FRI0428 PSORIATIC ARTHRITIS AND DEPRESSIVE SYMPTOMS: DOES SYSTEMIC INFLAMMATION PLAY A ROLE?
Authors: Enrico De Lorenzis, Gerlando Natalello, Dario Bruno, Giacomo Tanti, Giovanni Battista Canestrari, Maria Rosaria Magurano, Clara DI Mario, Barbara Tolusso, Giusy Peluso, Elisa Gremese
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Depression is one of the most common comorbidities in patients with Psoriatic Arthritis (PsA) but risk factors for mood disorders in these patients are still largely unrecognized. Pro-inflammatory cytokines involved in the pathogenesis of PsA have been also associated with depressive symptoms in patients without systemic autoimmune diseases. <h3>Objectives</h3> The aim of this study is to determine risk factors for depressive symptoms and compare serum cytokines concentrations in subjects with and without depressive symptoms in a court of PsA patients. <h3>Methods</h3> Eighty consecutive patients with PsA were screened for depressive symptoms with depression subscale of the Hospital Anxiety and Depression Scale (HADS-D). A validated cut-off of 8 was used to define patients with significative depressive mood. Patients with and without depressive symptoms were compared for the prevalence of general risk factors for depression, comorbidity, psoriatic disease age of onset, duration, activity and domains affected, treatment and serum levels of IL-6, TNF-α and IL-17A. <h3>Results</h3> Mean disease duration of skin disease and articular disease was 18.8 ± 15.3 years and 9.0 ± 11.1 years, respectively. All patients had a history of peripheral arthritis, 41.3% had dactylitis, 38.8% had enthesitis, 21.3% had spondylitis 82.5% had a psoriatic skin disease and 51.2% had psoriatic nail disease. According to DAPSA index, 20.0% were in remission, 50.0% in Low Disease Activity, 20.0% in Moderate Disease Activity and 10.0% in High Disease Activity. Thirty-five (43.8%) were in Minimal Disease Activity. Thirty-three patients (41.3%) had depressive symptoms according to HADS. Patients with and without depressive symptoms did not differ in terms of age, gender, comorbidity, general risk factors of depression, psoriatic disease age of onset, duration, domains affected, DAPSA activity, MDA achievement, PASI, HAQ, VAS pain, the intensity of treatment, serum TNF-α IL-17A and IL-23. Serum levels of IL-6 were higher in patients with depressive symptoms. (2.99±2.58 vs 1.54±1.60 pg/dl; p=0.006). A cut-off of 2.27 pg/ml of serum IL-6 had the best ability to predict a HADS≥8 according to higher Youden Index of the ROC curve (AUC 0.682±0.061; p=0.006). Multivariate logistic regression analysis revealed that serum IL-6≥2.27 pg/ml was a predictor of depressive symptoms even when adjusted for DAPSA, HAQ and PASI (OR 3,06; CI 1.14-8.20; p = 0.026). <h3>Conclusion</h3> Higher serum Il-6 is associated with depressive symptoms independently from articular and cutaneous disease activity and degree of disability. This association suggest a direct role of systemic inflammation in the modulation of mood in PsA patients. <h3>References</h3> [1] Husni ME, et al. The psychosocial burden of psoriatic arthritis. Semin Arthritis Rheum2017. [2] Ogata A, et al. Pathological Role of Interleukin-6 in Psoriatic Arthritis. Arthritis2012. [3] Hodes GE et al. Integrating Interleukin-6 into depression diagnosis and treatment. Neurobiol Stress 2016. [4] Zigmond AS et al. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand 1983. <h3>Disclosure of Interests</h3> Enrico De Lorenzis: None declared, Gerlando Natalello: None declared, Dario Bruno: None declared, Giacomo Tanti: None declared, Giovanni Battista Canestrari: None declared, Maria Rosaria Magurano: None declared, Clara Di Mario: None declared, Barbara Tolusso: None declared, Giusy Peluso: None declared, Elisa Gremese Consultant for: AbbVie, BMS, Celgene, Janssen, Lilly, MSD, Novartis, Sanofi, UCB, Roche, and Pfizer, Speakers bureau: BMS, Speakers bureau: Roche, Speakers bureau: AbbVie, BMS, Celgene, Janssen, Lilly, MSD, Novartis, Sanofi, UCB, Roche, and Pfizer