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Clinical Rheumatology
Published in: Clinical Rheumatology 1/2020

Open Access 01-01-2020 | Mood Disorders | Original Article

Systematic review of mental health comorbidities in psoriatic arthritis

Authors: Sizheng Steven Zhao, Natasha Miller, Nicholas Harrison, Stephen J. Duffield, Mrinalini Dey, Nicola J. Goodson

Published in: Clinical Rheumatology | Issue 1/2020

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Abstract

Objective

In this systematic review and meta-analysis of psoriatic arthritis (PsA) studies, we pooled data from existing literature to (1) estimate the prevalence of mental health disorders in PsA patients and (2) compare disease activity in PsA patients with and without these comorbidities.

Method

We searched PubMED, Web of Science, Scopus, PsycINFO and the Cochrane Library using a predefined protocol in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Where possible, meta-analysis was performed using random effects model. Prevalence estimates were pooled according to the severity of mental health disorders.

Results

A total of 24 studies, amounting to 31,227 PsA patients, were included for review. Anxiety and depression were the only consistently reported mental health disorders, defined using a range of screening criteria/thresholds. Anxiety prevalence ranged from 4 to 61% with a pooled estimate of 33% (95%CI 17 to 53%) having at least mild anxiety and 21% (95%CI 14 to 29%) at least moderate. Depression prevalence ranged from 5 to 51%, with 20% (95%CI 8 to 35%) having at least mild and 14% (95%CI 8 to 21%) at least moderate. Only two studies compared disease activity according to the presence of mental health comorbidities; both reported higher disease activity and pain among those with comorbid anxiety and depression.

