The relationship between depression and biologic treatment response in rheumatoid arthritis: An analysis of the British Society for Rheumatology Biologics Register
The relationship between depression and biologic treatment response in rheumatoid arthritis: An analysis of the British Society for Rheumatology Biologics Register
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DOI：
10.1093/rheumatology/kex528
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发表时间：
2018-05-01
期刊：
影响因子：
5.5
通讯作者：
Galloway, James
中科院分区：
文献类型：
--
作者：
Matcham, Faith;Davies, Rebecca;Galloway, James
客观的。旨在调查 RA 一年随访期间抑郁症状与治疗反应和疾病活动度之间的关系。方法。使用的数据来自英国风湿病学会生物制剂登记册，代表 18,421 名接受生物制剂治疗的 RA 患者。抑郁症状通过以下三种评估之一来确定：报告抑郁病史、医疗结果调查 36 项简表或 EuroQol 五维量表。逻辑回归分析检查了基线抑郁症状与一年内良好治疗反应的几率之间的关系。多层次模型解决了一年随访期间基线抑郁症状与疾病活动结果之间的关联，调整了年龄、性别、疾病持续时间、合并症以及基线疾病活动和身体残疾。结果。生物治疗开始时的抑郁症状与 1 年后获得良好治疗反应的几率降低 20-40% 相关。基线时的抑郁症状也与随访过程中疾病活动改善的减少有关。有抑郁症病史或根据 EuroQol 五维量表报告抑郁症状的患者在一年的随访中显示，关节压痛和肿胀、患者整体评估和 ESR 方面的改善有所减少。根据 36 项简表，有抑郁症状的患者显示关节压痛和肿胀的改善有所减少，但 ESR 或患者整体评估没有改善。结论。在生物制剂治疗开始时出现抑郁症状可能会降低获得良好治疗反应的几率，并随着时间的推移减少疾病活动的改善。抑郁症应作为常规临床护理的一部分进行管理，以优化治疗结果。
Objective. To investigate the relationship between depressive symptoms and treatment response and disease activity in RA over a 1-year follow-up.Methods. Data from the British Society for Rheumatology Biologics Register were used, representing 18 421 RA patients receiving biologic treatment. Depressive symptoms were identified through one of three assessments: reporting a history of depression, the Medical Outcomes Survey 36-item Short Form or the EuroQol five-dimension scale. Logistic regression analyses examined the relationship between baseline depressive symptoms and odds of good treatment response by 1 year. Multilevel models addressed the association between baseline depressive symptoms and disease activity outcomes over 1-year follow-up, adjusting for age, gender, disease duration, comorbidities and baseline disease activity and physical disability.Results. Depression symptoms at biologic treatment initiation were associated with 20-40% reduced odds of achieving a good treatment response at 1 year. Depressive symptoms at baseline also associated with reduced improvement in disease activity over the course of follow-up. Patients with a history of depression or reporting symptoms of depression according to the EuroQol five-dimension scale showed reduced improvement in tender and swollen joints, patient global assessment and ESR over 1-year follow-up. Patients with depression symptoms according to the 36-item Short Form showed reduced improvement in tender and swollen joints, but not ESR or patient global assessment.Conclusion. Experiencing symptoms of depression at the start of biologics treatment may reduce the odds of achieving a good treatment response, and reduce improvement in disease activity over time. Depression should be managed as part of routine clinical care to optimize treatment outcomes.