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Journal of Peking University (Health Sciences) ›› 2020, Vol. 52 ›› Issue (6): 1048-1055. doi: 10.19723/j.issn.1671-167X.2020.06.010

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Depression and anxiety in patients with psoriatic arthritis: Prevalence and associated factors

Yan GENG,Zhi-bo SONG,Xiao-hui ZHANG,Xue-rong DENG,Yu WANG,Zhuo-li ZHANG()   

  1. Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing 100034, China
  • Received:2020-08-03 Online:2020-12-18 Published:2020-12-13
  • Contact: Zhuo-li ZHANG E-mail:zhuoli.zhang@126.com
  • Supported by:
    National Natural Science Foundation of China(81901646);National Natural Science Foundation of China(81771740);National Natural Science Foundation of China(81971524);Youth Clinical Research Project of Peking University First Hospital(2019CR28)

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Abstract:

Objective: To determine the prevalence of depression and anxiety in patients with psoriatic arthritis (PsA), to investigate whether there is a difference in the prevalence of depression and anxiety between PsA and rheumatoid arthritis (RA) patients and to identify associated risk factors for depression and anxiety in PsA patients. Methods: PsA and RA patients who visited Department of Rheumatology and Clinical Immunology in Peking University First Hospital from May 2018 to Sep 2019 were recruited. Self-rating anxiety scale and self-rating depression scale were surveyed and compared between PsA and RA patients. Demographics and clinical features including age, gender, disease duration, disease activity score, psoriasis area and severity index (PASI), and medical application were collected. Power Doppler and grey-scale ultrasound of joints, tenosynovitis and enthesis were performed. Multivariate Logistic regression was used to identify the factors associated with mood disorders and the odds ratio of depression and anxiety between the PsA and RA patients. Results: Among the 114 enrolled PsA patients, 37 (32.5%) had mood disorders, in which 36 (31.6%) with depression and 15 (13.2%) with anxiety. Compared with 201 RA patients, PsA patients showed greater odds for depression [adjusted OR (95%CI): 2.7 (1.1-6.4)]. Depression was more often observed in the PsA than in the RA patients (31.6% vs. 18.9%, P=0.011). The similar trend for anxiety was also observed, although the difference was insignificant (13.2% vs. 8.5%, P=0.185). Age (OR=0.95, P=0.008), psoriasis duration (OR=0.94, P=0.018), pain visual analogue scale (OR=1.47, P=0.011), PASI score (OR=1.07, P=0.007) and presence of ultrasound enthesitis (OR=4.13, P=0.009) were identified as factors associated with depression in the PsA patients. PASI score (OR=1.07, P=0.001) was identified as associated factor for anxiety in the PsA patients. Conclusion: The prevalence of depression and anxiety is elevated in PsA patients. Depression is significantly more prevalent in PsA patients than in RA patients. Younger age, shorter psoriasis duration, worse pain and presence of ultrasound enthesitis are associated with depression, while severe psoriasis rash is associated with both depression and anxiety in PsA patients.

Key words: Psoriatic arthritis, Depression, Anxiety, Prevalence

CLC Number: 

  • R593.2

Table 1

Comparisons of clinical features and psychological disorders between PsA and RA patients"