Conclusions

Anxiety and depression are highly prevalent among PsA patients. Studies of other mental health disorders were scarce. More studies are needed on the impact of these comorbidities on disease activity and long-term outcomes.
Key Points
• One in three patients with psoriatic arthritis has at least mild anxiety, while 1 in 5 reported at least mild depression.
• PsA patients with anxiety and/or depression reported greater disease activity.
• More research is needed on other mental health comorbidities, particularly sleep, suicide/self-harm and substance misuse.
Appendix
Available only for authorised users
Literature
1.
Gladman D, Antoni C, Mease P, Clegg D, Nash P (2005) Psoriatic arthritis: epidemiology, clinical features, course, and outcome. Ann Rheum Dis 64(Suppl 2):ii14–ii17PubMedPubMedCentral
2.
Di Carlo M, Becciolini A, Lato V, Crotti C, Favalli EG, Salaffi F (2017) The 12-item psoriatic arthritis impact of disease questionnaire: construct validity, reliability, and interpretability in a clinical setting. J Rheumatol 44(3):279–285PubMed
3.
Ferreira BIRC, Abreu JLPDC, Reis JPGD, Figueiredo AMDC (2016) Psoriasis and associated psychiatric disorders. J Clin Aesthetic Dermatol 9(6):36–43
4.
Eder L, Polachek A, Rosen CF, Chandran V, Cook R, Gladman DD (2017) The development of psoriatic arthritis in patients with psoriasis is preceded by a period of nonspecific musculoskeletal symptoms: a prospective cohort study. Arthritis Rheum 69(3):622–629
5.
Kavanaugh A, Gottlieb A, Morita A, Merola JF, Lin C-Y, Birt J et al (2019) The contribution of joint and skin improvements to the health-related quality of life of patients with psoriatic arthritis: a post hoc analysis of two randomised controlled studies. Ann Rheum Dis 21 annrheumdis-2018-215003
6.
Bair MJ, Robinson RL, Katon W, Kroenke K (2003) Depression and pain comorbidity: a literature review. Arch Intern Med 163(20):2433–2445PubMed
7.
Lee YC, Lu B, Boire G, Haraoui BP, Hitchon CA, Pope JE et al (2013) Incidence and predictors of secondary fibromyalgia in an early arthritis cohort. Ann Rheum Dis 72(6):949–954PubMed
8.
9.
Prevoo ML, van’t Hof MA, Kuper HH, van Leeuwen MA, van de Putte LB, van Riel PL (1995) Modified disease activity scores that include twenty-eight-joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum 38(1):44–48
10.
Coates LC, Fransen J, Helliwell PS (2010) Defining minimal disease activity in psoriatic arthritis: a proposed objective target for treatment. Ann Rheum Dis 69(1):48–53PubMed
11.
Coates LC, Moverley AR, McParland L, Brown S, Navarro-Coy N, O’Dwyer JL et al (2015) Effect of tight control of inflammation in early psoriatic arthritis (TICOPA): a UK multicentre, open-label, randomised controlled trial. Lancet 386(10012):2489–2498PubMedPubMedCentral
12.
Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol 62(10):1006–1012PubMed
13.
Stern AF (2014) The hospital anxiety and depression scale. Occup Med (Lond) 64(5):393–394
14.
Kroenke K, Spitzer RL, Williams JB (2001) The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 16(9):606–613PubMedPubMedCentral
15.
16.
Spitzer RL, Kroenke K, Williams JBW, Löwe B (2006) A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med 166(10):1092–1097PubMed
17.
National Collaborating Centre for Mental Health2009 Depression in adults with a chronic physical health problem: treatment and management. NICE Clinical Guidance 91 London: National Institute for Health and Clinical Excellence. [Internet]. Available from: https://​www.​nice.​org.​uk/​guidance/​CG91
18.
Matcham F, Norton S, Steer S, Hotopf M (2016) Usefulness of the SF-36 Health Survey in screening for depressive and anxiety disorders in rheumatoid arthritis. BMC Musculoskelet Disord 17:224PubMedPubMedCentral
19.
McKenna SP, Doward LC, Whalley D, Tennant A, Emery P, Veale DJ (2004) Development of the PsAQoL: a quality of life instrument specific to psoriatic arthritis. Ann Rheum Dis 63(2):162–169PubMedPubMedCentral
20.
21.
Barendregt JJ, Doi SA, Lee YY, Norman RE, Vos T (2013) Meta-analysis of prevalence. J Epidemiol Community Health 67(11):974–978PubMed
22.
