Systematic review of depression and anxiety in psoriatic arthritis

Background/purpose: Depression and anxiety are often comorbid with rheumatic diseases. in psoriatic arthritis (PsA), the combination of inflammatory arthritis and psoriasis may contribute to a greater burden of depression and anxiety, however, the extent remains unclear. Treatments for PsA may also benefit these psychiatric conditions. Methods: We performed a systematic review examining point prevalence of depression and anxiety in PsA as well as putative reductions in these comorbidities with PsA treatment. MEDLINE, EMBASE, EBM Reviews and Cochrane, and PsycINFO were searched from inception to October 2017. Quality of studies was assessed using the Joanna Briggs Institute Checklist for Prevalence Studies. Study and population characteristics were extracted and entered into an electronic database for subsequent descriptive and meta-analysis of point prevalence. Results: Three studies matched inclusion criteria with significant statistical heterogeneity. The prevalence of depression ranged between 9-22% and anxiety between 15-30% in patients with PsA. One study matched inclusion criteria for treatment effect analysis, albeit with a high risk of bias, suggesting a benefit of etanercept on prevalence of depression (9% vs 16%) and anxiety (14% vs 30%) after 24 weeks of treatment. Conclusion: This is the first systematic review of point prevalence of depression and anxiety in patients with psoriatic arthritis. There is a moderate point prevalence of both depression and anxiety in patients with psoriatic arthritis, which is similar or slightly higher than the general population and comparable to that seen in other rheumatic diseases. The effects of treatment for psoriatic arthritis on comorbid depression and anxiety remain unclear.