The relationship between depression and long-term clinical outcomes in rheumatoid arthritis:: Disease activity, remission, and drug-free remission

Rheumatoid arthritis (RA) is a complex chronic illness marked by persistent inflammation and a range of physical and psychological symptoms. Although pharmacological treatments have improved the management of physical symptoms, comorbid depression remains a significant and largely unresolved burden. Depression adversely affects quality of life and reduces the efficacy of disease-modifying antirheumatic drugs (DMARDs), hindering reductions in disease activity and lowering the likelihood of achieving remission or drug-free remission. Conversely, high disease activity may contribute to the development of depression, suggesting a negative bidirectional relationship. This study examined the longitudinal, bidirectional relationship between RA disease activity and depression, and whether depression predicts remission and drug-free remission over time. Data were drawn from the IMPROVED trial, a 12-year longitudinal study, N = 215 early RA patients, recruited from 12 hospitals in the western...Show moreRheumatoid arthritis (RA) is a complex chronic illness marked by persistent inflammation and a range of physical and psychological symptoms. Although pharmacological treatments have improved the management of physical symptoms, comorbid depression remains a significant and largely unresolved burden. Depression adversely affects quality of life and reduces the efficacy of disease-modifying antirheumatic drugs (DMARDs), hindering reductions in disease activity and lowering the likelihood of achieving remission or drug-free remission. Conversely, high disease activity may contribute to the development of depression, suggesting a negative bidirectional relationship. This study examined the longitudinal, bidirectional relationship between RA disease activity and depression, and whether depression predicts remission and drug-free remission over time. Data were drawn from the IMPROVED trial, a 12-year longitudinal study, N = 215 early RA patients, recruited from 12 hospitals in the western Netherlands between 2007-2010, following a standardized treatment protocol. Depression was measured using the Beck Depression Inventory–II (BDIII), and disease activity with the Disease Activity Score (DAS). Linear and logistic regression analyses were conducted at five time points: baseline, 4 months, 12 months, 5 years, and 12 years. Significant bidirectional associations were found cross-sectionally (all p ≤ .001). Longitudinally baseline depression predicted higher disease activity at 4-month (p = .002) and 12-year (p = .029) follow-ups. Depression at 12 months predicted disease activity at 5-year and 12-year follow-ups (both p = .002). Depression also predicted remission at 4 months (p = .001) and at 5 years (p = .001), but not drug-free remission at any time point. Baseline disease activity predicted depression at 4-month (p = .020) and 12-month (p < .001) follow-ups, but early change in disease activity did not significantly predict later depression. The association was stronger when disease activity predicted depression, with clinically meaningful effects observed at 4 months and 12 years. These findings emphasize the need for prevention, early detection, and treatment of depression in patients with RA. Addressing psychological well-being alongside physical health is crucial for achieving long-term improvements. Further research is needed to elucidate the mechanisms underpinning this comorbidity and to develop integrative treatment strategies that target both RA disease activity and mental health.Show less

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The relationship between depression and long-term clinical outcomes in rheumatoid arthritis: Disease activity, remission, and drug-free remission