DESTIN, Fla. — There is a 53% higher prevalence of depression associated with rheumatoid arthritis, and a 21% higher prevalence in systemic lupus erythematosus, although depression severity was only demonstrated among patients with the former, according to findings presented at the 2018 North American Young Rheumatology Investigator Forum.
“Depression is very common is patients with rheumatoid arthritis (RA) and lupus,” Rui Zhang, MD, PhD, of New York Medical College and Westchester Medical Center, said during the presentation. “Depression increases the risk for morbidity and mortality in RA and lupus, due to cardiovascular diseases, suicidal ideation and others. Depression also increases health service utilization and decreases adherence with medication and may also contribute to unemployment, loss of work productivity and increased health care costs among persons with arthritis.”
To analyze depression and its correlation with RA and systemic lupus erythematosus (SLE) disease activity, as well as examine the effect of treatment on depression score, Zhang and colleagues conducted a cross-sectional study focusing on Patient Help Questionnaire (PHQ-9) data from a single rheumatology center. They recruited a total of 51 patients with RA, with a mean age of 50 years, as well as 19 patients with SLE, with a mean age of 43 years. Women made up 82% of the RA group and 95% of the SLE group.
The researchers collected PHQ-9 scores for each patient during every clinic visit, where physicians recorded corresponding disease activity, assessed using the Clinical Disease Activity Index (CDAI) or the SLE Disease Activity Index (SLEDAI). In addition, the physicians offered intervention, counseling or medication to patients with at least moderate depression, as defined as a PHQ-9 score of 10 or more; PHQ-9 scores were then reassessed following intervention.
According to the researchers, 53% of patients in the RA group were diagnosed with depression, including 29% with mild, 12% with moderate and 12% with moderately severe forms of the condition. In addition, depression severity was positively correlated with RA disease activity (Pearson R = 0.613; P < .001). Among patients in the SLE group, 21% were diagnosed with depression, although depression severity did not correlate with disease activity (Pearson R = 0.21). Patients with RA and a moderate or high CDAI demonstrated significantly higher PHQ-9 scores than those with low CDAI.
Among the 14 patients who qualified for depression intervention, 50% declined treatment. Among the 29% who received treatment, 2 patients demonstrated improved PHQ-9 scores, 1 patient’s scores worsened – although this result was cofounded by cancer surgery – and 1 patient exhibited no change in score.
“Our study shows higher prevalence of depression in both RA and SLE than in the general population, which has a prevalence of 7% to 12%,” Zhang said. “Correlation between disease activity and depression scores was only found in RA patients, and, overall, 50% of those with depression declined treatment, despite its ability to improve PHQ-9 scores. Although this is a small study, it may support the benefit of depression screening, active follow-up and depression treatment in patients in our rheumatology practice.” – by Jason Laday
Zhang R. Depression screening and intervention in rheumatoid arthritis and systemic lupus erythematosus. Presented at: North American Young Rheumatology Investigator Forum; May 16, 2018; Destin, Fla.
Disclosure: Zhang reports no relevant financial disclosures.