AB0342 DEPRESSION ON PATIENTS WITH RHEUMATOID ARTHRITIS
Authors: Simeon Monov, Russka Shumnalieva, Elena Miloshova, Daniela Monova
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Rheumatoid arthritis (RA) is a chronic representative inflammatory autoimmune disease. The association of disease activity and pro-inflammatory cytokines with depression has not been sufficiently investigated. <h3>Objectives</h3> The aim of this study is to analyze the association between disease activity and depression using Patient Help Questionnaire (PHQ-9) in patients with rheumatoid arthritis (RA). We also examined the outcome of intervention on depression score and determined the prevalence of depression and risk factors for depression and deterioration of depressive symptoms in RA patients. <h3>Methods</h3> 146 RA patients with a mean age of 51,3±11,2 years were included in the study. Demographic and laboratory data were examined. Disease activity score 28-joint count C-reactive protein (DAS 28-CRP) was performed to assess disease activity of RA. PHQ-9 scores were collected at each clinic visit. Physicians assessed corresponding disease activity using Clinical Disease Activity Index (CDAI). Patients with at least moderate depression (PHQ-9 _10) were offered depression intervention, counseling or medications. PHQ-9 was re-administered after intervention. <h3>Results</h3> 119 of RA patients were females, the average disease duration was 6,8 ± 5,9 years. Depression was diagnosed in 38 of RA patients: 18 - mild, 13 - moderate and 7 - moderately severe. Severity of depression positively correlated with disease activity in RA patients (p &lt;0.05). RA patients with moderate/high CDAI had significantly higher PHQ-9 than those with low CDAI (p&lt;0.001). Of 7 patients who met criteria for depression intervention, 6 were treated and 1 - declined. With treatment 5 patients had improved PHQ-9 scores, 1 patient worsened, and 1 patient had no change in score. The risk of developing a depressive disorder is highest between 5 and 10 years of onset of the disease and depression is a better predictor of work disability than disease activity and response to treatment. Depression is associated with more pain, fatigue and impaired quality of life. Therefore, the risk to develop a depression is increased with impaired function as measured by the health assessment questionnaire (HAQ). Increased disease activity increases the risk for depression in RA. The severity of disease activity of RA, DAS 28-CRP [OR 1.75, 95% CI 1.08-2.64]) and severity of fatigue (OR 1.32 95% CI 1.12-1.27) were associated with depression and deterioration of depressive symptoms in the multivariate analysis. Among the components of DAS 28-CRP, patient assessment for global health and abilities for daily performance were more related to depression. Depression unfavorably influences the response to therapy, the rate of remission is lower and the mortality is increased in RA patients. Taken together, this indicates that it is necessary to detect a depression in patients with RA as early as possible in order to initiate appropriate treatment of depression in such cases. <h3>Conclusion</h3> Our study shows depression in 19,18% of patients. Correlation between disease activity and depression score is found in RA patients. Depression intervention resulted in PHQ-9 improvement in some patients, supporting the benefit of depression screening and treatment in rheumatology practice. Depression was related with the level of fatigue and high RA disease activity, which was associated with impaired ability to perform activities of daily life. Strict control of fatigue and disease activity to improve one's capacity to perform daily life activities would be important to regulate depression. Depression is common and associated with worse outcomes among patients with RA. <h3>Disclosure of Interests</h3> None declared