Key result
Pharmacological depression treatments in RA improve symptoms over active comparators but not inactive controls.
Why the study?
Do interventions for depression and anxiety improve symptoms in persons with rheumatoid arthritis?
Meta-Analysis
Do interventions for depression and anxiety improve symptoms in persons with rheumatoid arthritis?
Effect estimate: SMD -0.79 (95% CI -1.34 to -0.25)
There is low to moderate evidence that pharmacological interventions with active comparators may improve depressive symptoms in patients with rheumatoid arthritis, but overall data is limited by a small number of trials and risk of bias.
Limited evidence does not support routine use; leaves open need for larger placebo-controlled trials in RA.
BACKGROUND: Psychiatric comorbidities, such as depression and anxiety, are very common in persons with rheumatoid arthritis (RA) and can lead to adverse outcomes. By appropriately treating these comorbidities, disease-specific outcomes and quality of life may be improved. OBJECTIVE: The aim of this study was to systematically review the literature from controlled trials of treatments for depression and anxiety in persons with RA. METHODS: We searched multiple online databases from inception until March 25, 2015, without restrictions on language, date, or location of publication. We included controlled trials conducted in persons with RA and depression or anxiety. Two independent reviewers extracted information including trial and participant characteristics. The standardized mean differences (SMDs) of depression or anxiety scores at postassessment were pooled between treatment and comparison groups, stratified by active versus inactive comparators. RESULTS: From 1291 unique abstracts, we included 8 RA trials of depression interventions (6 pharmacological, 1 psychological, 1 both). Pharmacological interventions for depression with inactive comparators (n = 3 trials, 143 participants) did not reduce depressive symptoms (SMD, -0.21; 95% confidence interval [CI], -1.27 to 0.85), although interventions with active comparators (n = 3 trials, 190 participants) did improve depressive symptoms (SMD, -0.79; 95% CI, -1.34 to -0.25). The single psychological trial of depression treatment in RA did not improve depressive symptoms (SMD, -0.44; 95% CI, -0.96 to 0.08). Seven of the trials had an unclear risk of bias. CONCLUSIONS: Few trials examining interventions for depression or anxiety in adults with RA exist, and the level of evidence is low to moderate because of the risk of bias and small number of trials.
No takes yet. Share an insight, caveat, or question.
Fiest et al. (2017) conducted a meta-analysis in Rheumatoid arthritis with depression or anxiety. Pharmacological and psychological interventions vs. Active and inactive comparators was evaluated on Depression or anxiety scores at postassessment (SMD -0.79, 95% CI -1.34 to -0.25). Pharmacological interventions for depression in rheumatoid arthritis improved symptoms versus active comparators (SMD -0.79; 95% CI -1.34 to -0.25) but not versus inactive comparators.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: