THU0304 Association of anxiety, depression and fatigue with disease activity, joints erosion and skin lesion severity in early psoriatic arthritis patients

Abstract

BackgroundDepression is one of the precursors of psoriasis and psoriatic arthritis (PsA) development. It was found that depression and anxiety negatively affect the achievement of remission in PsA. B. Michelsen 2017] Interrelation of anxiety, depression and fatigue (according to patient-reported outcomes) with disease activity, erosive arthritis and skin lesion severity in early PsA hadn’t been sufficiently studied.ObjectivesTo study anxiety, depression and fatigue disorders (according to patient-reported outcomes) and their correlation with disease activity, erosive arthritis and severity of psoriasis in early PsA patients (pts).Methods78 pts (M/F–39/39) with early PsA according to CASPAR criteria were included; all pts had peripheral arthritis for ≤2 years; mean age 36.5±10.7 years, disease duration 12.2±10.3 mo. It was a treatment naïve cohort. All pts underwent standard clinical examination of PsA activity. Mean disease activity indexes (DAS)=4. 0±1.4, DAS28=4.2±1.1. 78 patients were studied for fatigue (according to FACIT), patient global disease activity (PGA), patients pain measured by VAS, and Health Assessment Questionnaire (HAQ); 66 patients (M/F–33/33) were studied for anxiety and depression (according to HADS). At HADS score ≥8 patients had anxiety and depression disorders. Higher scores for FACIT scales indicate better quality of life (less fatigue). Skin lesion severity was evaluated in terms of body surface area (BSA) affected and Psoriasis Area Severity Index (PASI). When BSA was ≥3%, PASI was calculated. PASI≥11 indicates moderate and severe psoriasis. Descriptive statistics was used, M±SD, Me [Q25;Q75], U-test were performed; p<0.05 was considered to indicate statistical significance.ResultsMean FACIT score was low amounting to 35.3±9.6, testifying increased fatigue; mean anxiety index was 5.7±3.1, depression index was 3.8±3.0. Anxiety disorders were detected in 16 out of 66 (24.2%) pts, depression disorders in 9 out of 66 (13.0%) pts. Negative correlation was found between FACIT score and DAS (r=-0.26), DAS28 (r=-0.26), CRP (r=-0.27), PGA (r=-0.35); and pain VAS (r=-0.25). Depression was more pronounced in pts with erosive arthritis in hands and/or feet (r=0.31). Negative correlation of FACIT score (r=-0.54), correlation of anxiety (r=0.26) and depression (r=0.33) indexes was found with health-related functional indexes according to HAQ. HADS indexes (anxiety and depression) are cross-correlating (r=0.51) and are negatively correlating with FACIT scores (r=-0.49 and r=-0.48, accordingly). An association was found of anxiety and depression indexes with the severity of psoriasis PASI index (r=0.38 and r=0.31, accordingly).ConclusionsIn early treatment-naïve PsA patients, increased fatigue and in a quarter of cases anxiety disorders, in 13% of patients depression disorders had been found. Psychological disorders are associated with PsA activity, the severity of psoriasis and joints erosion. Fatigue, anxiety and depression in early PsA patients result in the reduction of their functional capacity.Di...

The Impact of Comorbidity on Patient-Reported Outcomes in Psoriatic Arthritis: A Systematic Literature Review

“…1). Ultimately, 66 of the 84 studies were excluded from inclusion in the systematic literature review (Table 1) [12,, and 18 articles were included [9,14,[83][84][85][86][87][88][89][90][91][92][93][94][95][96][97][98], one of which had been identified from the hand search (see Tables 2 and 3 for more detail).…”

“…Most of the studies included in the systematic literature review were cross-sectional [9,84,85,[87][88][89][90][92][93][94][95][96][97], although prospective observational studies were also found [14,83,86,91,98], and most were of moderate quality (predominantly Oxford CEBM levels of evidence 2b or 4). The total number of PsA patients included in each study ranged from 3571 [91] to 40 [97].…”

“…There was a great variability in the number and types of comorbidities. Some studies analysed the impact of an individual comorbidity, such as obesity [86,98], FM [9,94,96] or anxiety and depression [85,87], but others analysed the impact of the number of comorbidities [14,88,95], using indexes such as the Charlson Comorbidity Index (CCI).…”

“…The most frequently analysed PROs were function [83,84,86,89,92,94], quality of life [9,14,84,[91][92][93] and fatigue [83,85,87,93], but some studies evaluated the impact of comorbidity on pain [83,84,91,98], work disability [88] or sleep quality [93,96,97] The impact of comorbidity on PROs of PsA patients was examined using the CCI in two large, high-quality prospective cohorts [83,86]. In the first study (using DANBIO, a nationwide registry of biological therapies in Denmark), the authors noted that a higher score on the CCI was associated with worse function, pain, fatigue and PGA (univariate analyses) [83].…”

“…Anxiety and depression were examined in two small cross-sectional studies using the Hospital Anxiety and Depression Scale (HADS) questionnaire [85,87]. Both studies found 58 Rhee/2012_2 [73] No data regarding the impact of comorbidity on PROs 59 Rosen/2012 [75] No data regarding the impact of comorbidity on PROs 60 Salaff/2009 [76] No data regarding the impact of comorbidity on PROs 61 Sinnathurai/2018 [77] No data regarding the impact of comorbidity on PROs 62 Sinnathurai/2018 [78] No numerical data provided 63 Szentpetery/2016 [79] No data regarding the impact of comorbidity on PROs 64 Tillet/2013 [80] No data regarding the impact of comorbidity on PROs…”