Husted JA, Thavaneswaran A, Chandran V, Eder L, Rosen CF, Cook RJ, Gladman DD (2011) Cardiovascular and other comorbidities in patients with psoriatic arthritis: a comparison with patients with psoriasis. Arthritis Care Res 63(12):1729–1735
23.
Husted JA, Tom BD, Farewell VT, Gladman DD (2012) Longitudinal study of the bidirectional association between pain and depressive symptoms in patients with psoriatic arthritis. Arthritis Care Amp Res 64(5):758–765
24.
Khraishi M, MacDonald D, Rampakakis E, Vaillancourt J, Sampalis JS (2011) Prevalence of patient-reported comorbidities in early and established psoriatic arthritis cohorts. Clin Rheumatol 30(7):877–885PubMed
25.
Cauli A, Gladman DD, Mathieu A, Olivieri I, Porru G, Tak PP et al (2011) Patient global assessment in psoriatic arthritis: a multicenter GRAPPA and OMERACT study. J Rheumatol 38(5):898–903PubMed
26.
McDonough E, Ayearst R, Eder L, Chandran V, Rosen CF, Thavaneswaran A, Gladman DD (2014) Depression and anxiety in psoriatic disease: prevalence and associated factors. J Rheumatol 41(5):887–896PubMed
27.
Gniadecki R, Robertson D, Molta CT, Freundlich B, Pedersen R, Li W, Boggs R, Zbrozek AS (2012) Self-reported health outcomes in patients with psoriasis and psoriatic arthritis randomized to two etanercept regimens. J Eur Acad Dermatol Venereol JEADV 26(11):1436–1443PubMed
28.
Meesters JJL, Petersson IF, Bergman S, Haglund E, Jacobsson LTH, Bremander A (2014) Sociodemographic and disease-related factors are associated with patient-reported anxiety and depression in spondyloarthritis patients in the Swedish SpAScania cohort. Clin Rheumatol 33(11):1649–1656PubMed
29.
Howells L, Chisholm A, Cotterill S, Chinoy H, Warren RB, Bundy C (2018) Impact of disease severity, illness beliefs, and coping strategies on outcomes in psoriatic arthritis. Arthritis Care Res 70(2):295–302
30.
Freire M, Rodríguez J, Möller I, Valcárcel A, Tornero C, Díaz G, Armendáriz Y, Paredes S (2011) Prevalence of symptoms of anxiety and depression in patients with psoriatic arthritis attending rheumatology clinics. Reumatol Clin 7(1):20–26PubMed
31.
Lamb RC, Matcham F, Turner MA, Rayner L, Simpson A, Hotopf M, Barker JNWN, Jackson K, Smith CH (2017) Screening for anxiety and depression in people with psoriasis: a cross-sectional study in a tertiary referral setting. Br J Dermatol 176(4):1028–1034PubMed
32.
Kotsis K, Voulgari PV, Tsifetaki N, Machado MO, Carvalho AF, Creed F, Drosos AA, Hyphantis T (2012) Anxiety and depressive symptoms and illness perceptions in psoriatic arthritis and associations with physical health-related quality of life. Arthritis Care Res 64(10):1593–1601
33.
Papp K, Poulin Y, Vieira A, Shelton J, Poulin-Costello M (2014) Disease characteristics in patients with and without psoriatic arthritis treated with etanercept. J Eur Acad Dermatol Venereol JEADV 28(5):581–589PubMed
34.
Torre-Alonso JC, Gratacós J, Rey-Rey JS, Valdazo de Diego JP, Urriticoechea-Arana A, Daudén E et al (2014) Development and validation of a new instrument to measure health-related quality of life in patients with psoriatic arthritis: the VITACORA-19. J Rheumatol 41(10):2008–2017PubMed
35.
Michelsen B, Kristianslund EK, Sexton J, Hammer HB, Fagerli KM, Lie E, Wierød A, Kalstad S, Rødevand E, Krøll F, Haugeberg G, Kvien TK (2017) Do depression and anxiety reduce the likelihood of remission in rheumatoid arthritis and psoriatic arthritis? Data from the prospective multicentre NOR-DMARD study. Ann Rheum Dis 76(11):1906–1910PubMed
36.
Walsh JA, McFadden ML, Morgan MD, Sawitzke AD, Duffin KC, Krueger GG et al (2014 Aug) Work productivity loss and fatigue in psoriatic arthritis. J Rheumatol 41(8):1670–1674PubMed
37.
Davis JA, Robinson RL, Le TK, Xie J (2011) Incidence and impact of pain conditions and comorbid illnesses. J Pain Res 4:331–345PubMedPubMedCentral
38.
Kaine J, Song X, Kim G, Hur P, Palmer JB (2019) Higher incidence rates of comorbidities in patients with psoriatic arthritis compared with the general population using U.S. administrative claims data. J Manag Care Spec Pharm 25(1):122–132PubMed
39.
