Association between Proinflammatory Cytokines and Anxiety and Depression Symptoms in Rheumatoid Arthritis Patients: A Cross-sectional Study

Abstract

Objective: Rheumatoid arthritis (RA) patients have a greater prevalence of anxiety and depression. TNFα is an important inflammatory cytokine in RA and is associated with disease activity. Previous researches showed that disease activity correlates with anxiety and depression. We aim to evaluate the association between TNFα as a marker of systemic inflammation and anxiety and depression symptoms in RA patients. Methods: This is a cross-sectional study conducted at the outpatient rheumatology clinic of Cipto Mangunkusumo General Hospital (Jakarta, Indonesia). Patients were divided into active disease and remission groups that were matched by age and gender. 31 patients were included in this study: 16 patients with active disease activity and 15 patients in remission state. Disease activity was assessed using Disease Activity Score of 28 joints (DAS28)-CRP (C-reactive protein). Anxiety and depression symptoms were assessed using the Hospital Anxiety and Depression Scale. TNFα level was measured using ELISA. Results: Among 31 patients, ten patients showed anxiety symptoms, 19 patients showed depression symptoms, and two displayed mixed symptoms. Serum TNFα level was significantly higher in active disease than in the remission group (p-value 0.006). TNFα was significantly higher in patients with anxiety in the active disease group compared to the remission group (11.67 vs. 9.61 pg/ml, p-value 0.003). Likewise, TNFα was also significantly higher in patients with depression in the active disease group compared to the remission group (11.45 vs. 9.69 pg/ml, p-value 0.006). Conclusion: There is association between TNFα level and anxiety and depression symptoms RA patients with active disease. Our data indicate that disease activity and systemic inflammation may play a role in both anxiety and depression symptoms in RA patients.