Mood disorders like depression and anxiety commonly coexist with chronic physical health ailments, and psoriatic arthritis (PsA) is no exception. Now a new study suggests that PsA patients who struggle with depression or anxiety may be less likely to achieve minimal disease activity (MDA).
Although full remission is the ultimate goal for most people with any form of inflammatory arthritis, MDA is often considered a close-enough target. In order to meet the criteria for MDA, PsA patients must hit at least five of seven metrics:
- Tender joint count of one or less
- Swollen joint count of one or less
- Tender etheseal points of one or less
- Psoriasis Activity and Severity Index of or or less or Body Surface Area of three or less
- Patient pain visual analogue scale (VAS) of 15 or less
- Patient global disease VAS of 20 or less
- Health Assessment Questionnaire of 0.5 or less
The new study, which was published in the journal Arthritis Care and Research, examined 743 psoriatic arthritis patients between 2008 and 2017. Every six to 12 months during that time, patients were assessed for their physical and mental health.
The physical health exams involved detailed joint and skin assessments, which looked for joint damage and erosion, tendon and ligament inflammation, and inflammation of the sacroiliac joint (where the spine connects with the pelvis). Patients were also asked to complete several self-reported surveys, including the including the Health Assessment Questionnaire (HAQ), which measures functional status, and the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36), which measures quality of life. This information was used to determine their MDA.
When it came time for the mental health exams, researchers relied on a series of surveys, as well as reports of depression/anxiety made by the patient’s family physician or psychiatrist, or pharmacotherapy for depression/anxiety.
By the end of the study, 406 patients had achieved “sustained MDA,” which the researchers defined as meeting the criteria for MDA at two or more consecutive checkups. After conducting a variety of statistical analyses, the researchers determined that the patients who were defined as having depression and/or anxiety were 60 to 75 percent less likely to have achieved sustained MDA during the study period than patients who had no defined mental health issues.
Do Mental Health Issues Increase Disease Activity — or Vice Versa?
Although this study makes a connection to mental health issues and disease activity in psoriatic arthritis, further research is needed to determine how they impact each other. Additionally, the study’s lack of formal psychiatric assessments limited the researchers’ ability to specify if a specific mental health issue — in this case depression or anxiety — impact a patient’s MDA.
That said, this study does further the idea that mental health and physical health are connected and gives some insight into the reason.
“Presence of depression/anxiety may drive increased sensitivity to pain, and lead to avoidance, inactivity, deconditioning, and social isolation contributing to a reduced likelihood of achieving remission,” the authors noted. “Comprehensive management of PsA should therefore include measures for addressing anxiety and depression so that more patients achieve a state of MDA.”
In other words, getting to low disease activity in psoriatic arthritis is not just about reducing underlying inflammation that causes joint pain and skin plaques, but also involves treating mental health and other issues.
If you are feeling depressed or anxious, it’s important to talk to your health care provider, who can connect you with a mental health care professional.
You Can Participate in Arthritis Research Too
If you are diagnosed with arthritis or another musculoskeletal condition, we encourage you to participate in future studies by joining CreakyJoints’ patient research registry, ArthritisPower. ArthritisPower is the first-ever patient-led, patient-centered research registry for joint, bone, and inflammatory skin conditions. Learn more and sign up here.
Walsh N. Depression Seen Interfering With Psoriatic Arthritis Improvement. MedPage Today. March 9, 2021. https://www.medpagetoday.com/rheumatology/arthritis/91542.
Wong A, et al. Depression and anxiety reduce the probability of achieving a state of sustained minimal disease activity in patients with psoriatic arthritis. Arthritis Care and Research. March 4, 2021. doi: https://doi.org/10.1002/acr.24593.