Ballegaard C, Højgaard P, Dreyer L, Cordtz R, Jørgensen TS, Skougaard M, Tarp S, Kristensen LE (2018) Impact of comorbidities on tumor necrosis factor inhibitor therapy in psoriatic arthritis: a population-based cohort study. Arthritis Care Res 70(4):592–599
40.
Altobelli E, Maccarone M, Petrocelli R, Marziliano C, Giannetti A, Peris K, Chimenti S (2007) Analysis of health care and actual needs of patients with psoriasis: a survey on the Italian population. BMC Public Health 7:59PubMedPubMedCentral
41.
Sinnathurai P, Buchbinder R, Hill C, Lassere M, March L (2018) Comorbidity in psoriatic arthritis and rheumatoid arthritis: comorbidity in inflammatory arthritis. Intern Med J 48(11):1360–1368PubMed
42.
Patel P, Rosen CF, Chandran V, Ye YJ, Gladman DD (2018) Addressing comorbidities in psoriatic disease. Rheumatol Int 38(2):219–227PubMed
43.
Husted JA, Thavaneswaran A, Chandran V, Gladman DD (2013) Incremental effects of comorbidity on quality of life in patients with psoriatic arthritis. J Rheumatol 40(8):1349–1356PubMed
44.
Khraishi M, Aslanov R, Rampakakis E, Pollock C, Sampalis JS (2014) Prevalence of cardiovascular risk factors in patients with psoriatic arthritis. Clin Rheumatol 33(10):1495–1500PubMed
45.
Löfvendahl S, Jöud A, Petersson IF, Theander E, Svensson Å, Carlsson KS (2018 Apr) Income disparities in healthcare use remain after controlling for healthcare need: evidence from Swedish register data on psoriasis and psoriatic arthritis. Eur J Health Econ 19(3):447–462PubMed
46.
Wu CY, Chang YT, Juan CK, Shen JL, Lin YP, Shieh JJ et al (2016) Depression and insomnia in patients with psoriasis and psoriatic arthritis taking tumor necrosis factor antagonists. Med U S 95(22)PubMedPubMedCentral
47.
Wong ITY, Chandran V, Li S, Gladman DD (2017) Sleep disturbance in psoriatic disease: prevalence and associated factors. J Rheumatol 44(9):1369–1374PubMed
48.
Gezer O, Batmaz İ, Sariyildiz MA, Sula B, Ucmak D, Bozkurt M, Nas K (2017) Sleep quality in patients with psoriatic arthritis. Int J Rheum Dis 20(9):1212–1218PubMed
49.
Wu JJ, Penfold RB, Primatesta P, Fox TK, Stewart C, Reddy SP, Egeberg A, Liu J, Simon G (2017) The risk of depression, suicidal ideation and suicide attempt in patients with psoriasis, psoriatic arthritis or ankylosing spondylitis. J Eur Acad Dermatol Venereol 31(7):1168–1175PubMed
50.
Dommasch ED, Li T, Okereke OI, Li Y, Qureshi AA, Cho E (2015) Risk of depression in women with psoriasis: a cohort study. Br J Dermatol 173(4):975–980PubMedPubMedCentral
51.
Zhao S, Thong D, Miller N, Duffield SJ, Hughes DM, Chadwick L et al (2018) The prevalence of depression in axial spondyloarthritis and its association with disease activity: a systematic review and meta-analysis. Arthritis Res Ther 20(1)
52.
Dregan A, Matcham F, Harber-Aschan L, Rayner L, Brailean A, Davis K, Hatch S, Pariante C, Armstrong D, Stewart R, Hotopf M (2019 May 1) Common mental disorders within chronic inflammatory disorders: a primary care database prospective investigation. Ann Rheum Dis 78(5):688–695PubMed
53.
Chimenti MS, Caso F, Alivernini S, De Martino E, Costa L, Tolusso B et al (2019 Jun) Amplifying the concept of psoriatic arthritis: the role of autoimmunity in systemic psoriatic disease. Autoimmun Rev 18(6):565–575PubMed
54.
Zunszain PA, Hepgul N, Pariante CM (2013) Inflammation and depression. Curr Top Behav Neurosci 14:135–151PubMed
55.
56.
Kim HM, Smith EG, Stano CM, Ganoczy D, Zivin K, Walters H, Valenstein M (2012 Jan 23) Validation of key behaviourally based mental health diagnoses in administrative data: suicide attempt, alcohol abuse, illicit drug abuse and tobacco use. BMC Health Serv Res 12:18PubMedPubMedCentral
Metadata
Title
Systematic review of mental health comorbidities in psoriatic arthritis
Authors
Sizheng Steven Zhao
Natasha Miller
Nicholas Harrison
Stephen J. Duffield
Mrinalini Dey
Nicola J. Goodson
Publication date
01-01-2020
Publisher
Springer London
Published in
Clinical Rheumatology / Issue 1/2020
Print ISSN: 0770-3198
Electronic ISSN: 1434-9949
DOI
https://doi.org/10.1007/s10067-019-04734-8

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