title: Depressive symptoms predict future simple disease activity index scores and simple disease activity index remission in a prospective cohort of patients with early inflammatory polyarthritis.
abstract: OBJECTIVE
  To determine whether depressive symptoms assessed in treated patients with early inflammatory polyarthritis (EPA) influence disease activity during follow-up.
  
  
  METHODS
  Consecutively recruited EPA patients were actively treated to remission. Simple disease activity index (SDAI) and Center for Epidemiologic Studies Depression Scale (CES-D) scores were calculated at inclusion and up to 42 months into disease. SDAI scores were log-transformed to compute univariate and multivariate linear regressions. Parametric interval-censored Kaplan-Meier and survival regressions using Weibull distribution were used to assess time to and predictors of SDAI remission.
  
  
  RESULTS
  A total of 275 EPA patients were recruited at a median of 4 months into disease. In multivariate linear regression models, accounting for baseline demographic, clinical, serological and functional variables and 12-month inflammation markers, CES-D scores at 12 months into disease were correlated (r(2) = 0.14) with subsequent SDAI scores. Patients with 12-month high CES-D (≥19; suggestive of depression) had a lower proportion of SDAI remission (31.3% vs 84.3%; P < 0.001) and reached SDAI remission less rapidly [hazard ratio = 0.25 (95% CI 0.12, 0.53); P < 0.001].
  
  
  CONCLUSIONS
  Each follow-up SDAI correlated significantly with 12-month depressive symptoms, a median of 7 months after initiation of treatment. CES-D scores suggestive of depression at 12 months were strongly correlated with delay and failure to reach remission later on. Depressive symptoms in treated EPA patients represent important clinical issues with long-term association with disease activity. Interventions to alleviate persistent depressive symptoms in treated EPA warrant careful evaluation of their potential to improve disease remission rates.
authors.affiliation: Department of Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Leblanc-Trudeau
authors.affiliation: Department of Medicine, McGill Programs of Whole Person Care, McGill University.
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Dobkin
authors.affiliation: Centre Hospitalier Universitaire de Sherbrooke, Division of Rheumatology.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Carrier
authors.affiliation: Department of Medicine, Division of Internal Medicine, Université de Sherbrooke and.
authors.forename: Pierre
authors.initials: P
authors.lastname: Cossette
authors.affiliation: Department of Medicine, Division of Rheumatology, Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Québec, Canada.
authors.forename: Artur J
authors.initials: AJ
authors.lastname: de Brum-Fernandes
authors.affiliation: Department of Medicine, Division of Rheumatology, Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Québec, Canada.
authors.forename: Patrick
authors.initials: P
authors.lastname: Liang
authors.affiliation: Department of Medicine, Division of Rheumatology, Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Québec, Canada.
authors.forename: Ariel
authors.initials: A
authors.lastname: Masetto
authors.affiliation: Department of Medicine, Division of Rheumatology, Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Québec, Canada Gilles.Boire@usherbrooke.ca.
authors.forename: Gilles
authors.initials: G
authors.lastname: Boire
mesh_terms: D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000523:psychology*; D003863:Depression / Q000209:etiology / Q000523:psychology*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012074:Remission Induction; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents
keywords: disease activity; outcomes research; psychology; rheumatoid arthritis