What is the connection between anxiety and other symptoms in rheumatoid arthritis?


Study Title:

Anxiety impacts rheumatoid arthritis symptoms and health-related quality of life even at low levels.


Why do this research?

Patients with rheumatoid arthritis (RA) have higher levels of anxiety and depression compared to the general population. Depression, in particular, has been linked to increased RA symptoms, such as fatigue, diminished treatment response, and greater disability. Depression and anxiety affect the quality of life for patients living with RA and represent a large gap in patient care.


What was done?

We explored the burden of anxiety and depression on health-related quality of life (HRQL) in patients with RA. HRQL is a concept for examining the impact of health on a person’s ability to live a fulfilling life. HRQL includes broad concepts of physical, mental, and social well-being.

Upon enrollment, our participants with RA completed questionnaires to assess depression and anxiety status, as well as HRQL domains, including fatigue, physical function, pain, sleep disturbance, and social participation. We then looked at the association between anxiety and depression with aspects of HRQL.


Who was involved? 

196 adults with RA participated in our study. As is typical of many RA studies, patients were mainly female, white, with established disease, and two-thirds were in remission or had low disease activity.


The Research Found:

Of the participants, 18% had mild anxiety, 9% had moderate-severe anxiety, 18% had mild depression, and 14% had moderate-severe depression. Anxiety and depression were associated with significantly worse HRQL overall and across its individual domains. These findings tell us that anxiety and depression are common in RA, even when the disease is well controlled, and that even low levels of anxiety and depression may have serious consequences for HRQL. Management strategies that address worrying and low mood may improve HRQL, positively impacting the ability to participate in meaningful social and life events, and restoring a sense of normalcy for patients with RA.


Who is on the research team?

Dana D. DiRenzo, MD, MHS, Instructor of Medicine, The Johns Hopkins University

Ethan T. Craig, MD, MHS, Assistant Professor of Clinical Medicine, University of Pennsylvania

Clifton O. Bingham III, MD, Professor of Medicine, The Johns Hopkins University

Susan J. Bartlett, PhD, Professor of Medicine, McGill University


Funding Agency:

National Institutes of Health (NIH)/National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)


Link to Publication: