4 Questions About Mental Health and Psoriatic Arthritis

Research has shown an association between mental health conditions and psoriatic arthritis (PsA); findings from a previous study indicated that the incidence of anxiety and depression were greater among individuals with PsA compared with individuals with psoriasis without PsA.¹

Still, research on the prevalence of mental health disorders among individuals with PsA is limited.

In a new systematic review,² Sizheng Steven Zhao, MBChB(Hons), MRCP, from the Institute of Ageing and Chronic Disease at the University of Liverpool in the United Kingdom, and colleagues evaluated data to determine the prevalence of mental health disorders among individuals with PsA, as well as compared disease activity in PsA among individuals with and without mental health disorders.

The findings showed that 1 in 3 individuals with PsA reported at least mild anxiety, and 1 in 5 reported at least mild depression.

Rheumatology Consultant caught up with Dr Zhao about the research.

Rheumatology Consultant: What prompted you to conduct your study?

Sizheng Steven Zhao: We have known for a long time that mental health conditions are common among people with psoriasis. Stress and anxiety are also known triggers of psoriasis. Interestingly, there is not much research published on mental health conditions in PsA. Anxiety, depression, and sleep problems are incredibly common among people with PsA. If an individual has PsA, it is likely to impact mood and quality of life, like many chronic painful diseases. Many of our patients suffer with low mood, so we sought to quantify how common mental health conditions were among individuals with PsA, to apply the findings to consultations. Surprisingly, we found little research on areas such as suicide, despite the well publicized fact that the brodalumab development program was halted due to suicides, which some think is related more to the underlying PsA/psoriasis.

RHEUM CON: Individuals with PsA with anxiety and/or depression reported greater disease activity. How can a rheumatologist approach a patient’s mental health during management of PsA?

SZ: Management of all rheumatic diseases should be holistic; although PsA may be of primary interest to the rheumatologist, it may be one of many conditions that the patient has to manage. Keeping the patient at the center of the consultation is paramount. Patients with severe mental health symptoms should be referred for appropriate assessment and treatment. Regarding the management of PsA, rheumatologists should be aware that depression worsens perception of pain and can coexist with fibromyalgia, both of which will impact assessment of PsA disease activity.

RHEUM CON: Individuals with more severe PsA may be at higher risk of developing mental health comorbidities. What can a rheumatologist do to prevent this?

SZ: Identifying and managing mental health conditions early is key. We do not have evidence yet that treating PsA early will prevent mental health comorbidities, but our previous work³ in axial spondyloarthritis suggested that symptoms of anxiety and depression improved with successful axial spondyloarthritis treatment. Patients who received treatment with tumor necrosis factor inhibitors had improvements in axial spondyloarthritis disease activity, as well as improvements in symptoms of anxiety and depression.

RHEUM CON: What research is still needed on the relationship between PsA and mental health?

SZ: More research is needed on whether mental health conditions such as anxiety and depression can impact response to treatment and whether prompt treatment can prevent these comorbidities. More research is also needed on other mental health comorbidities, particularly sleep, suicide/self-harm, and substance misuse.

References:

1. McDonough E, Ayearst R, Eder L, et al. Depression and anxiety in psoriatic disease: prevalence and associated factors. J Rheumatol. 2014;41(5):887-896. doi:10.3899/jrheum.130797.
2. Zhao SS, Miller N, Harrison N, Duffield SJ, Dey M, Goodson NJ. Systematic review of mental health comorbidities in psoriatic arthritis [published online September 5, 2019]. Clin Rheumatol. doi:10.1007/s10067-019-04734-8.
3. Zhao S, Yoshida K, Jones GT, et al. The impact of smoking on response to TNF inhibitors in axial spondyloarthritis: methodological considerations for longitudinal observational studies [published online February 14, 2019]. Arthritis Care Res (Hoboken). doi:10.1002/acr.23851.

For more on PsA, visit the Resource Center.