Depression, Anxiety and Stress in Patients with Rheumatoid Arthritis and Their Relationship with Disease Activity: A Cross-Sectional Study Using DASS-21

Abstract

Background: Psychological morbidity is increasingly recognized as an important component of rheumatoid arthritis (RA), but its relationship with clinical disease activity remains incompletely understood. Objective: To assess depression, anxiety, and stress among patients with RA using the Depression Anxiety Stress Scale-21 (DASS-21) and examine their relationship with disease activity assessed using the Clinical Disease Activity Index (CDAI). Methods: This cross-sectional analysis included 93 patients with RA. Participants were categorized into low, moderate, and high disease activity according to CDAI. Depression, anxiety, and stress were assessed using DASS-21. Domain scores were compared across disease-activity groups using the Kruskal-Wallis test. Results: Of the 93 participants, 15 (16.1%) had low, 52 (55.9%) moderate, and 26 (28.0%) high disease activity. Depressive symptoms were present in 33 (35.5%), anxiety symptoms in 37 (39.8%), and stress symptoms in 10 (10.8%) patients. Median depression scores were 4 (0-9), 6 (2-12), and 6 (2-11.5) in the low-, moderate-, and high-disease-activity groups, respectively (P=0.493). Corresponding anxiety scores were 6 (3-8), 6 (2-8.5), and 6 (2-10) (P=0.897), while stress scores were 8 (4-10), 8 (4-12), and 9 (4-12) (P=0.725). Conclusion: Depression and anxiety symptoms were relatively common among patients with RA but did not differ significantly according to CDAI disease activity. Psychological morbidity may therefore represent an important dimension of RA that is not adequately reflected by conventional measures of clinical disease activity. Keywords: Rheumatoid arthritis; Anxiety