New research shows treatment for rheumatoid arthritis works less well in patients who also have symptoms of depression
Recently published research shows that people with rheumatoid arthritis (RA) responded less well to biologics, the key treatment for many autoimmune rheumatological diseases, if they also had symptoms of depression when they started the treatment. Depression is common in people with RA and this study adds more weight to evidence that having symptoms of depression predicts that patients are at risk of poorer rheumatological outcomes.
Findings in the study suggested depression symptoms at baseline contributed to approximately 30% reduced odds of good biologics treatment response 1 year later in RA. Having symptoms of depression is associated with less improvement in RA disease activity over time, once on biologics.
Dr Faith Matcham, Post-doctoral Research Associate in the Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience at King’s College London said “Getting the best possible treatment response via biologics means widening attention to the whole person with RA, not narrowing it to the RA alone.”
Dr Matcham continued “We also had some other interesting findings. Previous researchers emphasised the relationship between depressive symptoms and subjective experiences of physical disease, which makes sense. However, we found links between depression and both subjective and objective measures of disease activity. This could be due to reduced medication adherence, which can be impacted by depressive symptoms, or there may be a biological explanation. Systemic inflammation and elevated cytokines typically associated with the presentation of RA and its severity have also been identified in some people with depression. Access to the British Society for Rheumatology’s big dataset in the Biologics Register for RA provided sufficient statistical power to identify effect sizes you may not be able to observe in smaller datasets”.
Dr Lesley Kay, Consultant Rheumatologist The Newcastle Upon Tyne University Hospitals NHS Trust and Chair of BSR’s Clinical Affairs Committee said “These results remind us that depression is a common and significant factor for many people with rheumatoid arthritis. This highlights the importance for all healthcare professionals – GPs, nurses, rheumatologists - of talking to patients and considering with them whether they might have depression and whether treatment for this might help with their overall health and quality of life. Patients don’t always raise the question with us; this study suggests that patients may benefit from a pro-active approach to depression from everyone involved in their healthcare.”
Ali Rivett, CEO of the British Society for Rheumatology
which runs the Biologics Registers project said “We set up our Biologics Register in RA nearly 18 years ago and by now it’s probably the largest prospective observational biologics registry in the world. These results reinforce the value of opening up our Biologics Registry data to allow analysts to answer more questions for patient benefit and to help our multi-disciplinary membership. Published research from the Registers, like this study, strengthens the evidence base for the care of patients with RA and other rheumatological conditions in the UK, and across the world.”
The research, which uses data from the British Society for Rheumatology Biologics Registers, has been published in Rheumatology, the society’s academic Journal.
Access the paper here