Improvements in patient-reported outcomes, symptoms of depression and anxiety, and their association with clinical remission among patients with moderate-to-severe active early rheumatoid arthritis

被引:103
作者
Kekow, Joern [2 ]
Moots, Robert [3 ]
Khandker, Rezaul [1 ]
Melin, Jeffrey [1 ]
Freundlich, Bruce [1 ]
Singh, Amitabh [1 ]
机构
[1] Pfizer, Specialty Care Business Unit, Collegeville, PA 19426 USA
[2] Univ Magdeburg, Dept Rheumatol, Clin Rheumatol & Orthoped Surg, Vogelsang Gommen & Rheumatol Res Dept, D-39106 Magdeburg, Germany
[3] Univ Liverpool, Inflammat Res Unit, Sch Clin Sci, Liverpool L69 3BX, Merseyside, England
关键词
Rheumatoid arthritis; Remission; Depression; Anxiety; Patient-reported outcomes; PAIN; DISEASE; METHOTREXATE; COMBINATION; MONOTHERAPY; ETANERCEPT; PREDICTORS; FATIGUE; RA;
D O I
10.1093/rheumatology/keq327
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Methods. Patients from the COmbination of Methotrexate and ETanercept in Active Early Rheumatoid Arthritis (COMET) trial (104 weeks) with measures on the Hospital Anxiety and Depression Scale at baseline and subsequent visits (n = 389) were included. PROs investigated were the HAQ disability index, pain and fatigue visual analogue scales (VASs), EuroQoL health status VAS and the Medical Outcomes Short Form-36 physical and mental component summaries. The impact of clinical remission as measured by 28-joint DAS (DAS-28) on depression/anxiety symptoms at Week 104 was assessed using logistic regression. Least square means for PRO improvements from baseline were estimated by analysis of covariance. Missing data were imputed using the last observation carried forward method. Results. When depression/anxiety symptoms were absent at baseline, significantly more patients achieved clinical remission, low disease activity and normal functioning at Week 104. Reciprocally, patients who achieved clinical remission were less likely to maintain symptoms of depression or anxiety compared with non-remitters [depression odds ratio (OR): 0.35, P = 0.0233; anxiety OR: 0.48, P = 0.0371]. Fatigue and pain had a significant impact on changes in depression status, but did not influence anxiety status. Finally, clinical remission was significantly associated with improvements in all PRO measures (P < 0.001); conversely, depression/anxiety symptoms reduced PRO improvements. Conclusions. Among moderate-to-severe active early RA patients, clinical remission reduces symptoms of depression/anxiety, and independently improves PROs, thereby suppressing the negative impact of depression/anxiety on these measures.
引用
收藏
页码:401 / 409
页数:9
相关论文
共 25 条
[1]  
Bruce B, 2003, J RHEUMATOL, V30, P167
[2]   Comorbid depression in rheumatoid arthritis: Pathophysiology and clinical implications [J].
Bruce T.O. .
Current Psychiatry Reports, 2008, 10 (3) :258-264
[3]   Tumour necrosis factor blockade mediates altered serotonin transporter availability in rheumatoid arthritis: a clinical, proof-of-concept study [J].
Cavanagh, Jonathan ;
Paterson, Carolyn ;
McLean, John ;
Pimlott, Sally ;
McDonald, Moira ;
Patterson, James ;
Wyper, David ;
McInnes, Iain .
ANNALS OF THE RHEUMATIC DISEASES, 2010, 69 (06) :1251-U367
[4]   Depression in rheumatoid arthritis patients: demographic, clinical, and psychological predictors [J].
Covic, Tanya ;
Tyson, Graham ;
Spencer, David ;
Howe, Graydon .
JOURNAL OF PSYCHOSOMATIC RESEARCH, 2006, 60 (05) :469-476
[5]   Psychological adjustment to chronic disease [J].
de Ridder, Denise ;
Geenen, Rinie ;
Kuijer, Roeline ;
van Middendorp, Henriet .
LANCET, 2008, 372 (9634) :246-255
[6]   Comparison of methotrexate monotherapy with a combination of methotrexate and etanercept in active, early, moderate to severe rheumatoid arthritis (COMET): a randomised, double-blind, parallel treatment trial [J].
Emery, Paul ;
Breedveld, Ferdinand C. ;
Hall, Stephen ;
Durez, Patrick ;
Chang, David J. ;
Robertson, Deborah ;
Singh, Amitabh ;
Pedersen, Ronald D. ;
Koenig, Andrew S. ;
Freundlich, Bruce .
LANCET, 2008, 372 (9636) :375-382
[7]   Two-Year Clinical and Radiographic Results With Combination Etanercept-Methotrexate Therapy Versus Monotherapy in Early Rheumatoid Arthritis [J].
Emery, Paul ;
Breedveld, Ferdinand ;
van der Heijde, Desiree ;
Ferraccioli, Gianfranco ;
Dougados, Maxime ;
Robertson, Deborah ;
Pedersen, Ronald ;
Koenig, Andrew S. ;
Freundlich, Bruce .
ARTHRITIS AND RHEUMATISM, 2010, 62 (03) :674-682
[8]   Brain Involvement in Rheumatoid Arthritis A Magnetic Resonance Spectroscopy Study [J].
Emmer, Bart J. ;
van der Bijl, A. Egon ;
Huizinga, Tom W. J. ;
Breedveld, Ferdinand C. ;
Steens, Stefan C. A. ;
Bosma, Gerlof P. Th. ;
van Buchem, Mark A. ;
van der Grond, Jeroen .
ARTHRITIS AND RHEUMATISM, 2009, 60 (11) :3190-3195
[9]  
Fayers PM, 1998, STAT MED, V17, P679, DOI 10.1002/(SICI)1097-0258(19980315/15)17:5/7<679::AID-SIM814>3.3.CO
[10]  
2-O