PO:28:127 | Efficacy of b/ts-DMARDS therapy on depressive and anxiety symptoms in patients with chronic inflammatory joint diseases: preliminary results of a prospective study

Nikita Pecani¹, Christian D'Elia¹, Francesca Bartoli¹, Sabrina Aliberti¹, Francesco Rotella², Arianna Ida Altomare², Francesco Vinci², Lorenzo Cortoni², Davide Benedetti³, Camilla Ferrari⁴, Gemma Lepri¹, Silvia Bellando Randone¹, Serena Guiducci¹ | ¹SOD Reumatologia, Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi di Firenze; ²Unità di Psichiatria, Dipartimento di Scienze della Salute, Università degli Studi di Firenze; ³Dipartimento Salute Mentale, USL Umbria, Città di Castello (PG); ⁴Scuola di Scienze della Salute Umana - Università degli Studi di Firenze, Italy

Background. Depression and anxiety frequently co-occur in chronic inflammatory diseases, with a prevalence of up to 20% in psoriatic arthritis. These patients may experience an increased risk of depression due to the influence of chronic pain and limitations in daily activities. In addition to the psychological effects of chronic illness, new research shows that systemic inflammation may directly cause anxiety and depression through neuroinflammatory pathways involving pro-inflammatory cytokines like TNF-alpha, IL-1beta, IL-6, IL-8, IL-17, and IL-23. The aim of the study is to evaluate the effect of b/ts-DMARDs therapies on anxiety-depressive symptoms and their relationship with disease activity.

Materials and Methods. We present a prospective single-center longitudinal study on a cohort of patients with psoriatic arthritis, rheumatoid arthritis, or axial spondyloarthritis starting b/ts-DMARDs therapy, either as first-line or subsequent treatment. Patients were assessed at baseline (T0) and at 3 months (T3) using HAQ, SF-36, SAS, and BDI, self-report questionnaires for functional disability, quality of life, and anxious and depressive symptoms. We will integrate the currently available data, which represent preliminary 3-month results, with ongoing follow-up. Statistical analyses included comparisons between T0 and T3, correlations between changes in psychometric scores and clinical and functional parameters, as well as analysis of the influence of sex, antidepressant use, and drug class administered.

Results. A total of 37 patients were included (mean age 54.9 ± 15.1 years; 75.7% women). At 3 months, patients experienced a mean worsening in BDI score (+3.22, SD 8.01) and SAS score (+1.94, SD 5.83), while their HAQ score improved (-0.24, SD 0.43). No significant differences were found in BDI, SAS, or HAQ score changes based on sex or antidepressant therapy. However, patients treated with antidepressants showed a mean reduction in SAS (-2.33) compared to an increase in untreated patients (+2.38), a clinically relevant but not statistically significant finding (p = 0.19). HAQ improved more in patients with lower disease activity (SDAI) (r = -0.55, p = 0.0127). Changes in BDI and HAQ were significantly associated with perceived emotional limitations in daily activities (SF-36 "Role Emotional Limits," r = 0.49, p = 0.0049).

Conclusions. In the first 3 months of b/ts-DMARDs therapy, an improvement in functional disability is observed, but no benefit on anxiety-depressive symptoms, which in fact tend to worsen. This may reflect patients' disappointment with a clinical response perceived as incomplete, especially when chronic pain persists from sequelae, osteoarthritis, or fibromyalgia, often indistinguishable from inflammatory pain. It is therefore evident the importance of properly communicating realistic therapeutic goals to patients and integrating psychosocial support in the management of chronic inflammatory joint diseases.