THU0127 The dynamics of mental disorders frequency in complex dmards, biologics and antidepressants treatment of rheumatoid arthritis patients

Abstract

Backgroundmental disorders (MD) (anxiety/depressive (ADD) and cognitive (CD)) occur in rheumatoid arthritis (RA) patients (pts) very often, they are usually stress-related and, probably, have common pathogenesis chains with RA. In this connection the disease-modifying anti-rheumatic drugs (DMARDs) and biologics drugs treatment may be effective in ADD in RA-pts.Objectivesto determine the frequency of MD dynamics during DMARDs, biologics and antidepressants treatment of RA-pts in prospective 5yrs study.Methods128 RA-pts were enrolled in this study. All of them met the full ACR criteria. 86% RA-pts were women with a mean age of 47,4±1,0 (M±m) yrs. RA activity was assessed by DAS28 and was high (5,25±0,17 (M±m)) in the beginning of the study. 67% RA-pts were taking prednisone (5±2,7 mg/day),80% RA-pts - DMARDs, 26% - biologics (rituximab – 11%, anti-TNF-α – 10%, anti-IL6 – 5%). MD were diagnosed by psychiatrist in accordance with the ICD-10 in semi-structured interview. The severity of depression and anxiety was evaluated by Montgomery–Asberg Depression Rating Scale (MADRS) and Hamilton Anxiety Rating Scale (HAM-A). CD were diagnosed with psychology and neuropsychology methods. ADD were diagnosed in 121 (94,5%) and CD – in 87 (67,9%) of RA-pts. Major depressive disorder (MDD) was found in 41 (32%), minor depressive disorder (MinDD) – in 50 (39%) and anxiety disorders (AD) – in 30 (23,4%) of RA-pts. The occurrences of MD were evaluated in one and five yrs in 105 from 121 (87%) RA-pts divided into the following treatment groups: 1 – DMARDS (n=32), 2 - DMARDs + antidepressants (sertraline or mianserine) (n=37), 3 – DMARDs + biologics (n=27), 4 - DMARDs + biologics + antidepressants (sertraline or mianserine) (n=9).Results Group 1: the frequency of MDD was increased from 24,6% to 34,8% in a year and to 42,8% in 5 yrs (p=0,09); MinDD – from 47,8% to 60,8% (p=0,19) and 50% in 5 yrs; the number of pts with AD decreased from 27,5% to 4,3% (p=0,014) and 4,8% (p=0,021) accordingly. The frequency of CD was increased from 64,3% to 78,3% (p=0,16) in 5 yrs. Group 2: the frequency of MDD was decreased from 47,4% to 15,7% (p=0,049) in a year and to disappearance of depressive symptoms (p<0,001) in 5 yrs; MinDD – from 26,3% to 15,8% and to disappearance (p<0,001) in 5 yrs; AD – from 26,3% to 10,5% and to disappearance (p<0,001) in 5 yrs. The frequency of CD was decreased from 78,9% to 60% (p=0,25). Group 3: the frequency of MDD was unchanged (40,7%, 45,4% and 42,8% accordingly); the frequency of MinDD was increased not significantly – 40,7%, 40,9% and 52,4%; but AD – was significantly decreased (from 18,5% - to disappearance in a year (p=0,042) and 5 yrs (p=0,047)). The frequency of CD was increased from 77,8% to 85%. Group 4: the frequency of MDD was decreased significantly from 66,7% to 16,7% in a year and to disappearance in 5 yrs (p=0,03); MinDD and AD were decreased from 16,7% both to disappearance. The occurrence of CD was decreased from 71,4% to 57,1%.Conclusionsthe results demonstrated the best positive dynamics of MD (ADD and...

Pharmacological and non-pharmacological therapeutic strategies in difficult-to-treat rheumatoid arthritis: a systematic literature review informing the EULAR recommendations for the management of difficult-to-treat rheumatoid arthritis

“…Additionally, 36 papers were selected via reference screening and hand search ( figure 1A ). Thirty-two papers were selected for ttherapeutic strategies in patients with limited DMARD options, 17–48 73 for patients who failed ≥1 b/tsDMARD 49–121 and 50 for patients with predominantly non-inflammatory complaints. 122–171 …”

“…Thirty-two papers (6 SLRs, 9 RCTs, 17 observational studies; 1 low RoB, 7 moderate RoB, 24 high RoB) were selected comparing efficacy and/or safety of DMARDs in RA patients with limited DMARD options due to a comorbidity and/or another contraindication: HBV, HCV, hepatic disease, pulmonary disease, CV disease, obesity, osteoporosis/osteopenia, renal disease, extra-articular manifestations, pregnancy, psychological disease ( online supplemental table 1 ). 17–26 28–41 44–48 No evidence was identified comparing the efficacy and/or safety of DMARDs in RA patients with gastrointestinal disease, HIV, (latent) TBC, malignancies or previously experienced adverse events related to the treatment.…”