AB0357 CORRELATION BETWEEN DISEASE ACTIVITY AND MENTAL HEALTH OF RA PATIENTS- ASSESSMENT WITH SMART SYSTEM OF DISEASE MANAGEMENT (SSDM) MOBILE TOOLS
Authors: Bin Wu, Hua Wei, Jianhong Wu, Yi Zhao, LI Shengguang, LI Fen, Yuhua Jia, Hui Xiao, Fei Xiao, Hui Song
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> WHO survey showed that the prevalence of anxiety and depression in Chinese population and Chinese patients with chronic diseases were between 3.1% - 4.2% and 3.1% - 7.3%, respectively. DAS28, HAQ, Hospital Anxiety and Depression Scale (HADS) are commonly used to evaluate RA patients’ disease activity, physical function and mental health. All of those evaluations were mainly conducted by health professionals with paper questionnaire previously. SSDM is a novel smart disease management tool that allows patients to do self-evaluation on DAS28, HAQ and HADS by mobile terminal. <h3>Objectives</h3> To estimate the prevalence of anxiety and depression in Chinese patients with RA and to analyze the potential association between disease activity and mental health. <h3>Methods</h3> Under the guidance and training by health professionals, RA patients downloaded SSDM and performed self-evaluation bundle of DAS28, HAQ and HADS with SSDM. DAS28&lt;=3.2 and HAQ=0 are criteria for Treat-to-Target (T2T) and normal physical function, HADS score &gt;=8 can be diagnosed with anxiety or depression. <h3>Results</h3> From June 2016 to Jan 2019, 2,635 RA patients (461 male, 2,174 female) with a mean age of 49.94 ± 14.23 (11-88) years and the median disease duration of 25.37 months from 175 hospitals performed bundle self-evaluation for 7,455 times in total. According to the HADS and DAS28 assessment results, the prevalence of anxiety and depression in all patients was 33.30% and 39.04% respectively, which was significantly higher than that in the WHO survey in Chinese population and chronic disease patients. The proportion of patients achieved and failed on T2T was 29% and 71%, respectively. The prevalence of anxiety and depression was 20% and 25% among T2T achievers; and 31% and 38% among T2T failures, respectively (P<sub>A</sub>&lt;0.05, P<sub>D</sub>&lt;0.05). According to DAS28, the prevalence of anxiety was 19%, 20%, 27% and 41% in Remission (Rem), low disease activity (LDA), moderate disease activity (MDA) and high disease activity (HDA) subgroups respectively, the prevalence of depression was 24%, 26%, 33% and 49% respectively. The correlation coefficients of anxiety (A) and depression (D) with DAS28 were r<sub>A</sub>=0.9318 and r<sub>D</sub>=0.9334, respectively. It suggested that with the increase of disease activity, the proportion of RA patients with anxiety and depression increased significantly. Combined with physical function evaluation results, the overall prevalence of anxiety (23.65%) and depression (33.20%) in the normal HAQ group was significantly lower than that in the abnormal HAQ group (A: 36.37%, D: 43.19%, x<sub>A</sub><sup>2</sup> = 4.52, x<sub>D</sub><sup>2</sup> = 6.21, p<sub>A</sub>&lt;0.05, p<sub>D</sub>&lt;0.05). 30.50% of the patients with HAQ=0 and DAS28&lt;=2.6 were still depressed. The analysis showed that these subgroup patients comorbid with other rheumatic diseases (SS 37%, SLE 15%) or suffer adverse events (abnormal WBC count: 19%, abnormal liver function: 15%) during treatment. <h3>Conclusion</h3> Higher prevalence of anxiety and depression were associated with higher levels of disease activity and worse physical function. Rheumatic comorbidity and adverse events (ADEs) were potentially associated with depression in the Rem subgroup patients with normal physical function. SSDM is an effective mobile interface to monitor and study entanglement of disease activity, physical function and mental health in RA patients, which build a foundation for proactive interventions in future. <h3>Disclosure of Interests</h3> None declared