The relationship between depression and biologic treatment response in rheumatoid arthritis: An analysis of the British Society for Rheumatology Biologics Register.

Objective
To investigate the relationship between depressive symptoms and treatment response and disease activity over a one-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 (SF36); or the EuroQol (EQ5D). 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 EQ5D showed reduced improvement in tender and swollen joints, patient global assessment (PGA) and erythrocyte sedimentation rate (ESR) over 1-year follow-up. Patients with depression symptoms according to the SF36 showed reduced improvement in tender and swollen joints, but not ESR or PGA.
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 optimise treatment outcomes.