High Anxiety Levels in RA Patients Linked to Increased Disease Activity

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Presented at EULAR 2024, a study suggested controlling RA disease activity may be important from a psycho-social perspective.

A study found a high anxiety rate in patients with rheumatoid arthritis (RA) was linked to disease activity, patient visual analog (VAS) score, and depression.1 The data was presented at the 2024 European Alliance of Associations for Rheumatology (EULAR) from June 12 – June 15, 2024, in Vienna, Austria.

A 2020 retrospective cohort study found stress and anxiety hinder a patient’s response to RA treatment.2 Specifically, veterans with RA and comorbid PTSD, depression, or anxiety, demonstrated poor persistence of methotrexate and TNFi therapies resulting in worse outcomes.

Anxiety is reported to be 1.2 times greater in RA than in healthy controls and weakly correlated with disease activity.1 No new research in the last 10 years supported or counteracted this finding. Since then, RA treatment outcomes have improved, and it was expected that anxiety in RA would improve, too.

In the study presented at EULAR, investigators assessed the relationship between anxiety and disease activity, as well as the activity of daily living and depression, in patients with RA.

Investigators included 155 patients with RA who attended Showa University Hospital and Showa University Northern Yokohama Hospital outpatient clinics. They collected data on age, gender, prednisolone use, the simplified disease activity index, and the health assessment questionnaire for assessment of activity of daily living.

Additionally, depression was assessed through the Center for epidemiologic studies depression scale and the Patient Health Questionnaire-9 to evaluate depression. Anxiety was assessed with the State-Trait Anxiety Inventory; cutoff values for state anxiety was 41 for men and 42 for women and for trait anxiety was 44 and 45, respectively.

Participants had state anxiety scores of 39.0 ± 11.0 and trait anxiety scores of 39.5 ± 11.6; 41.3% and 32.9% of participants, respectively, scored above the cutoff value.

The group with greater state anxiety had a simplified disease activity index of 7.1 ± 9.0 vs. 4.2 ± 5.1 (P =.001), VAS score of 27.9 ± 28.7 vs. 15.8 ± 20.4 (P =.003), Center for epidemiologic studies depression scale score of 14.6 ± 7.7 vs. 7.8 ± 5.5 (P =.000), and a PHQ-9 score of 5.6 ± 4.7 vs. 2.1 ± 2.1 (P = .000).

Furthermore, the group with greater characteristic anxiety had a simplified disease activity index of 8.4 ± 9.4 vs. 3.9 ± 5.0 (P =.000), patient VAS score of 33.0 ± 29.9 vs. 14.8 ± 19.4 (P = 0.000), Center for epidemiologic studies depression scale score of 15.9 ± 7.9 vs. 8.0 ± 5.4 (P =.000), PHQ-9 score of 6.5 ± 4.8 vs. 2.1 ± 2.1 (P =.000), and health assessment questionnaire score of 0.63 ± 0.69 vs. 0.33 ± 0.55 (P =.004).

Investigators observed no significant differences in the relationship between age, gender, prednisolone use, state anxiety, and the health assessment questionnaire.

“The high rate of anxiety in RA patients was associated with disease activity, patient VAS, and depression, suggesting that controlling disease activity may be necessary from a bio-psycho-social perspective,” investigators concluded.


  1. Miwa, Y, Miwa, Y, Hosaka, M. Ab0505 A Cross-Sectional Study of The Association Between Anxiety State and Various Factors in Patients with Rheumatoid Arthritis. Abstract presented in 2024 European Alliance of Associations for Rheumatology (EULAR) from June 12 – June 15, 2024, in Vienna, Austria
  2. Rheumatoid Arthritis With PTSD, Anxiety and Depression. HCPLive. October 16, 2020. Accessed June 25, 2024.