PT  - JOURNAL ARTICLE
AU  - Alan M. Rathbun
AU  - Bryant R. England
AU  - Ted R. Mikuls
AU  - Alice S. Ryan
AU  - Jennifer L. Barton
AU  - Michelle D. Shardell
AU  - Marc C. Hochberg
TI  - Relationship Between Depression and Disease Activity in United States Veterans With Early Rheumatoid Arthritis Receiving Methotrexate
AID  - 10.3899/jrheum.200743
DP  - 2021 Jun 01
TA  - The Journal of Rheumatology
PG  - 813--820
VI  - 48
IP  - 6
4099  - http://www.jrheum.org/content/48/6/813.short
4100  - http://www.jrheum.org/content/48/6/813.full
SO  - J Rheumatol2021 Jun 01; 48
AB  - Objective. Depression is common in patients with rheumatoid arthritis (RA), exacerbates disease activity, and may decrease response to first-line disease-modifying antirheumatic drugs. This study aimed to determine if depression affects disease activity among veterans with early RA prescribed methotrexate (MTX).Methods. Participants included veterans enrolled in the Veterans Affairs Rheumatoid Arthritis (VARA) registry with early RA (onset < 2 yrs) prescribed MTX. Depression was assessed at enrollment using the International Classification of Diseases, 9th revision codes (296.2–296.39, 300.4, 311). Disease activity was measured using the Disease Activity Score in 28 joints (DAS28) and other core measures of RA disease activity. Propensity score weights were used to adjust depressed (n = 48) and nondepressed (n = 220) patients on baseline confounders within imputed datasets. Weighted estimating equations were used to assess standardized mean differences in disease activity between depressed and nondepressed patients at 6-month, 1-year, and 2-year follow-ups.Results. The analytic sample was composed of 268 veterans with early RA prescribed MTX who were predominantly male (n = 239, 89.2%) and older (62.7 yrs, SD 10.6) than patients with RA in the general population. Adjusted estimates indicated that depression was associated with significantly higher DAS28 at 6 months (β 0.35, 95% CI 0.01–0.68) but not at the 1- or 2-year follow-up. Also, depression was associated with significantly worse pain at 6 months (β 0.39, 95% CI 0.04–0.73) and 1 year (β 0.40, 95% CI 0.04–0.75).Conclusion. In early RA, depression is associated with greater short-term disease activity during MTX treatment, as well as more persistent and severe pain.