Abstract
Purpose
Depressive symptoms are common in rheumatoid arthritis (RA) and may affect disease
activity and treatment outcomes. The objective of this study was to determine if prevalent
depressive symptoms modify biologic treatment response through their effect on RA
disease activity.
Methods
RA patients with depressive symptoms, initiating biologic treatment, were identified
from a US RA registry sample. Patients with depression were compared with control
subjects (ie, those patients with no reports of depressive symptoms at, or before,
initiating therapy) in terms of clinical disease activity index (CDAI) remission and
low disease activity (LDA), and the changes in the component measures that comprise
this scale at 6 and 12 months of follow-up. Inverse probability weighting was used
to account for differences in baseline disease severity, concomitant treatment characteristics,
and other possible confounders. Logistic and linear regression models estimated differences
in response rates and changes in component disease activity measures.
Findings
Depressive symptoms were associated with a decreased likelihood of CDAI remission
at 6 months (odds ratio, 0.43 [95% CI, 0.19–0.96]) but not at 12 months (odds ratio,
0.83 [95% CI, 0.43–1.60]), and there was no effect on CDAI LDA. Adjusted core component
measurement changes showed smaller decreases in global assessment ratings in patients
with depressive symptoms; these associations were not statistically significant.
Implications
Poorer treatment outcomes among RA patients with depressive symptoms may be a result
of higher baseline disease severity. Adjusted estimates indicated symptoms of depression
only affected remission at 6 months’ follow-up through patient and physician global
assessments. Thus, any impact of depressive symptoms during biologic treatment might
not be due to a definitive impact on joint swelling and tenderness.
Key words
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Article info
Publication history
Published online: June 28, 2016
Accepted:
June 7,
2016
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
