title: Effect of psychological distress on continuation of anti-tumor necrosis factor therapy in patients with rheumatoid arthritis.
abstract: OBJECTIVE
  To investigate the relationship of psychological distress and associated factors with continuation of tumor necrosis factor (TNF) antagonist therapy in patients with rheumatoid arthritis (RA).
  
  
  METHODS
  Patients about to start therapy with TNF antagonists (n = 166) were assessed for psychological distress using the Hospital Anxiety and Depression Scale (HADS). A core set of demographic and clinical variables, including comorbidities from medical records and cigarette smoking history by questionnaire, were recorded at baseline and regular intervals thereafter. Cox proportional hazards regression analysis was used to assess the likelihood of patients discontinuing therapy over a 36-month followup period.
  
  
  RESULTS
  The number of years smoked was associated with anxiety (HADS-A; p for trend = 0.008) and general psychological distress (HADS-Total; p for trend = 0.03). In univariate analyses, earlier discontinuation was associated with these variables at baseline: anxiety (HADS-A), depression (HADS-D), abnormal mood (HADS-Total), smoking history (> 30 pack-yrs), years smoked (> 30 yrs), current smoking, high Disease Activity Score 28-joint count (DAS28), poor patient global assessment, and evidence of cardio/cerebrovascular disease (CVD). In multivariate analyses, the strongest predictors of discontinuation were HADS-Total, smoking history (> 30 pack-yrs), DAS28, and evidence of CVD at baseline.
  
  
  CONCLUSIONS
  Discontinuation of therapy with TNF antagonists is independently associated with psychological distress, heavy smoking, and CVD at baseline.
authors.affiliation: Staffordshire Rheumatology Centre, Haywood Hospital, University Hospital of North Staffordshire, Stoke-on-Trent, Staffordshire, England. derek.mattey@uhns.nhs.uk
authors.forename: Derek L
authors.initials: DL
authors.lastname: Mattey
authors.forename: Peter T
authors.initials: PT
authors.lastname: Dawes
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Hassell
authors.forename: Ann
authors.initials: A
authors.lastname: Brownfield
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Packham
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000523:psychology; D002318:Cardiovascular Diseases / Q000503:physiopathology; D003866:Depressive Disorder / Q000503:physiopathology; D005260:Female; D006304:Health Status; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D012907:Smoking / Q000009:adverse effects; D011795:Surveys and Questionnaires; D014409:Tumor Necrosis Factor-alpha / Q000627:therapeutic use*
chemical_list: D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha