Background: Depression, a common comorbidity in inflammatory arthritis, exacerbates disease activity, diminishes quality of life, and hampers assessment of treatment response. Prevalence data for depression in spondyloarthritis (SpA) vary widely, highlighting the challenges in detecting this comorbidity. Reported prevalence rates range from 0.8% to 27% in Psoriatic Arthritis (PsA) patients [1] and 11% to 64% in Axial Spondyloarthritis (axSpA) patients [2]. The European The European Alliance of Associations for Rheumatology (EULAR) recommends screening for depression using direct questions about formal diagnoses or past screenings. Cultural and social factors may influence self-awareness and acceptance of depressive symptoms including low mood. The Multidimensional Health Assessment Questionnaire (MDHAQ) can be a simple tool for identifying patients with low mood (LM) who might require further evaluation.

Objectives: The objectives of this study were to assess the prevalence of depression and low mood in patients with PsA and axSpA at a single rheumatology outpatient clinic, to compare characteristics of patients with and without LM as determined by MDHAQ scores, and to explore the link between LM, disease activity, inflammatory markers, and treatment.

Methods: This cross-sectional study utilized real-world data from adult patients diagnosed with Psoriatic Arthritis (PsA, n=250) and Axial Spondyloarthritis (axSpA, n=278) enrolled in the PolNorRHEUMA registry. Formally diagnosed depression was identified through physician-recorded medical history. Low mood (LM) was defined based on the MDHAQ score, with a rating of 2 or 3 on a 0-3 scale noted in at least one follow-up visit. All statistical analyses were performed using STATISTICA Tibco 13.3 software. Comparisons between patients with and without LM were conducted using independent t-tests or Mann-Whitney U tests for continuous variables and Chi-square tests for categorical variables, depending on data distribution. Age, sex, disease duration, smoking status, and physical activity were compared between the two groups. The prevalence of formally diagnosed depression and episodes of LM were expressed as percentages of the total patient population in each disease category (PsA and axSpA).

Results: The prevalence of formally diagnosed depression was surprisingly low – 5,6% in PsA and 1,8% in axSpA. However, we noticed much higher frequency of at least one episode of low mood according to MDHAQ score – accordingly 27,6% and 23%. Patients with LM comparing to patients without LM did not differ by age (PsA: 46 vs 48 years, p=0,5; axSpA: 41,5 vs 41 years, p=0,9), sex (PsA men: 36% vs 50%, p=0,9; axSpA men: 48% vs 58%, p=0,9), disease duration (PsA: 8,85 vs 9,71 years, p=0,6; axSpA: 11,85 vs 12,85 years, p=0,9), history of smoking and physical activity. Interestingly, in both diseases LM was associated with higher disease activity assessed in composite measures but no difference in CRP - in PsA: DAPSA (16,4 vs 11,7, p=0,03), BASDAI (4,62 vs 2,3, p=0,01), ASDAS-CRP (2,09 vs 1,53, p=0,05), CRP (2,0 vs 2,0, p=0,18), axSpA: BASDAI (3,5 vs 1,9, p=0,01), ASDAS-CRP (2,02 vs 1,33, p=0,01), CRP (1,0 vs 1,0, p=0,8). In spite of higher disease activity, treatment of patients with LM did not differ from patients without LM (PsA: NSAIDs 42% vs 34%, p=0,9, bDMARDs 64% vs 42%, p=0,9, iJAK 16% vs 8%, p=0,9, GC 7% vs 9%, p=0,9; axSpA: NSAIDs 58% vs 55%, p=0,9, bDMARDs 80% vs 69%, p=0,9, iJAK 8% vs 4%, p=0,9, GC 3% vs 1%, p=0,9).

Conclusion: Low mood is potentially linked with higher disease activity in PsA and axSpA patients. Detecting LM through MDHAQ scores should prompt further evaluation for depression, a condition that appears to be underrecognized in clinical settings.

REFERENCES: [1] Gupta S, Syrimi Z, Hughes DM, Zhao SS. Comorbidities in psoriatic arthritis: a systematic review and meta-analysis. Rheumatol Int. 2021 Feb;41(2):275-284

[2] Zhao S, Thong D, Miller N, Duffield SJ, Hughes DM, Chadwick L, Goodson NJ. The prevalence of depression in axial spondyloarthritis and its association with disease activity: a systematic review and meta-analysis. Arthritis Res Ther. 2018 Jul 11;20(1):140.

Acknowledgements: This research has been supported by a grant entitled ‘The POLish NORwegian research collaboration to increase quality of health care and improve health outcomes of children and adult patients with RHEUMAtological diseases’ (POLNOR-RHEUMA) 0026/2019-00 from the National Center for Research and Development (NCBiR).

Disclosure of Interests: None declared.