Ab0202 the Relationship of Psychiatric Comorbidities and Illness Perception With Signs of Subjective and Objective Signs of Inflammation in Rheumatoid Arthritis

Background: A bidirectional relationship exists between rheumatoid arthritis (RA) and mood and anxiety disorders, which may influence outcomes in inflammatory arthritis. In addition, subjective illness perception was also reported to be associated with patient reported outcomes longitudinally independently of inflammation. Objectives: To assess the association of depression, anxiety and illness perception with subjective and objective signs of inflammation in patients with RA and assess a clustering of the patients according to these variables. Methods: Patients with RA fulfilling the 2010 classification criteria were recruited consecutively from the outpatient clinic and asked to complete questionnaires reporting symptoms of depression (9-question Patient Health Questionnaire, PHQ-9), anxiety (Beck Anxiety Inventory, BAI) as well as illness perception (brief Illness Perception Questionnaire, bIPQ). Patients underwent physical examination and musculoskeletal sonography of 22 hand- and finger joints. The clinical disease activity index (CDAI) was calculated and signs for sonographic inflammation were assessed using the EULAR-OMERACT grading system. Pearson correlations were calculated between the PHQ-9, BAI, bIPQ and PD and GS score as well es items of the CDAI. Clusters based on subjective and objective signs of the disease activity as well as depression, anxiety, illness perception and VAS pain were built via k-means clustering. Results: We included 55 patients with a mean CDAI of 17.0 ± 12.8. Symptoms of at least mild depression was recorded in 63.0% and symptoms of anxiety in 23.1%. The tender joint count (TJC) was significantly associated with depression and the bIPQ (r=0.48, r=0.45) but not with anxiety. PGA as well as EGA were associated with depression (r=0.50, p<0.001; r=0.46, p<0.001), anxiety (r=0.30, r=0.28) and illness perception (r=0.58, r=0.33). None of the assessed psychiatric symptom scales, nor illness perception was was associated with swollen joint count (SJC). The PD and GS scores were associated with SJC (r=0.42, r=0.63) but not with depression, anxiety or illness perception (Table 1). The cluster analyses revealed 3 clusters (1,2,3). No significant difference was found among the clusters regarding SJC (1: 2.0±1.4, 2: 2.8±3.1, 3: 3.5±4.5, p=0.76). Mean CDAI of the patients corresponded to moderate disease activity (1: 14.5±6.3, 2: 12.1±10.1) and high disease activity (3: 24.4±14.). While the difference between objective (SJC, EGA) and subjective (TJC; PGA) signs of disease activity in cluster 1 and 2 were small (tender-swollen joint count difference (TSJCD): 1.0±0.0 and 0.7±4.8, respectively), we did find a discrepancy between subjective and objective markers in cluster 3 (TSJCD: 7.7±6.1, PGA 6.6±2.8 vs. EGA 3.0±2.1). Cluster 1 and 2 differed regarding anxiety (1: 51.0±21.2, 2:5.4±5.3)), illness perception (1: 3.5±0.7, 2: 40.7±11.2) and pain (1: 8.0±0.0 vs. 2: 3.8±2.6). (Figure 1) Conclusion: Illness perception, anxiety and depression were associated with subjective signs of disease activity (TJC, PGA) but interestingly also with EGA. The identification of 3 clusters differing regarding the discrepancies in subjective and objective signs of disease activity as well as anxiety, depression and illness perception underscores the complexity to be taken into account in targeted patient care. These results serve as the basis for future studies exploring the association of baseline psychiatric comorbidities and illness perception with treatment response rates and outcome. Table 1. Correlation of symptoms of depression and anxiety, illness perception, power Doppler and grey scale score with tender joint count (TJC), swollen joint count (SJC), PGA (patient global assessment), EGA (evaluator global assessment) and power Doppler and grey scale score. REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests: None declared.