Reductions in Psychological Distress and Physical Disability Recorded Over the Past 20 Years in Patients with Rheumatoid Arthritis

Researchers in the Netherlands found that improvements in diagnostic testing, new treatments, and better management may be responsible for improvements in physical disability, anxiety, and depression ratings over the past 20 years ago in patients with rheumatoid arthritis.

Compared with patients 20 years ago, patients with rheumatoid arthritis (RA) today may be experiencing less psychological distress and physical disability, according to a study published in Arthritis Care & Research on December 3. Researchers reported a reduction in measures of psychological distress and physical disability over the past 2 decades.

Analyzing information from 1151 patients with RA between 17 and 86 years of age, researchers compared measures of psychological distress and physical disability in trials that started in the 1990s with the same measures collected from similar patients enrolled in later studies in the late 2000s. Both the older and the newer prospective studies followed patients for 3 to 5 years.

Participants in trials rated depression severity on a 6-item rating scale, with scores ranging from 0 to 24 points, and rated anxiety on a 10-item scale, with scores ranging from 10 to 40 points. To estimate functional status, researchers used the disability index of the Health Assessment Questionnaire (HAQ). Each of 20 items on the disability index of the HAQ range from 0 to 3 points, resulting in a score between 0 and 60. In all surveys, higher scores indicate greater severity of depression, anxiety, or functional impairment.

Investigators classified clinically relevant levels of depression, anxiety, or disability by scores on each of the 3 scales. Patients scoring 6 or more points on the depression scale, 23 or more on the anxiety scale, and 1 or more on the disability scale of the HAQ were counted among patients with clinically relevant depression, anxiety, or disability. Based on these definitions, between 1990 and 1994, 43% of patients had depressed mood, 34% of patients had anxiety, and 64% of patients had physical disability.

In a similar group of patients evaluated between 2007 and 2011, each of these measures declined significantly. The percentage of patients with depressed mood fell from 43% to 14% (P = .01), the percentage of patients with anxiety fell from 34% to 12% (P = .001), and the percentage of patients with physical disability fell from 64% to 31% (P = .02).

Investigators concluded that improvements in pharmacologic treatment and nonpharmacologic management measures may have improved over the past 2 decades. For instance, in the past, physicians advised patients with RA to rest, whereas physicians today advise patients to engage in light physical activity. Diagnostic methods may also have improved, leading to earlier diagnosis and lower severity of RA at diagnosis. Investigators acknowledged that some of the improvement may be attributable to new medications that have changed outcomes for patients with RA.