Depression Prevalence Found to Be Higher in PsA Than RA, Diabetes

In comparison with patients who have rheumatoid arthritis (RA) and diabetes, depression was found to be more prevalent in patients with psoriatic arthritis (PsA), according to a recent study published in Therapeutic Advances in Musculoskeletal Disease.

Investigators were looking to determine the prevalence of major comorbidities, such as depression, cardiovascular risk factors such as hypertension and current smoking, obesity, hyperlipidemia, stroke, major adverse cardiac events (MACE), osteoporosis, and malignancies in patients with PsA compared with patients with RA and diabetes.

Evidence collected over time has demonstrating that comorbidities in PsA can have a significant impact on health-related-quality of life and can influence clinical outcomes. Very few studies have assessed a wide range of comorbidities in patients with PsA or made direct comparisons with patients who have other rheumatic conditions, according to the authors.

Researchers recorded data on patients who visited 2 different tertiary referral hospitals in Greece between December 2018 and June 2019, requiring a 6-month follow-up in order for patients to be included in the analysis. Patients with PsA were age- and sex-matched with patients with RA and DM (1:1:1) who had a similar disease duration. Each disease group contained 215 patients.

The overall number of comorbidities was significantly higher in patients with PsA compared with those who had RA (P = .003). Patients with PsA had higher weight, were taller, had a higher body mass index (BMI), were more obese, had more hyperlipidemia, and had higher rates of depression compared with patients with RA.

Researchers observed depression in 42 (19.5%) of patients with PsA compared with 3.3% (7%) of patients with RA and none in patients with diabetes.

“In fact, the risk for depression appears to be 3–5 times higher in PsA versus RA and [diabetes mellitus] DM, respectively. Rheumatologists should be aware of the high burden of multiple comorbidities in PsA,” noted the researchers in their report.

Compared with patients who had diabetes, patients with PsA had comparable prevalence of hyperlipidemia, smoking, obesity, stroke, MACE, and coronary artery disease. Patients with PsA had a greater prevalence of depression and osteoporosis than patients with diabetes.

Additionally, investigators found that smoking and hypertension were comparable between individuals with PsA (35.4% and 28.8%, respectively ), diabetes (39.5% and 45.1%, respectively), and RA (28.8% and 23.8%, respectively), suggesting that there is a need for better assessment and management of depression and cardiovascular risk factors in patients with rheumatic conditions.

Investigators said that it may be possible that the mechanisms that contribute to cardiovascular risk are different between RA and PsA because there is a metabolic component that is often more pronounced in PsA. Risk factors such as hypertension, hyperlipidemia, diabetes, and obesity may also contribute.

Depression is a commonly neglected comorbidity in patients with PsA and can significantly influence patient quality of life, they noted.

Researchers said the number of cardiovascular events across the study were low and therefore, the findings should be interpreted with caution in this regard and larger studied are needed to confirm.

This was also the first study to examine comorbidity prevalence in the different phenotypes of PsA, finding that there were no observed differences for any of the comorbidities included in the analysis, the authors said.

Reference

Fragoulis GE, Evangelatos G, Tentolouris, et al. Higher depression rates and similar cardiovascular comorbidity in psoriatic arthritis compared with rheumatoid arthritis and diabetes mellitus. Ther Adv Musculoskel Dis. 12:1-12. doi:10.1177/1759720X20976975