Impact and Prevalence of Depression and Anxiety in Rheumatoid Arthritis – a Cross-Sectional Study with Self-Reported Questionnaires

Objective: The study aims to screen for depression and anxiety a real-life sample of RA patients and to observe whether RA phenotype characteristics and RA disease activity measures are associated with depression and anxiety. Methods: This cross-sectional study screened for depression and anxiety using the PHQ9 and HADS, self-reported questionnaires, all patients with diagnosed RA that came for their disease follow-up during one month. The follow-up captured the date of RA diagnosis, pharmacological treatment, clinical examination, blood sampling, functional and radiographic assessment. The cut-off for positive screening of depression was a PHQ9 of 10 or more and a HADS-D of over 10, and the positive cut-off for anxiety was a HADS-A of over 10. Results: According to the medical history the prevalence of depression and anxiety in the 209 patients included was 10%, respectively 8.1%, while the likely depression diagnosis according to PHQ was 34.4% and according to HADS-D was 14.8% and a likely anxiety diagnosis using the HADS-A was 32.5%. The subgroup of patients that positively screened for depression using the self-reported questionnaires PHQ9 and HADS-D had significantly higher DAS28, disease activity class, tender joint count, VAS, functional stage, with some particularities regarding ESR and radiographic stage which were higher just in the HADS-D of more than 10 subgroup and glucocorticoid use which was higher just in the PHQ over 10 subgroup. Regarding patients with a HADS-A of more than 10 they were more frequently women, and had higher tender joint count and functional stage. Conclusions: Depression and anxiety are highly prevalent and underdiagnosed in the RA population and are associated with higher levels of pain, physical disability and disease activity.