Depression Predicts Early Retirement in Patients With RA

Alice Goodman

June 15, 2013

MADRID — Depression is the strongest predictor of work disability leading to early retirement in patients with early rheumatoid arthritis (RA), report researchers. Mental health outpaced disease activity, response to medication, stress at work, and comorbidity.

"Our study shows that whether patients with early RA consider applying for a disability pension is more dependent on depression than disease activity," lead investigator Angela Zink, PhD, from the German Rheumatism Research Center in Berlin, told reporters attending a news conference.

"Identifying patients who are depressed early in the course of RA using a simple question may help patients remain in the workforce," she said. Dr. Zink pointed out that rheumatologists do not often assess patients for depression, and she says she hopes that this study will serve as a wake-up call.

Musculoskeletal diseases account for 50% of all absences from work and 60% of work incapacity in Europe, she said. "Inadequate management of these diseases poses a significant economic burden, estimated to be up to 2% of gross domestic product."

The study, presented here at the European League Against Rheumatism (EULAR) Congress 2013, included 573 patients with early inflammatory arthritis.

Our study shows that whether patients with early RA consider applying for a disability pension is more dependent on depression than disease activity. Dr. Angela Zink

At baseline, 82% were either working, on sick leave, or actively employed. About half the sample reported mild to moderate or severe depression, as reflected by responses to the statement: "I have little pleasure or interest in doing things some or most days during the past 2 weeks."

The mean duration of disease was 13 weeks; 67% were rheumatoid factor– or anti-citrullinated protein antibody–positive; 65% fulfilled the 2010 American College of Rheumatolog–EULAR RA criteria at baseline; and 87% were taking disease-modifying antirheumatic drugs (DMARDs).

At 12 months, 12% of patients were actively considering or receiving a disability pension less than 18 months after the onset of arthritis. Of these, 2.6% retired early.

A univariate analysis found several baseline predictors of early retirement within the first year of treatment, including age, low education level, fatigue, disease activity, and chronic pain. But the strongest predictors were moderate and severe depression.

Those with severe depression with little or no interest in daily activities on most days were 4.4 times more likely to seek early retirement than those without depression. Those with mild to moderate depression were 3.1 times more likely to seek early retirement.

A multivariate analysis revealed that both age and functional level were somewhat associated with early retirement, but the link was most robust for severe depression, with an 8.7 times greater likelihood of seeking early retirement.

"Depression is the elephant in the room for patients with RA, and rheumatologists are reluctant to ask about it," said news conference moderator Christopher Buckley, PhD, from the University of Birmingham in the United Kingdom.

"It is not news to us that patients with RA are often depressed. We see a lot of depression in patients with chronic diseases," added Eric Ruderman, MD, from Northwestern University in Chicago, Illinois, who was not involved in the study.

Dr. Ruderman said that it can be challenging to assess depression in a new patient but that it is somewhat easier in patients you have been treating for a while.

"If you do identify a depressed patient, another hurdle is knowing where to refer them for help or which of the many available antidepressants to suggest," he said. "I generally refer the patient back to the primary care doctor, who can take it from there."

Dr. Zink, Dr. Buckley, and Dr. Ruderman have disclosed no relevant financial relationships.

European League Against Rheumatism (EULAR) Congress 2013. Abstract OP0092. Presented June 13, 2013.


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