AB0143 IMPACT OF MOOD DISORDERS ASSESSED WITH DASS-21 (DEPRESSION ANXIETY STRESS SCALE) ON DISEASE ACTIVITY IN PATIENTS WITH RHEUMATOID ARTHRITIS AND FIBROMYALGIA
Authors: M. Giannotta, M. Fornaro, M. Morrone, M. G. Anelli, G. Roselli, A. Carenza, D. Domanico, G. Lopalco, F. Iannone
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Rheumatoid arthritis (RA) is a chronic, inflammatory, systemic autoimmune disease that primarily affects the joints, impacting patients' quality of life and contributing to mood disorders. The concurrent presence of fibromyalgia (FM), a central sensitization syndrome characterized by widespread musculoskeletal pain, adds complexity due to overlapping symptoms that impact mood. <h3>Objectives:</h3> This study aimed to evaluate the impact of mood disorders in a cohort of patients with both RA and RA+FM, using the Depression Anxiety Stress Scales Short Version (DASS-21). <h3>Methods:</h3> A cross-sectional study was conducted at our Rheumatology clinic involving 76 patients with RA, as defined by the ACR/EULAR 2010 criteria. Of these, 36 were also diagnosed with FM according to the 2016 diagnostic criteria. We collected demographic and clinical data, including HAQ, SDAI, CDAI, DAS28-CRP, tender (TJC) and swollen joint counts. The DASS-21, a globally recognized self-reported questionnaire, was used to assess mood disorders. From the DASS-21 we can derive a global score for mood disorders, as well as three individual scores for anxiety, depression, and stress [1]. Group comparisons were conducted using one-way ANOVA and Fisher's test. Correlation analyses using the Pearson test were performed to assess possible associations between DASS-21 and disease activity scores. The ROC curve was constructed to evaluate the association between DASS21 scores and FM diagnosis. Statistical significance was defined as a p-value ≤ 0.05. Statistical analyses were performed using SPSS 21.0. <h3>Results:</h3> The study included 97.4% female patients, with an average age of 59.8 years and an average disease duration of 11.9 years for RA. No significant differences were observed between the RA and RA+FM groups in terms of demographic and treatment data. However, significant differences were noted in disease activity, with higher scores in the RA+FM group according to the HAQ (mean±S.D.: 0.76±0.8 in RA patients vs. 1.2±0.8 in RA+FM patients) and the DAS28-CRP (mean±S.D: 2.24±1.1 in RA patients vs. 2.74±1.0 in RA+FM patients). Notably, a statistically significant difference was found in the DASS-21 scores (mean±S.D: 9.3±11.8 in RA patients vs. 23.11±11.8 in RA+FM patients, p&lt;0.001). Correlation analysis, conducted separately for RA and RA+FM patients, revealed that the majority of correlations were observed in RA without FM. Specifically, positive correlations were found between DASS-21 and its subscales for depression and anxiety, and disease activity indexes (refer to Table 1a). In patients with RA+FM, only a correlation between anxiety and TJC was found (refer to Table 1b). Finally, according to the ROC curve (AUC: 0.858), a DASS-21 threshold score of 12.5 has a sensitivity of 86.1% and specificity of 82.5% for diagnosing FM in patients with RA (Figure 1). <h3>Conclusion:</h3> Patients with RA+FM demonstrated higher levels of disease activity and more severe mood disorders. Interestingly, a positive correlation between mood disorders and disease activity was predominantly observed in RA without FM. This suggests that the presence of FM may impact on the relationships between mood disorders and disease activity. <h3>REFERENCES:</h3> [1] Bottesi G et al. C.Compr Psychiatry. 2015. <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>