Ultrasound evaluation contrasts clinical disease activity evaluation in rheumatoid arthritis patients with concomitant anxiety or depression

• Published in: Seminars in arthritis and rheumatism 2024-10, Vol.68, p.152502, Article 152502
• Main Authors: Michelsen, Brigitte, Sexton, Joseph, Kvien, Tore K, Provan, Sella Aarestad, Hammer, Hilde Berner
• Format: Article
• Language: English
• Subjects: Aged; Anxiety; Anxiety - complications; Arthritis, Rheumatoid - complications; Arthritis, Rheumatoid - diagnostic imaging; Arthritis, Rheumatoid - pathology; Depression; Depression - complications; Disease activity; Female; Humans; Male; Middle Aged; Rheumatoid arthritis; Sociodemographic Factors; Ultrasonography; Ultrasound
• ISSN: 0049-0172; 1532-866X; 1532-866X
• DOI: 10.1016/j.semarthrit.2024.152502

•The study highlights the challenges in assessing disease activity among rheumatoid arthritis patients with anxiety or depression, as well as the higher burden of patient-reported outcome measures, unemployment, worse self-evaluated economy and sleep difficulties among these patients.•As assessed by a comprehensive ultrasound assessment, disease activity was similar between patients with and without anxiety or depression, contrasting the higher disease activity found in those experiencing anxiety or depression when using a comprehensive clinical assessment.•The study advocates for the consideration of objective methods, such as ultrasound assessments, in evaluating disease activity among rheumatoid arthritis patients dealing with anxiety or depression. To compare disease activity as assessed by ultrasonography (US) between rheumatoid arthritis (RA) patients with and without anxiety or depression, and to compare clinical disease activity and sociodemographic measures between these patient groups. Anxious or depressed patients were identified by EuroQoL-5D-3L question “I am not/moderately/extremely anxious or depressed.” US assessments of 36 joints and 4 tendons were performed and power Doppler (PD) and grey scale (GS) sum scores calculated (both range 0–120). Comparisons between anxious/depressed and not anxious/depressed patients were performed in unadjusted analyses, adjusted logistic regression, and sensitivity analyses. A total of 201 RA patients starting biological disease-modifying antirheumatic drugs were included (82 % women, mean age 52 years, disease duration 10 years). Hundred-and-nine patients (54.2 %) were moderately or extremely anxious/depressed. Median (IQR) PD (13 (4, 21) vs. 10 (3, 20), p = 0.53) and GS (28 (18, 42) vs. 25 (14, 41), p = 0.51) sum scores were similar between anxious/depressed and not anxious/depressed patients, respectively, whereas composite scores of disease activity were significantly worse in the anxious/depressed patients (p < 0.001), as were also patient-reported outcomes, ESR, CRP and plasma calprotectin (all p ≤ 0.02). Sensitivity analyses confirmed these findings, except for CRP. Self-reported economy and sleep difficulties were also worse in the anxious/depressed patients and a higher proportion were not working (all p < 0.001). This study highlights the negative impact of anxiety and depression on RA patients in standard care, and underscores the challenges in disease activity assessment. US examination may be a