Depression and Anxiety Reduce the Probability of Achieving a State of Sustained Minimal Disease Activity in Patients With Psoriatic Arthritis

Objective We aimed to determine whether the presence of depression or anxiety is associated with the achievement of sustained minimal disease activity (MDA) in patients with psoriatic arthritis (PsA). Methods Adult patients satisfying classification criteria for PsA prospectively followed from 2008 to 2017 were included. A standard protocol including physician assessment and patient-reported outcomes determined whether patients achieved sustained MDA, which was defined as meeting MDA criteria for >= 2 consecutive visits. The presence of depression/anxiety was determined using 3 definitions: 1) a score of <= 38 on the mental component summary of the Medical Outcomes Study Short Form 36 (SF-36) health survey, 2) a score of <= 56 on the mental health domain of the SF-36 health survey, and 3) a rheumatologist's report of a diagnosis or treatment for depression/anxiety. A discrete time-to-event analysis was conducted based on a proportional odds model to identify factors associated with achieving sustained MDA. Results A total of 743 patients were included in the study. The number of patients identified as having depression/anxiety at baseline included 331 patients (44.54%) according to definition 1, 364 patients (48.99%) according to definition 2, and 211 patients (28.4%) according to definition 3. A total of 337 patients (45.36%) did not achieve sustained MDA. The presence of depression/anxiety was associated with reduced probability of achieving sustained MDA, with odds ratio (OR) 0.30 (P < 0.0001), OR 0.34 (P < 0.0001), and OR 0.47 (P < 0.0001) for definitions 1, 2, and 3, respectively. Other variables associated with a reduced probability of achieving sustained MDA included the Charlson comorbidity index and fibromyalgia. Conclusion Symptoms of anxiety/depression reduce the probability of achieving sustained MDA in PsA. Comprehensive management of PsA should include measures for addressing these comorbidities.