Ab1184 anxiety, depression and fibromyalgia: similar prevalence in osteoarthritis as in rheumatoid arthritis

Background Non-articular comorbidities, including anxiety (ANX), depression (DEP) and fibromyalgia (FM), are common in patients with rheumatic diseases. Their presence may impact measures of disease activity and responses to treatment. The burden of ANX, DEP and FM has been described in many reports concerning patients with rheumatoid arthritis (RA), but far less information is available concerning these comorbidities in patients with osteoarthritis (OA). It is feasible to screen for these comorbidities in all patients seen in routine care using a multidimensional health assessment questionnaire (MDHAQ)[1,2], completed by patients in 5-10 minutes before seeing the rheumatologist, which includes screening indices for ANX, DEP, and FM. Objectives To analyze the prevalence of positive screening for ANX, DEP, and/or FM in patients with OA compared to RA in routine care at an academic rheumatology center. Methods All patients seen for routine rheumatology care are asked to complete an MDHAQ, which includes 0-3 physical function and ANX and DEP scales in the patient friendly HAQ format, three 0-10 visual numeric scales (VNS) for pain, fatigue and global status, self-report 0-54 RADAI painful joint count, 60-symptom checklist review of systems (ROS) including ANX and DEP, medical history queries, and 4 indices: RAPID3 (routine assessment of patient index data to assess patient status in all diseases studied), MDHAQ ANX screen (MAS2), MDHAQ DEP screen (MDS2)[1], and fibromyalgia assessment screening tool (FAST4)[2]. MAS2 and MDS2 are positive for ANX or DEP if 0-3 ANX or DEP response is ≥2 OR positive ANX or DEP on the symptom checklist. FAST4 is positive if 3/4: pain VNS ≥6/10, fatigue VNS ≥6/10, self-report painful joint count ≥16/54, and/or symptom checklist ≥16/60. Patients were classified as OA or RA according to primary ICD 10 diagnosis. An MDHAQ database was used to compute retrospectively medians and interquartile ranges (IQR). Results The study included 366 OA and 488 RA patients seen between 2013 and 2022. Patients were mostly female and OA patients were slightly older (Table 1). RAPID3 was similar in RA and OA patients. Positive screening for ANX was seen in 28.4% of OA and 21.9% of RA patients (p= 0.04, Table 1), for DEP in 21.6% of OA and 18% of RA patients (p>0.05), and for FM in 20.4% of OA and 20% of RA patients (p>0.05). Conclusion Positive ANX, DEP, and FM screening is seen in > 20% of routine care patients with primary diagnoses of OA or RA, at similar levels in OA and RA. Although definitive diagnosis requires a physician, MAS2, MDS2, and FAST4 agree more than 80% with reference standards which are highly associated with positive diagnoses. The results underscore a need for rheumatologists to aware of these comorbidities, easily screened for using an MDHAQ. References [1]Arthritis Care Res, 73: 120-129, 2021 [2]ACR Open Rheumatology, 1: 516-525, 2019 Table 1. Positive anxiety, depression and fibromyalgia screening in routine care OA and RA patients Rheumatoid Arthritis Osteoarthritis p-value* N 488 366 RAPID3 median (IQR ) 13.3 (13.2) 14.0 (10.1) 0.48 MAS screening for anxiety n (% ) 107 (21.9%) 104 (28.4%) 0.04 MDS screening for anxiety n(% ) 88 (18.0%) 79 (21.6%) 0.23 FAST4 ≥3 screening for fibromyalgia n(% ) 98 (20%) 75 (20.4%) 0.95 *Chi square test for comparison of proportions, Mood’s median test for comparison of RAPID3 Acknowledgements. Acknowledgements: NIL. Disclosure of Interests None Declared.