A new study has found that more than one-third of patients with osteoarthritis or rheumatoid arthritis may screen positive for anxiety, depression, and/or fibromyalgia using a single questionnaire in routine care.
In the retrospective analysis, published in ACR Open Rheumatology, researchers included 361 patients with osteoarthritis and 488 patients with rheumatoid arthritis who completed the Multidimensional Health Assessment Questionnaire (MDHAQ) during regular clinic visits at a single academic center between 2011 and 2022. The mean age of the patients with osteoarthritis was 66.6 years (standard deviation [SD] = 11.7) and the mean age for those with rheumatoid arthritis and 56.9 years (SD = 15.2).
Overall, 40.4% of patients with osteoarthritis and 36.3% of patients with rheumatoid arthritis screened positive for at least one of the three comorbidities, with 8.1% and 7% screening positive for all three, respectively.
The researchers found that 29% of the patients with osteoarthritis and 22% of patients with rheumatoid arthritis screened positive for anxiety using the MDHAQ Anxiety Screen (MAS2), whereas 22% and 18% screened positive for depression using the MDHAQ Depression Screen (MDS2), respectively. The Fibromyalgia Assessment Screening Tool (FAST3F) identified fibromyalgia in 23% of patients with osteoarthritis and 22% of patients with rheumatoid arthritis. Age-adjusted odds ratios showed significantly higher rates of anxiety and depression in the patients with osteoarthritis compared to those with rheumatoid arthritis.
The researchers also revealed strong associations between the comorbidities and poorer patient status, as measured by the Routine Assessment of Patient Index Data 3 (RAPID3) and its components. The median RAPID3 score was 14.0 (interquartile range [IQR] = 10.1) in the patients with osteoarthritis and 13.3 (IQR = 13.2) in those with rheumatoid arthritis. The patients with osteoarthritis who had a RAPID3 score ≥ 12 vs < 12 had odds ratios of 3.93, 3.79, and 6.70 for anxiety, depression, and fibromyalgia, respectively. Similarly, those with rheumatoid arthritis who had a MDHAQ-FN (physical function score) ≥ 2 vs < 2 had odds ratios of 2.58, 5.04, and 12.0 for anxiety, depression, and fibromyalgia, respectively.
Among the patients who screened positive for at least one comorbidity, 21% of those with osteoarthritis and 19% of those with rheumatoid arthritis screened positive for all three conditions (anxiety, depression, and fibromyalgia).
"Our results indicate a prevalence of anxiety, depression, and/or fibromyalgia of about 40% in patients with [osteoarthritis] and 36% in patients with [rheumatoid arthritis], with strong associations of these comorbidities with poorer patient status," the study authors revealed. "Screening for anxiety, depression, and/or fibromyalgia can be incorporated feasibly into routine clinical care using a single MDHAQ to better inform health professionals concerning patient status, prognosis, and response to treatments."
The MDHAQ included indices for RAPID3, FAST3F, MDS2, and MAS2, which have shown agreement (> 80%) with widely used reference standards, such as the Hospital Anxiety and Depression Scale and the 2011 fibromyalgia diagnostic criteria. Patients completed the questionnaire at each rheumatology visit while waiting to see their providers. The researchers compared the prevalence of positive screens for each comorbidity between the osteoarthritis and rheumatoid arthritis groups using chi-square tests and calculated odds ratios. They also performed age-adjusted analyses using the Mantel-Haenszel method.
Limitations of the study included its cross-sectional design, single-center setting, and lack of data on clinical variables associated with the comorbidities, such as body mass index and medication history. However, the findings are consistent with previous research reporting high rates of anxiety, depression, and fibromyalgia in patients with osteoarthritis and rheumatoid arthritis.
The researchers concluded that further studies are needed to better understand pain mechanisms in relation to these comorbidities and improve patient management. They emphasized the feasibility and importance of routinely screening for anxiety, depression, and fibromyalgia using a single questionnaire in rheumatology practice.
Conflict of interest disclosures can be found in the study.