Mood Disorders Worse in RA Patients with Fibromyalgia

A new study found patients with rheumatoid arthritis (RA) and fibromyalgia have greater levels of disease activity and more severe mood disorders than patients with only RA.¹ Conversely, a correlation analysis found a positive correlation between mood disorders and disease activity in patients with RA—but not with patients with both RA and fibromyalgia.

The research was presented as an abstract at the 2024 European Congress of Rheumatology (EULAR) in Vienna, Austria from June 12 – 15, led by author Maria Giannotta, from the Policlinico di Bari, Reumatologia, in Italy.

Earlier this year, a study found major depressive disorder (MDD), followed by somatoform disorder and generalized anxiety disorder (GAD), were the most observed comorbidity in patients with RA.² Not only that, but 80% of participants (n = 1000) reported some sort of psychological distress during the study, which was 1 and a half times more than the percentage reported in the literature. Additionally, the prevalence of depression rose with the severity of disease activity; the prevalence increased from 31.7% to 36.8% to 63.8% when the disease activity shifted from low to moderate to high.

In this study, investigators wanted to see how mental disorders impact not just patients with RA but patients with both RA and fibromyalgia.¹ Giannotta and colleagues conducted a cross-sectional study at her team’s rheumatology clinic aiming to assess the impact of mood disorders in a cohort of patients with RA, as well as patients with both RA and fibromyalgia, with the Depression Anxiety Stress Scales Short Version (DASS-21).

Investigators collected demographic and clinical data, such as HAQ, SDAI, DAS28-CRP, and tender and swollen joint counts. Furthermore, DASS-22 was used to calculate a global score for mood disorders and to assess individual scores for anxiety, depression, and stress.

The study included 76 patients with RA defined by the ACR/EULAR 2010 criteria, with 97.4% female patients, a mean age of 59.8 years, and a mean disease duration of 11.9 years. Of those patients, 36 received a fibromyalgia diagnosis based on the 2016 diagnostic criteria.

The team observed no significant differences between the RA group and the RA and fibromyalgia group regarding demographic and treatment data. They did observe differences in disease activity between the 2 groups.

The RA and fibromyalgia group had greater scores in HAQ (mean score: 1.2±0.8) and DAS28-CRP (2.74±1.0), compared to the RA group (HAQ: 0.76±0.8; DAS28-CRP: 2.24±1.1). Additionally, the RA and fibromyalgia group had a statistically significant greater DASS-21 score (23.11±11.8) than the RA group (9.3±11.8) highlighting their greater levels of disease activity (P < .001). A ROC curve (AUC: 0.858) found a DASS-21 threshold score of 12.5 has a sensitivity of 86.1% and a specificity of 82.5% when diagnosing fibromyalgia in patients with RA.

In only the RA group, a correlation analysis showed a positive correlation between DASS-21 and disease activity indexes. The depression and anxiety subscales of DASS-21 also showed a positive correlation with disease activity.

As for the RA and fibromyalgia group, investigators only found a correlation between anxiety and tender joint count.

“This [study] suggests that the presence of [fibromyalgia] may impact the relationships between mood disorders and disease activity,” investigators concluded.

References

1. ^{Ab0143 Impact of Mood Disorders Assessed with Dass-21 (Depression Anxiety Stress Scale) On Disease Activity in Patients with Rheumatoid Arthritis and Fibromyalgia. Abstract presented at the 2024 European Congress of Rheumatology (EULAR) in Vienna, Austria from June 12 – 15.}
2. ^{Derman, C. Major Depressive Disorder Is the Most Observed Psychiatric Comorbidity in RA. HCPLive. May 28, 2024. https://www.hcplive.com/view/major-depressive-disorder-is-the-most-observed-psychiatric-comorbidity-in-ra. Accessed June 20, 2024.}