Items PsA (n=114) RA (n=201) P
Female 55 (48.2) 166 (82.6) <0.001
Age/years 47.6±13.5 49.5±13.0 0.222
Disease duration/years 14.0 (7.0, 24.3) 3.4 (1.0, 10.0) <0.001
TJC 28 3.0 (1.0, 8.0) 2.0 (0.0, 6.5) 0.253
SJC 28 2.0 (0.0, 6.0) 1.0 (0.0, 3.5) 0.054
ESR/(mm/h) 11.5 (5.0, 27.3) 21.0 (10.0, 40.0) <0.001
CRP/(mg/L) 5.5 (2.0, 15,6) 6.1 (2.6, 14.8) 0.176
PGA (0-10) 4.0 (2.0, 6.0) 3.0 (2.0, 6.0) 0.276
EGA (0-10) 3.0 (2.0, 5.0) 2.0 (1.0, 5.0) 0.124
Pain VAS (0-10) 3.8 (2.0, 5.0) 3.0 (1.3, 5.0) 0.615
DAS28-CRP 3.4±1.5 3.6±1.6 0.419
SDAI 14.1 (7.3, 24.4) 10.6 (5.6, 24.0) 0.067
HAQ 1.0 (0.0, 8.0) 4.0 (0.5, 15.0) 0.001
PASI 3.2 (0.8, 9.4) 0.0 (0.0, 0.0) <0.001
Mood disorder
Depression 36 (31.6) 38 (18.9) <0.001
Anxiety 15 (13.2) 17 (8.5) 0.185
Cigarette smoking <0.001
Non-smokers 76 (66.7) 170 (84.6)
Ex-smokers 14 (12.3) 15 (7.5)
Current smokers 24 (21.1) 16 (8.0)
csDMARDs used <0.001
csDMARDs-naive 14 (12.3) 66 (32.8)
Single csDMARDs 80 (70.2) 49 (24.4)
Combined csDMARDs 20 (17.5) 86 (42.8)
Biological DMARDs used 2 (1.8) 4 (2.0) 0.882
Metabolic syndrome 38 (33.3) 19 (9.5) <0.001

Table 2

The factors for associated with depression (PsA vs. RA odds ratio, Logistic regression)"

Items OR 95%CI P
PsA vs. RA 2.70 1.14-6.44 0.025
Age 0.97 0.95-0.99 0.004
Disease duration 0.94 0.91-0.98 0.002
SDAI 1.00 0.98-1.03 0.977
HAQ 1.04 1.01-1.08 0.031
PASI 1.06 1.02-1.11 0.009

Table 3

Comparisons of clinical and ultrasonographic features between PsA patients with depression and without depression"

Items PsA with depression (n=36) PsA without depression (n=78) P
Female 18 (50.0) 37 (47.40) 0.799
Age/years 41.6±14.5 50.4±12.1 0.001
Disease duration of PsO/years 10.0 (5.3, 15.8) 15.5 (7.8, 29.3) 0.048
Disease duration of PsA/years 3.5 (1.0, 9.5) 3.3 (1.2, 8.5) 0.932
TJC 68 3.0 (1.3, 9.8) 2.5 (1.0, 8.0) 0.495
SJC 66 3.0 (0.3, 6.0) 2.0 (0.0, 5.3) 0.641
Pain VAS (0-10) 4.0 (3.0, 6.0) 3.0 (2.0, 5.0) 0.015
PGA (0-10) 5.0 (3.0, 6.8) 4.0 (2.0, 5.0) 0.059
EGA (0-10) 3.0 (2.0, 5.0) 3.0 (1.5, 4.3) 0.207
CRP/(mg/L) 5.7 (2.4, 20.3) 4.6 (1.9, 15.6) 0.592
ESR/(mm/h) 12.5 (7.0, 27.0) 11.0 (5.0, 28.3) 0.676
DAPSA 17.4 (8.7, 27.7) 14.2 (7.8, 24.4) 0.239
HAQ 2.5 (0.0, 8.8) 1.0 (0.0, 7.3) 0.305
PSAI 4.4 (1.2, 29.4) 2.6 (0.7, 7.7) 0.018
Ultrasonographic feathers
Synovitis GS total score 1.5 (0.0, 3.8) 1.5 (0.0, 4.0) 0.957
Synovitis PD total score 0.0 (0.0, 1.0) 0.0 (0.0, 2.0) 0.414
Tenosynovitis GS total score 0.0 (0.0, 2.0) 0.0 (0.0, 2.0) 0.279
Tenosynovitis PD total score 0.0 (0.0, 1.0) 0.0 (0.0, 1.0) 0.528
Presence of enthesitis 23 (63.9) 33 (42.3) 0.032
Bone erosion 16 (44.4) 32 (41.0) 0.731
csDMARDs used 0.165
csDMARDs-naive 4 (11.1) 10 (11.8)
Single csDMARD 22 (61.1) 58 (74.4)
Combined csDMARDs 10 (27.8) 10 (12.8)
Biological DMARDs used 1 (2.8) 1 (1.3) 0.534
NSAIDs used 12 (33.3) 19 (24.4) 0.317
BMI/(kg/m2) 23.2±2.8 24.0±3.0 0.178
Waist circumference/cm 82.3±10.5 84.6±8.5 0.250
Onychosis 16 (44.6) 53 (62.4) 0.069
Ophthalmitis 2 (5.6) 1 (1.3) 0.234
Metabolic syndrome 8 (22.2) 30 (38.5) 0.087
Cigarette smoking 0.902
Non-smoker 23 (63.9) 53 (67.9)
Ex-smoker 5 (13.9) 9 (11.5)
Current smoker 8 (22.2) 16 (20.5)
Family history of PsO/PsA 17 (47.2) 23 (29.5) 0.065

