By Phoebe Starr
Madrid, Spain—It is well known that patients with rheumatoid arthritis (RA) have a greater frequency of depression than the general population. A study presented at the 2013 European League Against Rheumatism (EULAR) annual meeting showed that depression in patients with early RA was the strongest predictor of early retirement, even stronger than disease activity level, response to RA therapy, work-related stress, or comorbid conditions. These findings underscore the need for rheumatologists to ask patients about their mood and to refer them for help if they exhibit signs or symptoms of depression.
“Work absences and work disability account for a large proportion of work. Inadequate management of diseases like RA can produce a significant economic burden. Identifying patients who are depressed early in the course of RA using a simple question may help patients remain in the workforce,” said lead investigator Angela Zink, MD, PhD, Head of the Epidemiology Unit, German Rheumatism Research Center, Berlin.
Patients were asked whether they felt a lack of interest in activities on most or some days in the past 2 weeks. Those who answered “most days” were considered to have more severe depression, whereas those who answered “some days” were deemed to have mild-to-moderate depression.
The study enrolled 573 patients. At baseline, the mean duration of disease was 13 weeks; 67% of patients had rheumatoid factor and/or anticitrinullated protein antibody, and 65% fulfilled the 2010 American College of Rheumatology EULAR RA classification criteria at baseline. At 12 months, 87% of patients were taking disease-modifying antirheumatic drugs (DMARDs).
Of the 573 patients, 82% were working, were on sick leave, or were actively employed at baseline. Approximately 50% of the sample reported mild-to-moderate or severe depression, as reflected by the response to the statement, “I have had little pleasure or interest in doing things some/most of the days during the past 2 weeks.”
At 12 months, 67 (12%) patients were actively considering or receiving a disability pension <18 months after the onset of arthritis; of these, 2.6% retired early.
In a univariate analysis, significant predictors of early retirement within the first year of DMARD treatment were age, low education level, fatigue, disease activity, and chronic pain; the strongest predictors were severe depression and moderate depression. Patients with severe depression (little or no interest in daily activities for most of the days in the previous 2 weeks) were 4.4 times more likely to seek early retirement than those without depression, and those with mild-to-moderate depression (little interest on some of the days in the previous 2 weeks) were 3.1 times more likely to seek early retirement than those without depression.
A multivariate analysis revealed that age and functional level were associated with early retirement; severe depression had the strongest association with early retirement. Patients with severe depression were 8.7 times more likely to apply for early retirement than nondepressed patients; patients with mild-to-moderate depression were 3.4 times more likely to apply for early retirement than those without depression.
Dr Zink said she hopes that this study would alert rheumatologists to the importance of screening patients with RA for depression using a simple method like the one she and her coinvestigators used, and then referring patients who exhibit signs of depression for appropriate care.