POS1045 LOW MOOD MAY BE RELATED TO HIGHER DISEASE ACTIVITY AND MINOR RESPONSE TO TREATMENT IN RA
Authors: M. Korkosz, Z. Guła, P. Kuszmiersz, G. Haugeberg
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Concomitant depressive disorders are increasingly recognised as a risk factor for worse disease activity and other outcomes in many diseases including rheumatoid arthritis (RA)<sup>1</sup>. Approximately 16.8% of RA patients are affected by depression, a condition often overlooked in routine rheumatologic practice.<sup>2,3</sup> Low mood (LM), distinct from clinically diagnosed depression, can still substantially influence patient-related outcomes and treatment approaches. <h3>Objectives:</h3> This study aims to quantify the prevalence of depression and low mood among RA patients in a single-center rheumatology outpatient clinic. It also seeks to compare characteristics of patients with LM, as determined by the Multidimensional Health Assessment Questionnaire (MDHAQ) score, against those without, and to explore the relationship between LM, disease activity, inflammatory markers, and treatment modalities. <h3>Methods:</h3> Cross sectional study of real-world data of 458 adult RA patients from PolNorRHEUMA registry utilizing GoTreatIT software<sup>4</sup>. The study identified cases of depression through physician-recorded medical histories. Additionally, a criterion for 'Low mood' (LM) was established, characterized by a score of 2 or 3 on the MDHAQ's 0-3 scale. For our statistical computations and data analysis, we employed STATISTICA Tibco software, version 13.3. Our approach involved contrasting RA patients with LM against those without. We employed either independent t-tests or the non-parametric Mann-Whitney U tests for continuous variables, while categorical variables were examined using Chi-square tests. Key variables in this comparison included gender, activity levels, age, disease history, BMI, and smoking habits. We computed prevalence rates for clinically diagnosed depression and instances of LM, presenting them as percentages relative to the entire patient pool. <h3>Results:</h3> Out of 458 RA patients, only 8 (1.8%) had a depression diagnosis confirmed. However, 21% reported LM according to the MDHAQ score. Notably, patients with LM were predominantly women (90% vs. 76%, p=0.01) and had lower levels of physical activity (83% vs. 68%, p=0.01). There were no significant differences in age (56 vs. 58 years), disease duration (13 vs. 13 years), BMI (25.5 vs. 25.3 kg/m<sup>2</sup>), and history of ever smoking status (53% vs. 50%). LM was associated with higher DAS 28 scores (4.0 vs. 3.05, p=0.01), increased swollen (2.0 vs. 1.0, p=0.02) and tender joint counts (4.0 vs. 3.0, p=0.01), and elevated patient VAS scores (45 vs. 30, p=0.01), but not CRP levels (1.0 vs. 1.0 mg/l, p=0.28). Additionally, LM correlated with worse outcomes on HAQ (1.25 vs. 0.75, p=0.01), MDHAQ FN - physical function (1.2 vs. 0.7, p=0.01), and MDHAQ PS - psychological index (1.25 vs. 0.75, p=0.01). Patients with LM more frequently required biologic DMARDs (65% vs. 37%, p=0.01) and JAK inhibitors (30% vs. 15%, p=0.01), but not glucocorticoids (36% vs. 29%, p=0.17) nor NSAIDs (36% vs. 29%, p=0.28). <h3>Conclusion:</h3> Low mood in RA patients, even in the absence of a confirmed depression diagnosis, is linked to increased disease activity, diminished quality of life, and higher need for b/tsDMARDs treatment. The disparity between the prevalence of diagnosed depression and reported LM in the MDHAQ scores suggests that depression may be significantly underrecognized in routine rheumatological practice. <h3>REFERENCES:</h3> [1] Ng CYH et al. Elucidating a bidirectional association between rheumatoid arthritis and depression: A systematic review and meta-analysis. J Affect Disord. 2022 Aug (15);311:407-415. [2] Matcham F et al. The prevalence of depression in rheumatoid arthritis: a systematic review and meta-analysis. Rheumatology (Oxford). 2013 Dec;52(12):2136-48. doi: 10.1093/rheumatology/ket169. Epub 2013 Sep 3. [3] Fakra E, Marotte H. Rheumatoid arthritis and depression. Joint Bone Spine. 2021 Oct;88(5):105200. doi: 10.1016/j.jbspin.2021.105200. Epub 2021 Apr 28. <h3>Acknowledgements:</h3> This research has been supported by a grant entitled 'The POLish NORwegian research collaboration to increase quality of health care and improve health outcomes of children and adult patients with RHEUMAtological diseases' (POLNOR-RHEUMA) 0026/2019-00 from the National Center for Research and Development (NCBiR). <h3>Disclosure of Interests:</h3> <b>None declared.</b>