Effect of type of disease-modifying antirheumatic drugs on depression and anxiety of patients with rheumatoid arthritis in Saudi Arabia: a cross-sectional study

Abstract

BackgroundRheumatoid arthritis (RA) can cause depression and anxiety. This study evaluated the factors associated with depression and anxiety in patients with RA and examined the effect of conventional and biologic disease-modifying antirheumatic drugs (DMARDs).MethodsThis cross-sectional study was conducted in a regional hospital in Riyadh between March and November 2022 and included 213 patients with RA. Depression and anxiety were measured using the Hospital Anxiety and Depression Scale (HADS) and data about patients’ DMARDs use was obtained from the hospital’s medical records.ResultsBased on the HADS scores, 35 (16.4%) and 49 (23%) patients with RA had depression and anxiety, respectively. There was a significant association between the level of depression and anxiety and the use of leflunomide and tocilizumab among patients with RA (p = 0.006 and p = 0.009, respectively). Patients with RA who took leflunomide had significantly higher scores for anxiety (β = 0.158, value of p = 0.037) when compared to patients who did not take leflunomide. Patients with RA who took etanercept showed a significantly lower depression score even after adjusting for confounders, including sociodemographic, clinical, and lifestyle factors (β = −0.189, p = 0.043).ConclusionThe present study highlighted the prevalence of psychiatric disorders among patients with RA and the level of depression and anxiety may differ between patients with RA depending on the type of DMARDs used. We recommend patients with RA be screened regularly for depression and anxiety to avoid further extra-articular systemic complications associated with RA.

Prevalence and Comorbidities Among Individuals With Rheumatoid Arthritis in the Saudi Arabian Context

“…The substantial occurrence of comorbid conditions among RA patients, as unveiled in this study, underscores the requirement for holistic management approaches that tackle not only the underlying disease but also the accompanying comorbidities. The finding that 96.7% of patients with RA in the cohort had at least one documented comorbidity aligns with previous research emphasizing the high comorbidity burden in this population [ 27 , 28 ].…”

A 62-year-old woman with depressive disorder due to a medical condition - rheumatoid arthritis

“…It is essential to consider that depression can be aggravated by medications used in RA treatment, with particular attention needed for glucocorticoids and infliximab, both associated with an increased risk of depressive symptoms. Patients with RA using Leflunomide showed a statistically significant difference in depression level scores compared to those using other DMARDs, with leflunomide being associated with a higher level of depression [2]. In contrast, RA patients receiving Etanercept had a lower risk of depression compared to those receiving infliximab, suggesting that etanercept may be a more appropriate biologic drug for RA-associated depression [16].…”

The missing hallmark of health: psychosocial adaptation

“…Thus, relapsing multiple sclerosis is associated with depression that responds to fingolimod [ 87 ], an immunosuppressor which is also active against SCZ [ 88 ]. Anti-TNFα-based treatments mitigate depressive symptoms in rheumatic diseases patients [ 89 ]. Likewise, intracerebroventricular infusions of anti-TNFα antibody or several resolvins produce antidepressant-like effects in rodent models [ 90 ], while in MDD patients, oral supplementation with the ω-3 fatty acid eicosapentaenoic acid induces clinical responses associated with elevated plasma concentrations of pro-resolving lipid mediators [ 91 ].…”