FRI0669 DEPRESSION AND ANXIETY AND THEIR CLINICAL CORRELATES IN SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)
Authors: David Eldeiry, Moe Zandy, Oshrat Tayer-Shifman, Sherief Marzouk, Jiandong Su, Zahi Touma
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> In our recent systematic review, we have shown a high prevalence for depression [35% (95% CI: 29.9%-40.3%)] and anxiety [25.8% (95% CI: 19.2%-32.9%)] in Systemic Lupus Erythematosus (SLE)<sup>1</sup>. A better understanding of the SLE phenotypic manifestations associated with depression and anxiety may lead to enhanced early diagnosis and treatment strategies. <h3>Objectives</h3> To determine the overall prevalence of anxiety and depression in a cohort of SLE patients, stratified by SLE-implicated organ systems and to study their correlates. <h3>Methods</h3> Patients attending the Toronto Lupus Clinic from August 2017 to January 2019 were studied. Depression and Anxiety were diagnosed with Center for Epidemiological Studies-Depression Scale (CES-D; cut-off≥26), BECK Depression Inventory-II (BDI-II; cut-off≥18), and the BECK Anxiety Inventory (BAI; cut-off≥19). Disease activity was measured with the SLEDAI-2k (SLE Disease Activity Index 2000). The SLE phenotypic manifestations were stratified based on the organ systems of cumulative 10-year SLEDAI-2K – skin, musculoskeletal (MSK), ocular, neuropsychiatric, and internal organ manifestations (including renal, pulmonary, immunologic, and hematologic). Separate univariate and multivariate logistic regression analyses (for depression [D], anxiety [A], and anxiety and depression [AD]) were performed to study the factors associated with A, D, and AD, including age at enrollment, sex, ethnicity, disease duration, inception status (enrolled in the clinic within 1 year of SLE diagnosis), fibromyalgia, and SLE phenotypic manifestations, comparing their significance to the group with neither A or D. <h3>Results</h3> 341 patients (89.7% female), with mean age 45.9±17.8 years were studied. The prevalence of anxiety and depression in the cohort was 34% and 27% respectively, while 21% of the total cohort was found to have both anxiety and depression. Among the 3 outcome groups (A, D, and AD), MSK system involvement has a significantly higher prevalence when compared to the group with neither A or D (p-values&lt;0.05). Concurrently, skin system involvement was also significantly more prevalent among A, D, and AD groups, in comparison to the normal group (p-values&lt;0.05). Patients with anxiety had significantly higher odds of skin system involvement compared to the normal group (OR=1.81; 95% CI: 1.09, 3.01). Also, patients with depression had higher odds of MSK (OR=1.94; 95% CI: 1.07, 3.50) and skin system involvement (OR=1.79; 95% CI: 1.00, 3.20) compared to the group with neither A or D. Additionally, the odds of skin system involvement was significantly higher among patients with both A and D, compared to the group with neither (OR=2.02, 95% CI: 1.05, 3.88). In all three models (A, D, and AD), employment and fibromyalgia were also significant (p-values&lt;0.05). Age at enrolment was significant in the D and AD models (p-value&lt;0.05), while inception patient status [inception had a mean disease duration at study visit of 12.1±11.4 years compared to non-inception 19.6±10.6 years] was significant in the D model exclusively (p-value&lt;0.05). <h3>Conclusion</h3> SLE phenotypic manifestation, specifically those involving patients' skin or MSK systems, along with fibromyalgia, socio-demographic factors, and inception status were associated with anxiety or depression. Routine patient screening and evaluation, especially among patients with shorter disease duration, for these correlates may facilitate the diagnosis of these mental health disorders, and allow for more timely diagnosis and intervention strategies. <h3>References</h3> [1] Moustafa A, Hassanein M, Eder L, Wither JE, Fung W, Lambiris P, Touma Z. Prevalence and Metric of Depression and Anxiety in Lupus: A Systematic Review and Meta-Analyses [abstract]. Arthritis Rheumatol.2016; 68 (suppl 10). <h3>Disclosure of Interests</h3> David Eldeiry: None declared, Moe Zandy: None declared, Oshrat Tayer-Shifman: None declared, Sherief Marzouk: None declared, Jiandong Su: None declared, Zahi Touma Grant/research support from: GSK Canada, Consultant for: UBC, Pfizer, Janssen, Inc