AB0118 REMISSION OF ANXIETY AND DEPRESSIVE DISORDERS IMPROVES HAQ TREATMENT RESPONSE IN RHEUMATOID ARTHRITIS PATIENTS
Authors: A. Abramkin, T. Lisitsyna, D. Veltishchev, O. Seravina, O. Kovalevskaya, S. Glukhova, E. Nasonov
Journal: Annals of the Rheumatic Diseases (2021)

Background: Anxiety and depressive disorders (ADD) significantly affect disease activity and functional disability in rheumatoid arthritis (RA) patients. Psychopharmacotherapy (PPT) of ADD attempts to improve RA disease activity and lower progression of functional limitations. Objectives: To determine factors associated with HAQ treatment response in antidepressants-treated RA-patients at five years endpoint. 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. Baseline HAQ scores were 1,39±0,75, 1,42±0,9, 1,58±0,76 and 1,38±0,83 in groups 1-4, respectively. At 5-yrs endpoint in 83 RA-pts differences between baseline and endpoint HAQ scores (Δ HAQ = endpoint HAQ – baseline HAQ) were assessed as HAQ treatment response with minimal clinically important difference (MCID) (Δ HAQ ≥ 0,22). HAQ response rates were 4,2%, 65,5%, 47,6% and 76,7% in groups 1-4, respectively, with the lowest response rate in group 1 (p&lt;0,0001). Logistic regression analysis was conducted to determine factors associated with RA remission rate. Results: By univariate logistic regression, anxiety and depressive symptoms remission at 5-yrs endpoint, baseline HAQ and major depression, lower baseline age, BMI and DAS28, no minor depression and cardiovascular diseases at baseline were significantly (p≤0,2) associated with HAQ treatment response (table 1). These variables were subjected to multivariate stepwise logistic regression. Only remission of anxiety and depressive symptoms at 5-yrs endpoint (OR 6,6 (95%CI 1,78 – 24,43), p=0,005), higher baseline HAQ (OR 2,61 (95%CI 1,12 – 6,11), p=0,027) and lower baseline BMI (OR 0,9 (95%CI 0,85 – 0,96), p=0,001) were independently associated with HAQ treatment response at 5-years follow-up. Table 1. Factors associated with RA remission at 5 years (univariate logistic regression). Factor p OR 95%CI low up Anxiety and depressive symptoms remission at 5-yrs endpoint 0,007 5,0 1,561 16,016 Baseline HAQ 0,01 2,657 1,264 5,588 Baseline major depression 0,142 2,082 0,782 5,542 Baseline age 0,098 0,992 0,982 1,002 Body mass index (BMI) 0,048 0,981 0,963 1,0 Baseline minor depression 0,167 0,563 0,249 1,273 Cardiovascular diseases 0,1 0,417 0,147 1,183 Baseline DAS28 0,008 0,077 1,071 2,096 Conclusion: higher HAQ and lower BMI at baseline and remission of anxiety and depressive symptoms at 5-yrs endpoint are independently associated with HAQ treatment response (MCID) at 5-years follow-up. Disclosure of Interests: None declared