Mental Disorder Effects Due to Drug Treatments in Rheumatoid Arthritis

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The best positive dynamics of mental disorder frequency occurred in the RA groups receiving antidepressant treatment in combination with DMARDs and biologics.
The best positive dynamics of mental disorder frequency occurred in the RA groups receiving antidepressant treatment in combination with DMARDs and biologics.

Patients receiving disease-modifying anti-rheumatic drugs (DMARDs) saw no positive dynamics of mental disorders (MD), according to research presented at the 2017 Annual European Congress of Rheumatology (EULAR), held June 14-17 in Madrid, Spain. In addition, patients receiving biologics saw mild positive dynamics of anxiety disorder.

Researchers from the Nasonova Research Institute of Rheumatology in Moscow, Russia, conducted a prospective 5-year study to determine the frequency of MD dynamics when using antidepressants, biologics, and DMARDs.

They enrolled 128 patients who met American College of Rheumatology (ACR) criteria (86% were women, with a mean age of 47). Of the patients with RA 67% were taking prednisone (5±2.7 mg/day), 80% were taking DMARDs, 26% were taking biologics (rituximab, 11%, anti-tumor necrosis factor alpha [TNF-α] 10%, anti-interleukin-6 [IL-6] 5%).

The Montgomery-Asberg Depression Rating Scale (MADRS) and Hamilton Anxiety Rating Scale (HAM-A) evaluated anxiety and depression severity. "ADD was diagnosed in 121 (94.5%) [and] major depressive disorder (MDD) was found in 41 (32%), and anxiety disorders (AD) in 30 (23.4%) of RA-pts," the researchers said.

The occurrences of MD were evaluated at 1 and 5 years in 105 of 121 patients with RA (87%)  divided into 4 distinct treatment groups: DMARDS (n=32); DMARDs + antidepressants (sertraline or mianserine) (n=37); DMARDs + biologics (n=27); and DMARDs + biologics + antidepressants (sertraline or mianserine) (n=9).

In the first group, the frequency of MDD increased from 24.6% to 34.8% in a year and to 42.8% in 5 years (P =.09), and the number of patients with AD decreased from 27.5% tо 4.3% (P =.014) and 4.8% (P =.021) accordingly. In the second group, the frequency of MDD decreased from 47.4% tо 15.7% (P =.049) in a year and to disappearance of depressive symptoms (P <.001) in 5 years; AD decreased from 26.3% tо 10.5% and to disappearance (P <.001) in 5 years.

In the third group, the frequency of MDD remained unchanged (40.7% and 42.8%, respectively), but AD significantly decreased (from 18.5%  to disappearance in a year [P =.042) and 5 years [P =.047]). Meanwhile, in the fourth group, the frequency of MDD decreased significantly from 66.7% tо 16.7% in 1 year and to disappearance in 5 years (P =.03), and AD decreased from 16.7% to disappearance.

These results led the researchers to conclude that the best positive dynamics of MD frequency occurred in the RA groups receiving antidepressant treatment in combination with DMARDs and biologics.

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Reference

  1. Abramkin A, Lisitsyna T, Veltishchev D, Seravina O, Kovalevskaya O, Nasonov E. The dynamics of mental disorders frequency in complex DMARDs, biologics, and antidepressants treatment of rheumatoid arthritis patients. Presented at: 2017 Annual European Congress of Rheumatology (EULAR); June 14-17, 2017; Madrid, Spain. doi:10.1136/annrheumdis-2017-eular.3759
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