OP0215 FUNCTIONAL ABILITIES IMPROVEMENT IN RHEUMATOID ARTHRITIS PATIENTS WITH DEPRESSIVE AND ANXIETY DISORDERS TREATED WITH BIOLOGIC DMARDS AND/OR ANTIDEPRESSANTS
Authors: A. Abramkin, T. Lisitsyna, D. Veltishchev, O. Seravina, O. Kovalevskaya, E. Nasonov
Journal: Annals of the Rheumatic Diseases (2020)

Background: Anxiety and depressive disorders (ADD) significantly increase functional limitations in patients with rheumatoid arthritis (RA). Successful psychopharmacotherapy (PPT) of ADD can potentially improve the functional abilities of RA-patients. Objectives: To compare changes in functional disability of RA patients with comorbid ADD treated with conventional disease-modifying antirheumatic drugs (cDMARDs) alone or in combination with biologic DMARDs (bDMARDs) and/or PPT. Methods: 128 RA-patients (pts) were enrolled, 86% were women with a mean age of 47,4±11,3 (M±SD) yrs. All patients met the full ACR/EULAR 2010 criteria for RA. Functional limitations were assessed using Health Assessment Questionnaire (HAQ), mean HAQ was 1,42±0,78 at baseline. 69,4% RA-pts were already taking prednisone (9 [5; 10] mg/day (Me (25%; 75%)), 84,4% - cDMARDs, 7,8% - bDMARDs (anti-TNF-α – 6,3%, rituximab – 1,6%). ADD were diagnosed by psychiatrist in 123 (96,1%) of RA-pts in accordance with ICD-10 in semi-structured interview. Severity of depression and anxiety was evaluated with Montgomery–Asberg Depression Rating Scale (MADRS) and Hamilton Anxiety Rating Scale (HAM-A). RA-pts with ADD were divided into the following treatment groups: 1 – сDMARDs (n=39), 2 – сDMARDs + PPT (sertraline or mianserine) (n=43), 3 – сDMARDs + bDMARDs (n=32), 4 – сDMARDs + bDMARDs + PPT (sertraline or mianserine) (n=9). Biologics treatment duration varied from 1 to 6 years, antidepressants – from 6 to 96 weeks. Results: HAQ scores were high in all 4 groups at baseline and after five years remained high in all groups except group 2 with the lowest endpoint scores among 4 groups (table 1). To measure changes in HAQ scores between groups we compared the differences between baseline and endpoint HAQ scores (Δ HAQ = endpoint HAQ – baseline HAQ) (table 2). The table shows an improvement in HAQ scores in groups 2 and 3, no significant changes in group 4 and a worsening of HAQ scores in group 1. HAQ scores in groups 2 and 3 significantly improved compared to group 1. Table 1 Mean HAQ scores in RA patients with ADD at baseline and after 5 years, by groups. Groups At baseline (n=128) After 5 years (n=83) P between time points 1 (cDMARDs), n=39 1,39±0,75 1,61±0,7 &gt;0,05 2 (сDMARDs + PPT), n=43 1,42±0,9 0,85±0,66 0,011 3 (сDMARDs + bDMARDs), n=32 1,58±0,76 1,36±0,71 &gt;0,05 4 (сDMARDs + bDMARDs + PPT), n=9 1,38±0,83 1,49±0,26 &gt;0,05 P between groups &gt;0,05 P 2-1 &lt;0,001; P 2-3 =0,023 P 2-4 =0,015 Table 2. Differences between baseline and 5-years endpoint HAQ scores, by groups сDMARDs, n=24 сDMARDs + PPT, n=29 сDMARDs + bDMARDs, n=21 сDMARDs + bDMARDs +PPT, n=9 p 1 2 3 4 Δ HAQ 0,23±0,49 -0,3±0,42 -0,28±0,94 0±0,82 P 1-2 =0,002; P 1-3 =0,033 Conclusion: Functional abilities measured by HAQ scores significantly improved in RA-patients with ADD receiving cDMARDs in combination with bDMARDs or PPT compared to cDMARDs only. The lowest HAQ scores were observed in patients receiving cDMARDs in combination with PPT. Disclosure of Interests: None declared