Depression Reduces Remission Likelihood in Rheumatoid, Psoriatic Arthritis

New research is shedding light on factors potentially influencing the likelihood of achieving remission in patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA), highlighting the negative impact of depressive symptoms during the first 2 years after disease diagnosis.1

Leveraging data from the Rotterdam Early Arthritis CoHort (tREACH) trial and the Dutch southwest Early Psoriatic Arthritis (DEPAR) cohort, the study found patients with depression and anxiety had reduced odds of achieving remission, although anxiety lost significance in adjusted analyses.1

According to the Arthritis Foundation, having any form of arthritis — osteoarthritis, RA, PsA, juvenile arthritis, lupus, ankylosing spondylitis, gout, fibromyalgia, or related conditions — can have a negative effect on mental health, most commonly manifesting as depression or anxiety.2 The presence of comorbid depression and/or anxiety has previously been linked to the inability to achieve RA and PsA remission, and additional research suggests the presence of a bidirectional relationship between depression/anxiety and inflammatory arthritis.1

“To date, depression and anxiety have mostly been explored as baseline predictors for poor outcomes,” Selinde V J Snoeck Henkemans, MD, of the department of rheumatology at Erasmus Medical Center in The Netherlands, and colleagues wrote.1 “Studies exploring the effect of depression and anxiety separately, using a validated questionnaire, on remission over time in both RA and PsA are lacking.”

To address this gap in research, investigators analyzed data from the tREACH trial and the DEPAR cohort.1

tREACH was a multicentre, stratified, single-blinded randomized controlled trial. Eligible patients had arthritis in ≥1 joints and a symptom duration of <1 year. For the present study, RA patients who fulfilled the 1987 and/or 2010 classification criteria for RA were selected (n = 425).1

DEPAR is an ongoing, multicenter, prospective cohort study that started in 2013. Eligible patients have a new diagnosis of PsA, according to the treating rheumatologist, and have not yet had DMARDs for musculoskeletal inflammation. From DEPAR, investigators collected data up to March 2019 from all consecutive PsA patients who were included between November 2013 and March 2017 (n = 442).1

In addition to clinical outcomes and blood samples, patients filled out questionnaires on pain, general health, depression, and anxiety. Pain and general health were measured on a visual analogue scale (VAS), while depression and anxiety were measured with the Hospital Anxiety and Depression Scale (HADS).1

A score > 7 on the depression subscale or anxiety subscale of HADS was defined as a possible depression or anxiety disorder, respectively. Remission was defined as Disease Activity Score (DAS44) <1.6 in RA and Disease Activity index for Psoriatic Arthritis (DAPSA) ≤ 4 in PsA.1

Among the 425 included RA patients, 400 (94%) had data on depression/anxiety at baseline. Of these patients, 78 (20%) were depressed and 120 (30%) were anxious based on HADS scores > 7. Among the 442 included PsA patients, 367 (83%) had data on depression/anxiety at baseline. Of these patients, 67 (18%) were depressed and 85 (23%) were anxious based on HADS.1

Investigators noted remission was less frequently achieved after 1 and 2 years of follow-up in both RA and PsA patients with depression or anxiety at baseline. Further analysis revealed depression and anxiety were associated with reduced odds of achieving remission in both RA and PsA.1

Of note, after adjustment for depression in the analyses of anxiety and vice versa, only depression remained associated with a lower likelihood of achieving remission. The depression/anxiety adjusted odds ratio (OR) for DAS44 remission was 0.45 (95% CI, 0.25–0.80) in RA patients with depression and 0.70 (95% CI, 0.43–1.14) in those with anxiety. After full adjustment, the ORs increased to 0.50 (95%CI 0.28–0.88) and 0.85 (95%CI 0.52–1.36) for depression and anxiety, respectively.1

For PsA, the depression/anxiety adjusted ORs for achieving DAPSA remission were 0.24 (95% CI, 0.08–0.71) and 0.47 (95% CI, 0.19–1.16) in patients with depression or anxiety, respectively. Similarly, after full adjustment, the ORs increased to 0.78 (95% CI, 0.26–2.34) for depression and 0.39 (95% CI, 0.14–1.09) for anxiety.1

Investigators additionally pointed out the presence of depression/anxiety was associated with higher tender joint count, worse general health, more pain and slightly elevated inflammation markers, but not with more swollen joints in both RA and PsA.1

“Proper recognition of depression may improve disease management of patients with RA or PsA,” investigators concluded.1 “This could potentially result in fewer (unnecessary) treatment alterations and reduced healthcare and societal costs.”

References

1. Snoeck Henkemans SVJ, Vis M, Koc GH, et al. Association between depression and anxiety and inability to achieve remission in rheumatoid arthritis and psoriatic arthritis. Rheumatology (Oxford). doi:10.1093/rheumatology/keae621

2. Arthritis Foundation. Arthritis and Mental Health. Accessed June 16, 2025. https://www.arthritis.org/health-wellness/healthy-living/emotional-well-being/anxiety-depression/arthritis-and-mental-health