA 患者报告疾病活动度更高。
需要更多研究来了解其他心理健康合并症，特别是睡眠障碍、自杀/自残和物质滥用。
