Psychological distress over 12 months post-diagnosis in an early inflammatory arthritis cohort

Lucy Zhao; James Galloway; Jo Ledingham; Sarah Gallagher; Gerasimina Garnavos; Paul Amlani-Hatcher; Nicky Wilson; Lewis Carpenter; Kirsty Bannister; Sam Norton

doi:10.1093/rheumatology/keae276

Psychological distress over 12 months post-diagnosis in an early inflammatory arthritis cohort

Rheumatology (Oxford). 2024 May 15:keae276. doi: 10.1093/rheumatology/keae276. Online ahead of print.

Authors

Lucy Zhao^{1

2

3

4}, James Galloway², Jo Ledingham⁵, Sarah Gallagher⁶, Gerasimina Garnavos⁶, Paul Amlani-Hatcher⁶, Nicky Wilson², Lewis Carpenter⁴, Kirsty Bannister³, Sam Norton^{2

4}

Affiliations

¹ Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
² Center for Rheumatic Diseases, King's College London, London, UK.
³ Wolfson Centre for Age-Related Diseases, King's College London, London, UK.
⁴ Department of Psychology, King's College London, London, UK.
⁵ Rheumatology Department, Portsmouth Hospitals University NHS Trust, Portsmouth, UK.
⁶ National Early Inflammatory Arthritis Audit (NEIAA), British Society for Rheumatology, London, UK.

PMID: 38749000
DOI: 10.1093/rheumatology/keae276

Abstract

Objectives: People with inflammatory arthritis (IA) experience worsened mental wellbeing alongside disease progression. Using the National Early Inflammatory Arthritis Audit (NEIAA), we assessed trends in psychological distress during 12-months following IA diagnosis, mapping these against clinical outcomes to identify associations.

Methods: This is a prospective study of people recruited to NEIAA receiving an IA diagnosis and completing the baseline patient survey. Patient reported outcomes (PROs) at baseline, 3-months and 12-months were collected, including psychological distress (assessed using Patient Health Questionnaire Anxiety and Depression Screener (PHQ4ADS)). Mixed effects linear regression models estimated associations between predictor variables with psychological distress at baseline and over time.

Results: Of 6,873 eligible patients, 3,451 (50.2%) showed psychological distress at baseline. Of those completing follow-ups, 30.0% and 24.1% were distressed at 3-months and 12-months, respectively. Higher psychological distress at diagnosis was more commonly reported by younger, female, and non-white patients. Clinical factors, including higher counts of comorbidities, prior depression, and higher disease activity at diagnosis were associated with higher distress. Higher distress at baseline was associated with poorer outcomes over time in quality of life, disability, work performance, disease activity, as well as reduced likelihood of achieving good treatment response by EULAR criteria.

Conclusion: Half of patients with IA show significant mental health comorbidity at presentation, which associated with worse disease outcomes and quality of life. Screening for anxiety and depression should be a universal standard, and access to effective mood therapies alongside arthritis treatments is essential. Strategies should be culturally valid and consider multi-morbidities.

Keywords: Early inflammatory arthritis; longitudinal study; mental health; patient-reported outcomes; quality of life.