BALTIMORE — Rheumatoid arthritis patients often suffer from depression which exacerbates disease activity and can decrease response to first-line disease-modifying antirheumatic drugs.

In light of that, a study published in The Journal of Rheumatology sought to determine if depression affects disease activity among veterans with early RA prescribed methotrexate (MTX).1

The study was led by University of Maryland Baltimore researchers and included participation from the VA Maryland Healthcare System and the VA Nebraska-Western Iowa Healthcare System.

Participants were all enrolled in the Veterans Affairs Rheumatoid Arthritis Registry with early RA, defined as less than two years, and prescribed MTX. Researchers assessed depression at enrollment using International Classification of Diseases codes (296.2-296.39, 300.4, 311), while RA disease activity was measured using the 28 joint count disease activity score (DAS-28) and other core measures. Propensity score weights were used to adjust 48 depressed and 220 nondepressed patients on baseline confounders within imputed datasets.

Veterans in the study were predominantly, 89.2%, male and had a median age of 62.7, which is older than general population RA patients.

Adjusted estimates indicated that depression was associated with significantly higher DAS-28 at six months (β=0.345; 95% CI: 0.007, 0.682) but not at one- or two-years follow-up, according to researchers. They also reported that depression was associated with significantly worse pain at six months (β=0.385; 95% CI: 0.040, 0.730) and one-year (β=0.396; 95% CI: 0.042, 0.750) follow-up.

“In early RA, depression is associated with greater short-term disease activity during MTX treatment, as well as more persistent and severe pain,” the authors concluded.


  1. Rathbun AM, England BR, Mikuls TR, Ryan AS, et. Al. JL. Relationship between Depression and Disease Activity in United States Veterans with Early Rheumatoid Arthritis Receiving Methotrexate. J Rheumatol. 2020 Nov 15:jrheum.200743. doi: 10.3899/jrheum.200743. Epub ahead of print. PMID: 33191277.