Higher Anxiety at 3 Months Predicts Escalation to Biologics/JAKi by 12 and 24 Months in Early RA: Results from the Canadian Early Arthritis Cohort (CATCH)

Objectives Pain, fatigue, anxiety and depression are common in new RA and may predict worse outcomes. We compared the likelihood of biologics/JAKi use by 12 and 24 months by pain, fatigue, anxiety, and depression status at diagnosis and after 3 months of MTX.

Methods We evaluated new RA patients in the Canadian Early Arthritis Cohort (CATCH) between 1/17-8/22 with active disease and on MTX. Participants underwent assessments and completed PROMIS-29 at 0 and 3 months. Anxiety, depression, fatigue, and pain interference were defined as PROMIS ≥55. Multivariable logistic regression and ROC curves at baseline and 3 months were adjusted for CDAI, age, sex, race, education, smoking, obesity, comorbidities, serology, and symptom duration.

Results 255 adults had a mean (SD) age of 56(14), and were mostly women (69%), White (78%) with a CDAI of 30(14) at diagnosis. All started MTX monotherapy [55%] or with csDMARDs [45%]. At 3 months, mean CDAI improved substantially; 41% were classified as anxious (Table). Mean Pain, Fatigue, Anxiety and Depression scores were 8-15 points higher in anxious vs non-anxious patients. By 12 months, >2X as many patients who were anxious at 3 months were on advanced therapies (15% vs 7%); a similar trend was observed at 24 months (18% vs 10%). However, the proportion of patients on advanced therapies was similar by pain interference, fatigue, or depression status at 3 months. The optimal multivariable model for predicting advanced therapy use by 12 months included Anxiety status and CDAI at 3 months after adjustment for covariates (ROC=0.84). Patients who were anxious at 3 months had 5.1 the odds (95% CI 1.4, 18.2) of being on advanced therapy at 1 year, with a similar trend at 24 months (OR 3.0; 95% CI 1.1, 8.2). In contrast, Depression, Pain, and Fatigue status at 3 months was not associated with a greater likelihood of advanced therapy use by 12 and 24 months.

Conclusion In CATCH, 41% reported anxiety at 3 months even after a robust response to treatment. A novel finding is that Anxiety at 3 months (but not pain, fatigue, or depression) predicted worse CDAI, PROs and 3-5 times greater odds of advanced therapy use by 12 and 24 months. Anxious patients may be more likely to advocate for a treatment change; anxiety may also reflect a greater impact of social determinants of health. Better understanding of anxiety in early RA may help improve QOL and support treatment decision making.