THU0080 Depression and anxiety reduce the likelihood of achieving remission in patients with rheumatoid arthritis: real life data from the nor-dmard study
Authors: B Michelsen, EK Kristianslund, KM Fageli, E Lie, HB Hammer, G Haugeberg, TK Kvien
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Depression and anxiety are reported to predict poorer treatment outcomes in rheumatoid arthritis (RA).<sup>1</sup> Whether this can be confirmed in larger prospective observational studies using various remission criteria remains to be explored. <h3>Objectives</h3> To investigate the predictive value of baseline depression/anxiety on the likelihood of achieving remission in RA as well as the associations between baseline depression/anxiety and the components of the remission criteria at follow-up. <h3>Methods</h3> From the prospective, multi-center NOR-DMARD study we included RA patients starting first-time tumour necrosis factor inhibitors (TNFi) and DMARD naïve RA patients starting methotrexate (MTX) between year 2006 and 2012. The following two criteria for depression/anxiety were assessed: 1) the Medical Outcomes Survey Short Form-36 (SF-36) Mental Health subscale (MH)≤56 and 2) the SF-36 Mental Component Summary score (MCS)≤38.<sup>2</sup> The predictive value of baseline depression/anxiety on remission after 3 and 6 months treatment was explored in prespecified logistic regression models adjusted for age, sex, disease duration and smoking and the associations between baseline depression/anxiety and the different components of the remission criteria at follow-up in prespecified multiple linear regression models adjusted for age, sex, disease duration and smoking. <h3>Results</h3> A total of 1450 RA patients were included (mean (SD) age 54.4 (13.5) years, median (25th-75th percentile) disease duration 0.4 (0.0–5.0) years, 68.7% females and 28.6% current smokers). According to the SF-36MH≤56/SF-36MCS≤38 criteria 18.1/29.9% of the patients were depressed/anxious at baseline, respectively. Lower percentages of patients with versus without baseline depression/anxiety achieved remission at 3 and 6 months treatment (unadjusted analyses, figure). Baseline depression/anxiety negatively predicted remission after 3 and 6 months (adjusted analyses, table 1 and 2). The findings were confirmed in separate subgroup analyses of TNFi/MTX treated patients. Baseline depression/anxiety were associated with increased patient9s and evaluator9s global assessment and 28 tender joint count at 3 and 6 months, but not with level of acute phase reactants or 28 swollen joint count. <h3>Conclusions</h3> Depression and anxiety may reduce likelihood of remission based on composite scores in RA and should be taken into account in individual patients when making a shared decision on a treatment target. <h3>References</h3> Matcham et al.Rheumatology. 2016;55(2):268–78 Matcham et al.BMC musculoskel disorders. 2016;17:224. <h3>Disclosure of Interest</h3> B. Michelsen: None declared, E. Kristianslund: None declared, K. Fageli: None declared, E. Lie Consultant for: Hospira, Pfizer, UCB, Speakers bureau: AbbVie, Celgene, H. Hammer Consultant for: AbbVie, Pfizer, UCB, Roche, MSD, BMS and Novartis., Speakers bureau: AbbVie, Pfizer, UCB, Roche, MSD, BMS and Novartis., G. Haugeberg: None declared, T. Kvien Consultant for: AbbVie, Biogen, BMS, Boehringer Ingelheim, Celltrion, Eli Lilly, Epirus, Janssen, Merck-Serono, MSD, Mundipharma, Novartis, Oktal, Orion Pharma, Hospira/Pfizer, Roche, Sandoz and UCB, Speakers bureau: AbbVie, Biogen, BMS, Boehringer Ingelheim, Celltrion, Eli Lilly, Epirus, Janssen, Merck-Serono, MSD, Mundipharma, Novartis, Oktal, Orion Pharma, Hospira/Pfizer, Roche, Sandoz and UCB