088 The impact of anxiety on quality of life and disease activity in rheumatoid arthritis: a systematic review

Machin, Annabelle R; Haththotuwa, Randula; Babatunde, Opeyemi; Scott, Ian; Bucknall, Milica; Corp, Nadia; Chew-Graham, Carolyn A; Hider, Samantha L

Abstract

Background: Co-morbid anxiety and depression are frequent in patients with rheumatoid arthritis (RA), but are often under-recognised and under-treated, contributing to increased morbidity and mortality. Most studies examining the impact of mood problems in RA have focused on depression. The aim of this systematic review was to determine the impact of anxiety in RA on quality of life (QoL) and disease activity.

Methods: Databases (Web of Science, PsycINFO, CINAHL, Embase and Medline) were systematically searched for studies examining the impact of anxiety on QoL and disease activity in adults with RA, from inception to October 2017. Primary outcome measures were DAS28 and SF-36, though validated secondary outcome measures were included. Screening for eligibility and data extraction were completed by two independent reviewers, with disagreements resolved by discussion or a third independent reviewer. Quality assessment was carried out using the Newcastle-Ottawa Scale. Findings were brought together using a narrative synthesis framework. For the analysis, data relating to the Physical Component Score (PCS) and Mental Component Score (MCS) subscales of SF-36 were pooled separately. A random effects meta-analysis of correlation coefficients between anxiety and the PCS/ MCS of SF-36 as well as DAS28 was conducted.

Results: From 6,404 unique citations, 48 articles were assessed for eligibility. 16 studies (13 cross-sectional, 3 cohort) involving 4012 people were suitable for inclusion in the review. Of these, 6 studies reported QoL outcome measures, 7 examined disease activity and 3 reported both. From the studies reporting QoL, 4 provided suitable data for meta-analysis. Similarly, 4 studies reporting disease activity provided suitable data, and were pooled in the analysis. Overall, anxiety was associated with increased disease activity and worse QoL. Anxiety was correlated with increased DAS28 scores (r = 0.230, CI: 0.099, 0.360), in addition to reduced physical (r= -0.386, CI: -0.575, -0.198) and mental (-0.501, CI: -0.571, -0.431) QoL.

Conclusion: Anxiety in patients with RA is associated with increased disease activity and worse QoL in cross sectional analyses. Further studies are required to examine the longer term impact of anxiety and whether intervention strategies may improve outcomes for people with RA.

Citation

Machin, A. R., Haththotuwa, R., Babatunde, O., Scott, I., Bucknall, M., Corp, N., …Hider, S. L. (2019). 088 The impact of anxiety on quality of life and disease activity in rheumatoid arthritis: a systematic review. Rheumatology, 58(Supplement_3), https://doi.org/10.1093/rheumatology/kez106.087

• Journal Article Type: Commentary
• Conference Name: British Society for Rheumatology Annual Conference 2019
• Online Publication Date: Apr 12, 2019
• Publication Date: Apr 1, 2019
• Deposit Date: Jun 28, 2023
• Journal: Rheumatology
• Print ISSN: 1462-0324
• Electronic ISSN: 1462-0332
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Volume: 58
• Issue: Supplement_3
• DOI: https://doi.org/10.1093/rheumatology/kez106.087
• Keywords: Pharmacology (medical); Rheumatology