Department of Human Health Sciences, Kyoto University Graduate School of Medicine, 53 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
Department of Advanced Medicine for Rheumatic Diseases, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Adv Rheumatol. 2021 Oct 29;61(1):65. doi: 10.1186/s42358-021-00223-2.
The management of anxiety and depression symptoms in rheumatoid arthritis (RA) patients is vital. Previous study findings on this topic are conflicting, and the topic remains to be thoroughly investigated. This study aimed to clarify the association of RA disease activity with anxiety and depression symptoms after controlling for physical disability, pain, and medication.
We conducted a cross-sectional study of RA patients from the XXX Rheumatoid Arthritis Management Alliance cohort. We assessed patients using the Disease Activity Score (DAS28), Health Assessment Questionnaire Disability Index (HAQ-DI), and Hospital Anxiety and Depression Scale (HADS). Anxiety and depression symptoms were defined by a HADS score ≥ 8. We analyzed the data using multivariable logistic regression analyses.
Of 517 participants, 17.6% had anxiety symptoms and 27.7% had depression symptoms. The multivariable logistic regression analysis demonstrated that DAS28 was not independently associated with anxiety symptoms (odds ratio [OR] [95% confidence interval; CI] 0.93 [0.48-1.78]; p = 0.82) and depression symptoms (OR [95% CI] 1.45 [0.81-2.61]; p = 0.22). However, DAS28 patient global assessment (PtGA) severity was associated with anxiety symptoms (OR [95% CI] 1.15 [1.02-1.29]; p = 0.03) and depression symptoms (OR [95% CI] 1.21 [1.09-1.35]; p < 0.01). Additionally, HAQ-DI scores ≤ 0.5 were associated with anxiety symptoms (OR [95% CI] 3.51 [1.85-6.64]; p < 0.01) and depression symptoms (OR [95% CI] 2.65 [1.56-4.50]; p < 0.01). Patients using steroids were more likely to have depression than those not using steroids (OR [95% CI] 1.66 [1.03-2.67]; p = 0.04).
No association was found between RA disease activity and anxiety and depression symptoms in the multivariable logistic regression analysis. Patients with high PtGA scores or HAQ-DI scores ≤ 0.5 were more likely to experience anxiety and depression symptoms, irrespective of disease activity remission status. Rather than focusing solely on controlling disease activity, treatment should focus on improving or preserving physical function and the patient's overall sense of well-being.
类风湿关节炎（RA）患者的焦虑和抑郁症状的管理至关重要。此前关于这一主题的研究结果存在冲突，需要对此进行深入研究。本研究旨在明确 RA 疾病活动度与控制身体残疾、疼痛和药物治疗后焦虑和抑郁症状之间的关联。
我们对 XXX 类风湿关节炎管理联盟队列中的 RA 患者进行了横断面研究。我们使用疾病活动评分（DAS28）、健康评估问卷残疾指数（HAQ-DI）和医院焦虑和抑郁量表（HADS）对患者进行评估。焦虑和抑郁症状通过 HADS 评分≥8 来定义。我们使用多变量逻辑回归分析来分析数据。
在 517 名参与者中，17.6%有焦虑症状，27.7%有抑郁症状。多变量逻辑回归分析表明，DAS28 与焦虑症状（比值比 [OR] [95%置信区间；CI] 0.93 [0.48-1.78]；p=0.82）和抑郁症状（OR [95%CI] 1.45 [0.81-2.61]；p=0.22）无独立相关性。然而，DAS28 患者总体评估（PtGA）严重程度与焦虑症状（OR [95%CI] 1.15 [1.02-1.29]；p=0.03）和抑郁症状（OR [95%CI] 1.21 [1.09-1.35]；p<0.01）相关。此外，HAQ-DI 评分≤0.5 与焦虑症状（OR [95%CI] 3.51 [1.85-6.64]；p<0.01）和抑郁症状（OR [95%CI] 2.65 [1.56-4.50]；p<0.01）相关。与未使用类固醇的患者相比，使用类固醇的患者更有可能出现抑郁症状（OR [95%CI] 1.66 [1.03-2.67]；p=0.04）。
在多变量逻辑回归分析中，未发现 RA 疾病活动度与焦虑和抑郁症状之间存在关联。无论疾病活动缓解状态如何，PtGA 评分较高或 HAQ-DI 评分≤0.5 的患者更有可能出现焦虑和抑郁症状。治疗不应仅仅关注控制疾病活动，而应注重改善或维持身体功能和患者整体幸福感。
