RA outcomes worsened by depression and anxiety, study finds

Patients diagnosed with rheumatoid arthritis (RA) and co-occurring anxiety or depression are less likely to achieve low disease activity and better symptom control after three months of treatment, according to new research presented at the Canadian Rheumatology Association (CRA) 2024 Annual Meeting in Canada.

The findings have emphasised the importance of taking a multidisciplinary approach to RA treatment, said presenter Susan Bartlett, professor in clinical epidemiology, rheumatology and respiratory epidemiology at McGill University, Montreal.

The study explored how certain symptom clusters in RA predicted prognosis. The researchers used data from the Canadian Early Arthritis Cohort (CATCH), a multisite prospective research study following individuals with new-onset RA. They identified patients starting methotrexate (MTX) therapy who also had clinical and patient-reported outcome measures available. Individuals included in the analysis may have also been taking additional disease-modifying antirheumatic drugs beyond MTX.

Across the 310 selected individuals, researchers identified four key symptoms: Pain, fatigue, anxiety and depression. Pain and fatigue were defined as physical symptoms, while anxiety and depression were classified as emotional symptoms. Results showed that the patients could be sorted into four distinct symptom clusters: Minimal symptoms (12%), mild physical and emotional symptoms (11%), moderate to severe pain and fatigue (40%), and moderate to severe physical and emotional symptoms (37%).

Researchers then followed patients during the first 6 months of treatment to evaluate if patients' symptoms improved.

Symptom improvement mostly occurred during the first three months of treatment and remained consistent at six months. Overall, patients with moderate to severe emotional symptoms had a worse prognosis and were less likely to achieve milder symptoms than those who had only pain and fatigue or mild emotional symptoms.

While 64% of patients in the moderate to severe physical symptoms group achieved minimal symptoms after three months of treatment, only 13% of patients with moderate to severe physical and emotional systems reported minimal symptoms during this same time frame.