Table 4

Comparisons of clinical and ultrasonographic features between PsA patients with anxiety and without anxiety"

Items PsA with anxiety (n=15) PsA without anxiety (n=99) P
Female 8 (53.3) 47 (47.5) 0.672
Age/years 42.8±16.8 48.3±12.8 0.140
Disease duration of PsO/years 11.0 (4.0, 20.0) 14.0 (8.0, 26.0) 0.401
Disease duration of PsA/years 7.0 (1.0, 12.0) 3.0 (1.0, 8.0) 0.233
TJC 68 2.0 (0.0, 10.0) 3.0 (1.0, 8.0) 0.939
SJC 66 2.0 (0.0, 6.0) 2.0 (0.0, 5.0) 0.963
Pain VAS (0-10) 3.0 (3.0, 6.0) 4.0 (2.0, 5.0) 0.343
PGA (0-10) 3.0 (2.0, 6.0) 4.0 (2.0, 6.0) 0.922
EGA (0-10) 2.0 (2.0, 5.0) 3.0 (2.0, 5.0) 0.806
CRP/(mg/L) 5.5 (1.3, 11.9) 5.4 (2.0, 15.8) 0.672
ESR/(mm/h) 11.0 (5.0, 21.0) 12.0 (5.0, 29.0) 0.540
DAPSA 14.5 (5.1, 31.5) 15.7 (8.3, 24.4) 0.983
HAQ 3.0 (0.0, 14.0) 1.0 (0.0, 7.0) 0.263
PSAI 7.6 (0.6, 39.0) 3.0 (0.8, 8.4) 0.047
Ultrasonographic feathers
Synovitis GS total score 0.0 (0.0, 2.0) 2.0 (0.0, 4.0) 0.147
Synovitis PD total score 0.0 (0.0, 0.0) 0.0 (0.0, 2.0) 0.270
Tenosynovitis GS total score 0.0 (0.0, 2.0) 0.0 (0.0, 2.0) 0.608
Tenosynovitis PD total score 0.0 (0.0, 0.0) 0.0 (0.0, 1.0) 0.200
Presence of enthesitis 7 (46.7) 49 (49.5) 0.838
Bone erosion 5 (33.3) 43 (43.4) 0.460
csDMARDs used 0.068
csDMARDs-naive 2 (13.3) 12 (12.1)
Single csDMARDs 7 (46.7) 73 (73.7)
Combined csDMARDs 6 (40.0) 14 (14.1)
Biological DMARDs used 1 (6.7) 1 (1.0) 0.617
NSAIDs used 3 (20.0) 28 (28.3) 0.718
BMI/(kg/m2) 24.3±2.4 23.6±3.0 0.417
Waist circumference/cm 84.7±11.8 83.7±8.8 0.734
Onychosis 6 (40.0) 58 (58.6) 0.176
Ophthalmitis 0 3 (3.0) 0.652
Metabolic syndrome 6 (40.0) 32 (32.3) 0.557
Cigarette smoking 0.266
Non-smokers 11 (73.3) 65 (65.7)
Ex-smokers 3 (20.0) 11 (11.1)
Current smokers 1 (6.7) 23 (23.2)
Family history of PsO/PsA 7 (46.7) 33 (33.3) 0.313

Table 5

The associated factors for depression/anxiety in PsA (multivariate Logistic regression)"

Items OR 95%CI P
Associated factors for depression
Age 0.95 0.91-0.99 0.008
Disease duration 0.94 0.90-0.99 0.018
Pain VAS 1.47 1.09-1.98 0.011
PASI 1.07 1.02-1.13 0.007
Presence of ultrasound enthesitis 4.13 1.42-12.05 0.009
Associated factor for anxiety
PASI 1.07 1.03-1.12 0.001
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