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Risk factors, including different biologics, associated with depression and anxiety in patients with rheumatoid arthritis: a cross-sectional observational study

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Abstract

Background

To evaluate the associated factors of depression and anxiety in patients with rheumatoid arthritis (RA) and examine the effect of different biologics.

Methods

This cross-sectional study was conducted in a regional hospital in southern Taiwan from August of 2017 to April of 2018. A total of 625 patients with RA were included. RA disease activity was measured with Disease Activity Score over 28 joints based on erythrocyte sedimentation rate (DAS28-ESR). Depression and anxiety were measured with Hospital Anxiety and Depression Scale (HADS).

Results

Based on HADS scores, 38 subjects (6.1%) and 15 subjects (2.4%) were classified as depression and anxiety, respectively. Increased disease activity of RA is noted in RA patients with depression or anxiety, and among the items of DAS28-ESR, only the two subjective components: tender joint count over 28 joints (TJC28) and patient’s global assessment (PGA) were significantly different. Multiple logistic regression analysis indicated that depression was significantly associated with TJC28 (adjusted odds ratio [aOR] = 1.10, 95% confidence interval [CI] 1.05–1.14) and female (aOR = 5.43, 95% CI 1.25–23.52); and anxiety was associated with TJC 28 (aOR = 1.07, 95% CI 1.00–1.15) and PGA (aOR = 1.03, 95% CI 1.01–1.06). Secondary analysis found a significantly lower risk of depression (aOR = 0.20, 95% CI 0.04–0.88) in patients receiving etanercept, but not anxiety, when compared with the non-biologic group.

Conclusions

This study suggests that only subjective components of DAS28-ESR were significantly associated with depression and anxiety. In comparison with other biologics, patients receiving etanercept appeared to have a lower risk of depression.

Key Points

• Rheumatoid arthritis patients possessed higher risk of depression and anxiety.

• Both depression and anxiety are strongly correlated with the subjective components of DAS28-ESR.

• Etanercept might be the choice of biologics in rheumatoid arthritis patients with depression.

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Abbreviations

RA:

Rheumatoid arthritis

DAS28-ESR:

Disease Activity Score over 28 joints based on erythrocyte sedimentation rate

HADS:

Hospital Anxiety and Depression Scale

SJC28:

swollen joint counts

TJC28:

tender joint count over 28 joints

PGA:

patient’s global assessment

HAQ:

Health Assessment Questionnaire

ACR:

American College of Rheumatology

EULAR:

European League Against Rheumatism

DMARDs:

disease-modifying anti-rheumatic drugs

VAS:

visual analog scale

CRP:

C-reactive protein

GHQ:

General Health Questionnaire

TNF-α:

tumor necrosis factor α

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Acknowledgments

The authors thank Dr. Malcolm Koo for assistance with preparation and statistical analysis of this manuscript.

Funding

From Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation (No: DTCRD106(2)-I-14).

Author information

Authors and Affiliations

  1. School of Medicine, Tzu Chi University, Hualien City, Hualien, Taiwan

    Khai-**g Ng, Kuang-Yung Huang, Chien-Hsueh Tung, Ming-Chi Lu & Ning-Sheng Lai

  2. Department of Internal Medicine, Buddhist Tzu Chi Medical Foundation, Dalin Tzu Chi Hospital, Dalin, Chiayi, Taiwan

    Khai-**g Ng, Kuang-Yung Huang, Chien-Hsueh Tung, Ming-Chi Lu & Ning-Sheng Lai

  3. Division of Immunology, Allergy and Rheumatology, Buddhist Tzu Chi Medical Foundation, Dalin Tzu Chi Hospital, No. 2, Minsheng Road, Dalin, Chiayi, 62247, Taiwan

    Khai-**g Ng, Kuang-Yung Huang, Chien-Hsueh Tung, Bao-Bao Hsu, Cheng-Han Wu, Ming-Chi Lu & Ning-Sheng Lai

  4. Department of Medical Research, Buddhist Tzu Chi Medical Foundation, Dalin Tzu Chi Hospital, Dalin, Chiayi, Taiwan

    Ming-Chi Lu

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Contributions

MCL, KJN, and NSL made substantial contributions to the conception and design of the study. KJN, MCL, KYH, CHT, BBH, CHW, and NSL participated in data collection and drafted the manuscript. KJN conducted the statistical analysis and revised the manuscript. MCL provided substantial supervision and interpretation of the statistical analysis. All authors have critically read this manuscript and approved the final version.

Corresponding authors

Correspondence to Ming-Chi Lu or Ning-Sheng Lai.

Ethics declarations

Ethics approval and consent to participate

All participants signed informed consent under a study protocol approved by the institutional review board of Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation (No. B10603008).

Disclosures

None.

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Ng, KJ., Huang, KY., Tung, CH. et al. Risk factors, including different biologics, associated with depression and anxiety in patients with rheumatoid arthritis: a cross-sectional observational study. Clin Rheumatol 39, 737–746 (2020). https://doi.org/10.1007/s10067-019-04820-x

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