Depression And Anxiety In Psoriatic Arthritis:prevalence And Associated Factors

Objective:Psoriatic arthritis(PsA)is a kind of inflammatory joint disease with Psoriatic skin damage and joint swelling and pain as the main symptoms.It not only leads to physical dysfunction,but also causes different degrees of psychological effects,and even shows anxiety and depression.At present,there is still a lack of systematic research on PsA combined with anxiety and depression in China.The purpose of this study was to investigate the prevalence of PsA combined with anxiety and depression in domestic population and related influencing factors,and to explore the efficacy of biological agents on patients with PSA combined with anxiety and depression.Methods:Patients included in the study were all PsA and AS patients in outpatient and inpatient departments of rheumatology and immunology of Shanxi Bethune Hospital from March 2020 to March 2021.Full-time physicians by self-made questionnaire records of patients general demographic data,disease characteristics,laboratory indexes,including age,gender,income,level of education,family history,smoking history,drinking history,body mass index,disease recurrence of first diagnosis,skin lesions,and joint symptom duration,any special parts(face,foot,navel,ear,tongue,mucous membrane,gluteal,genital)was detected,complications,previous and current treatment situation and ESR、CRP.Disease Activity was evaluated by international common assessment indexes for both PsA and AS patients,among which the assessment indexes for PsA included Tender joint count(TJC),Swollen joint count(SJC),Bath Ankylosing Spondylitis Disease Activity Index(BASDAI),Bath Ankylosing Spondylitis Functional Index(BASFI),Psoriasis Area and Severity Index(PASI),Nail Area of Psoriasis Severity Index(NAPSI),Psoriasis Severity Index(Severity Index),Psoriasis Severity Index(Severity Index),Nail Area of Psoriasis Severity Index(Severity Index),Psoriasis Severity Index(Severity Index),Psoriasis Severity Index(Severity Index),Psoriasis Severity Index(Severity Index).Leeds Enthesitis Index(LEI),Dactylitis Count(DC),and Diseas Activity Index for Psoriatic Arthritis(DAPSA).As evaluation indicators include TJC,SJC,BASDAI,BASFI.The Hospital Anxiety and Depression Scale(HADS)was used to evaluate the Anxiety and Depression status of patients with PsA and AS.The Quality of Life for Psoriatic Arthritis Scale(PsAQo L)was used to evaluate the health-related Quality of Life of patients with PsA.The prevalence of anxiety or depression was compared between PsA and AS.PsA patients were grouped according to whether they were combined with anxiety or depression,and the differences of various indicators between groups were analyzed by t-test,Mann-Whitney U test and X~2test.Logistic regression was used to analyze the risk factors of PsA combined with anxiety or depression.PsA combined with anxiety and depression were compared before and after treatment with biological agents.Results:1.PsA merger disease status and risk factors of anxiety or depression study included 70 patients,aged 44.14±8.41,40 cases(57.1%)of men,women,30 cases(42.9%),more than a high school diploma 45 cases(64.3%),earn 4.90±2.38 ten thousand/year,body mass index(BMI)of 25.01±1.26,family history of 28 cases(40.0%),17 cases(24.3%),smoking history17 cases(24.3%),drinking history 13 cases(18.6%),both the 31 cases(44.3%),recurrence of 39 cases(55.7%),The duration of skin lesions was 13.61±6.32 years,and the duration of arthritis was 5.69±2.79 years.There were 33 cases(47.14%)with nail lesions,27 cases(38.6%)with special site lesions,37cases(52.9%)with tendonitis,and 23 cases(32.9%)with phalangitis.There were 13cases(18.6%)complicated with hypertension and 15 cases(21.4%)complicated with hyperuricemia.Twenty-two patients(31.4%)received three types of>previously or currently using traditional DMARDs and biologic agents.2.Among the 70 PsA patients included in the study,the prevalence of combined anxiety was 10.0%,the prevalence of combined depression was 17.1%,the prevalence of combined anxiety and depression was 11.4%,and the total prevalence of combined psychological disorders(anxiety+depression+combined anxiety and depression)was38.6%.75 AS patients were evaluated AS the control group.The prevalence of combined anxiety was 8.0%,the prevalence of combined depression was 9.3%,the prevalence of combined anxiety and depression was 6.7%,and the total prevalence of combined psychological disorders was 24.0%.The prevalence of simple depression and the total prevalence of mental disorders in PsA patients was higher than that in AS patients,and the difference was statistically significant(P<0.05).However,there was no significant difference in the prevalence of anxiety and the combination of anxiety and depression(P>0.05).3.70 patients with PsA were divided into the anxiety group(including patients with simple anxiety and concurrent anxiety and depression,n=15)and the non-psychological disorder group(without anxiety or depression,n=43).The TJC,PASI,NAPSI,PsAQo L,FSS and female patients in the anxiety group were higher than those in the non-psychological disorder group(P<0.05),and the difference was statistically significant.The number of patients with family history,special site rash,SJC,PASI,DAPSA and PsAQo L in the depression group(including patients with simple depression and patients with anxiety and depression,n=20)and the non-psychological disorder group(without anxiety or depression,n=43)were higher than those in the non-psychological disorder group(P<0.05),and the differences were statistically significant.4.Multivariate Logistic regression showed that female,TJC,PASI and PsAQo L were risk factors for PsA combined with anxiety(P<0.05).Family history,special site rash,and DAPSA were the risk factors for PsA with depression(P<0.05).5.Thirty-one PsA patients who completed the initial evaluation and were reevaluated one month after treatment were included in the study.After 1 month of biologic agent treatment,DAPSA and PsAQo L were significantly decreasing(P<0.05),HAD-A and HAD-D were decreasing trend after treatment(P>0.05),no statistical difference was found.Conclusion:1.PsA patients had a higher prevalence of mental disorders,including 10.0%of combined anxiety,17.1%of depression,and 38.6%of combined mental disorders.The prevalence of simple depression and total mental disorders were higher than those of AS patients.2.Female,more painful joints,more severe rash and lower quality of life are the risk factors for PsA combined with anxiety.3.Family history,special site rash and high activity of comprehensive disease are risk factors for PsA with depression.4.After treatment with biological agents,the anxiety and depression of PsA patients showed a decreasing trend.