title: Are depression and anxiety associated with disease activity in rheumatoid arthritis? A prospective study.
abstract: BACKGROUND
  This study aimed to investigate the impact of depression and anxiety scores on disease activity at 1-year follow-up in people with Rheumatoid Arthritis (RA).
  
  
  METHODS
  The Hospital Anxiety Depression Scale (HADS) was used to measure depression and anxiety in a cross-section of RA patients. The primary outcome of interest was disease activity (DAS28), measured one-year after baseline assessment. Secondary outcomes were: tender joint count, swollen joint count, erythrocyte sedimentation rate and patient global assessment, also measured one-year after baseline assessment. We also examined the impact of baseline depression and anxiety on odds of reaching clinical remission at 1-year follow-up.
  
  
  RESULTS
  In total, 56 RA patients were eligible for inclusion in this analysis. Before adjusting for key demographic and disease variables, increased baseline depression and anxiety were associated with increased disease activity at one-year follow-up, although this was not sustained after adjusting for baseline disease activity. There was a strong association between depression and anxiety and the subjective components of the DAS28 at 12-month follow-up: tender joint count and patient global assessment. After adjusting for age, gender, disease duration and baseline tender joint count and patient global assessment respectively, higher levels of depression and anxiety at baseline were associated with increased tender joint count and patient global assessment scores at 1-year follow-up.
  
  
  CONCLUSIONS
  Symptoms of depression and anxiety have implications for disease activity, as measured via the DAS28, primarily due to their influence on tender joints and patient global assessment. These findings have implications for treatment decision-making as inflated DAS28 despite well controlled inflammatory disease markers may indicate significant psychological morbidity and related non-inflammatory pain, rather than true disease activity.
authors.affiliation: Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 10 Cutcombe road, London, SE5 9RJ, UK. faith.matcham@kcl.ac.uk.
authors.forename: Faith
authors.initials: F
authors.lastname: Matcham
authors.affiliation: South London and the Maudsley NHS Foundation Trust, London, UK.
authors.forename: Sheila
authors.initials: S
authors.lastname: Ali
authors.affiliation: King's College Hospital NHS Foundation Trust, London, UK.
authors.forename: Katherine
authors.initials: K
authors.lastname: Irving
authors.affiliation: Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 10 Cutcombe road, London, SE5 9RJ, UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: Hotopf
authors.affiliation: Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 10 Cutcombe road, London, SE5 9RJ, UK.|South London and the Maudsley NHS Foundation Trust, London, UK.
authors.forename: Trudie
authors.initials: T
authors.lastname: Chalder
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D003863:Depression / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
keywords: Anxiety; Depression; Disease activity; Prospective; Rheumatoid arthritis