Improvements in patient-reported outcomes, symptoms of depression and anxiety, and their association with clinical remission among patients with moderate-to-severe active early rheumatoid arthritis

Rheumatology, 11/10/2010

Kekow J et al. – Among moderate-to-severe active early RA patients, clinical remission reduces symptoms of depression/anxiety, and independently improves PROs, thereby suppressing the negative impact of depression/anxiety on these measures.

Methods

  • Patients from COmbination of Methotrexate and ETanercept in Active Early Rheumatoid Arthritis (COMET) trial (104 weeks) with measures on Hospital Anxiety and Depression Scale at baseline and subsequent visits (n=389) included
  • PROs investigated HAQ disability index, pain and fatigue visual analogue scales (VASs), EuroQoL health status VAS and Medical Outcomes Short Form-36 physical and mental component summaries
  • Impact of clinical remission as measured by 28-joint DAS (DAS-28) on depression/anxiety symptoms at Week 104 assessed using logistic regression
  • Least square means for PRO improvements from baseline estimated by analysis of covariance
  • Missing data imputed using last observation carried forward method

Results

  • When depression/anxiety symptoms were absent at baseline, significantly more patients achieved clinical remission, low disease activity and normal functioning at Week 104
  • Reciprocally, patients who achieved clinical remission less likely to maintain symptoms of depression or anxiety compared with non-remitters [depression OR: 0.35, P=0.0233; anxiety OR: 0.48, P=0.0371]
  • Fatigue and pain had significant impact on changes in depression status, but did not influence anxiety status
  • Clinical remission was significantly associated with improvements in all PRO measures (P<0.001); conversely, depression/anxiety symptoms reduced PRO improvements

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