People with early rheumatoid arthritis can experience persistent depression.
In patients with early rheumatoid arthritis (RA), initial high disease activity is associated with self-reported depression and its persistence, according to the results of the Ontario Best Practices Research Initiative (OBRI), a provincial prospective registry of patients with RA, published in The Journal of Rheumatology.
The investigators sought to determine whether initial high disease activity or changes in disease activity contribute to the development of persistent depression among patients with early RA. Furthermore, they explored whether disease activity and depression are modifiable based on sex.
In the current study, depression was established by self-report among patients enrolled in the OBRI. The link between baseline disease activity, assessed by the Clinical Disease Activity Index (CDAI), and persistent depression was evaluated using multivariate regression models, and effect modification according to sex was examined.
A total of 469 patients with early RA were enrolled in the study. Overall, 73% of the participants were women and the mean patient age was 56.8±13.6 years. At baseline, the incidence of depression was 26%, and 23% of participants reported persistent depression. Compared with patients who did not report depression, patients who reported depression were significantly more likely to be women (84% vs 69%, respectively; P <.001) and to have a significantly greater mean number of comorbidities (4.1 vs 2.7, respectively; P <.0001).
The incidence of depression was considerably higher among participants with initial moderate or high CDAI scores (87%). Treatment patterns appeared to be reflective of this trend among participants who reported depression vs those who reported no depression, with greater prior use of conventional synthetic disease-modifying drugs (DMARDs; 68% vs 51%, respectively; P <.01) and current users of biologic DMARDs (11% vs 5%, respectively; P <.02).
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