Dose Efficacy of Biologic Agents for RA Patients Exerts an Influence on Quality of Life and Depression

Abstract

Objectives : The objective of this study was to investigate the relationships between response to the treatment and activity of daily living (ADL), health-related quality of life (HRQoL) and depression in rheumatoid arthritis (RA) patients treated with biologic agents. Methods : Seventy-five RA patients (infliximab, 36 patients ; etanercept, 15 patients ; adalimumab, 19 patients tocilizumab, 17 patients) were assessed prior to treatment and again 14 weeks after the initiation of therapy. Age, gender, and steroid dosage were obtained for each participant. The disease activity in the patients was evaluated using the disease activity score (DAS) 28. The ADL (modified health assessment questionnaire [mHAQ]), HRQoL questionnaire (Short Form [SF]-36) and the depression scale (Japanese version of the structured interview guide for the Hamilton Depression rating scale [HAM-D] and the Self-rating Depression Scale [SDS]) were evaluated. Based on the EULAR improvement criteria for RA, patients were classified into three groups : good response to treatment (39 patients), moderate response to treatment (24 patients) and no response to treatment (12 patients). Results : After 14 weeks of treatment, scores of the "physical function" and "social functioning" from the SF-36 showed significant improvement among 3 groups, according to the repeated measure ANOVA. Although three groups' interaction was recognized, score of the "body pain", "general health perception" and "energy" from the SF-36 significantly improved in the good response group according to the paired t-test adjusted for the Bonferroni. The score of the mHAQ showed significant improvement among 3 groups, based on the repeated measure ANOVA. Although three groups' interaction was recognized, The scores of SDS and HAM-D significantly improved in the good response group. The score of the "pain" and "general health perception" in the SF-36 and the score of SDS significantly improved, but the scores of "energy" in SF-36 and the HAM-D did not significantly improve in the moderate response group. By contrast, no significant improvement was indicated in all the items in the no response group.Conclusions : Our results show that good treatment-response asa measured by the EULAR response criteria can be translated into improved depression anda HR-QoL dimensions in RA patients.