Association between depression and anxiety and inability to achieve remission in rheumatoid arthritis and psoriatic arthritis

Objectives: To investigate the association between depression and anxiety and the inability to achieve remission in RA and PsA patients. In addition, the association between depressive and anxiety symptoms and disease activity components was explored. Methods: A total of 400 RA and 367 PsA patients from the tREACH and DEPAR were included, respectively. Patients had a possible depression or anxiety disorder if they scored >7 on the Hospital Anxiety and Depression Scale (HADS). Remission was defined as DAS44 <1.6 in RA and DAPSA <= 4 in PsA. Mixed models were used to assess the association between depression/anxiety, at any timepoint during 2 years, and remission during 2 years, and to explore which disease activity components are most influenced by depression/anxiety. Results: At baseline, 20% of RA patients had a possible depression and 30% a possible anxiety disorder. In PsA this was 18% and 23%. After adjustment for concurrent anxiety symptoms, depression was associated with a lower odds of achieving remission during 2 years of follow-up [OR 0.45 (95%CI 0.25-0.80) for RA and OR 0.24 (95%CI 0.08-0.71) for PsA]. Anxiety was not associated with remission after adjustment for concurrent depression symptoms. The presence of depression/anxiety was associated with higher tender joint count, worse general health, more pain and slightly elevated inflammation markers, but not with more swollen joints in both RA and PsA. Conclusion: The presence of depressive symptoms in RA and PsA patients at baseline or during follow-up was associated with a lower likelihood of achieving remission. Healthcare professionals should, therefore, be aware of symptoms of depression.