Anxiety and Depression in Rheumatoid Arthritis Patients and its Impact on the Quality of Life
DOI:
https://doi.org/10.51985/Keywords:
Anxiety, DAS-28, depression, HADS, HAQ-DI, rheumatoid arthritisAbstract
Objective: To determine the frequency of depression and anxiety among patients with rheumatoid arthritis (RA) and to assess its impact on the quality of life.
Study Design and Setting: This cross-sectional study was conducted in KRL hospital Islamabad from 1-January-2025 to 31-July-2025.
Methodology: 115 patients aged 18 years or older with a confirmed diagnosis of RA were included. To evaluate disease severity, standardized criteria i.e. the Disease Activity Score involving 28 joints (DAS28) was employed. The Hospital Anxiety and Depression Scale (HADS), a validated instrument, was used to measure symptoms related to depression and anxiety. The impact on patients' quality of life was assessed using the Health Assessment Questionnaire Disability Index (HAQ-DI).
Results: 15 participants (13.0%) were male, while 100 participants (87.0%) were female. The mean duration of RA was 7.70 (±6.41) years. Among the participants, 30 patients (26.1%) were identified as experiencing depression, whereas 22 patients (19.1%) were found to have anxiety. Mean ESR, tender joint count (TJC), swollen joint count (SJC) and VAS score were significantly high in patients with depression and anxiety. The DAS-28 scores averaged 4.88 (±1.36) for those with anxiety/depression versus 3.85 (±1.26) for those without (P-value <0.0001) showing moderate disease activity in both groups. The HAQ-DI score averaged 1.33 (±0.84) for individuals with anxiety/depression as compared to 0.77 (±0.68) for those without (P-value <0.0001).
Conclusion: There is a considerably high prevalence of anxiety and depression among RA patients with a significant impact on the quality of life
References
1. Gravallese EM, Firestein GS. Rheumatoid arthritis—common
origins, divergent mechanisms. N Engl J Med. 2023;388(6):
529–42. DOI:10.1056/NEJMra2207277.
2. Jang S, Kwon EJ, Lee JJ. Rheumatoid arthritis: Pathogenic
roles of diverse immune cells. Int J Mol Sci. 2022;23:746.
DOI:10.3390/ijms23020746.
3. Qureshi S, Adas M, Cope PJ, Mahfouz H, Bechman K, Deane
KD, et al. Autoantibodies as predictors of progression to
rheumatoid arthritis: a systematic review and meta-analysis.
RMD Open. 2026 Feb 11;12(1):e006368. DOI: 10.1136/
rmdopen-2025-006368.
4. Muheremu A, Aierxiding S, Gao J. Regulation of the innate
immune response in rheumatoid arthritis. Front Immunol.
2025 Nov 3;16:1545625. DOI: 10.3389/fimmu.2025.1545625.
5. Zhang Z, Gao X, Liu S, et al. Global, regional, and national
epidemiology of rheumatoid arthritis among people aged
20–54 years from 1990 to 2021. Sci Rep. 2025 May 14;15(1):
10736. DOI: 10.1038/s41598-025-92150-1.
6. Díaz-González F, Hernández-Hernández MV. Rheumatoid
arthritis. Med Clin (Barc). 2023;161(12):533–42. DOI:10.
1016/j.medcli.2023.05.002.
7. Fatima S, Pope JE, Chen L, Schieir O, Valois M, Bartlett SJ,
et al. Higher comorbidities associated with less improvement
in disease activity in early RA: results from CATCH cohort.
Rheumatology. 2025;64(10):5785-92. doi: 10.1093/
rheumatology/keaf350.
8. Radmanoviæ O, Janjiæ V, Veselinoviæ M, et al. The impact
of insomnia on the clinical course and treatment outcomes of
rheumatoid arthritis. Biomedicines. 2025 Oct 17;13(10):2535.
DOI: 10.3390/biomedicines13102535.
9. Giblon RE, Achenbach SJ, Myasoedova E, Davis JM 3rd,
Kronzer VL, Bobo WV, et al. Trends in anxiety and depression
among individuals with rheumatoid arthritis: a populationbased study. J Rheumatol. 2025 Mar 1;52(3):210-218. DOI:
10.3899/jrheum.2024-0165.
10. Hill J, Harrison J, Christian D, Reed J, Clegg A, Duffield SJ,
et al. The prevalence of comorbidity in rheumatoid arthritis:
a systematic review and meta-analysis. Br J Community Nurs.
2022;27(5):232–41. DOI:10.12968/bjcn.2022.27.5.23211. Mudra Rakshasa-Loots A, Swiffen D, Steyn C, Marwick
KFM, Smith DJ. Affective disorders and chronic inflammatory
conditions: analysis of 1.5 million participants in Our Future
Health. BMJ Ment Health. 2025;28(1):e301706. doi:
10.1136/bmjment-2025-301706.
12. Drakes DH, Fawcett EJ, Yick JJ, Coles ARL, Seim RB, Miller
K, Lasaga M, Fawcett JM. Beyond rheumatoid arthritis: a
meta-analysis of the prevalence of anxiety and depressive
disorders in rheumatoid arthritis. J Psychiatr Res. 2025;184:
424–38. DOI:10.1016/j.jpsychires.2025.03.020.
13. Moudi S, Heidari B, Yousefghahari B, Gholami R, Gholinia
H, Babaei M. The prevalence and correlation of depression
and anxiety with disease activity in rheumatoid arthritis.
Reumatologia. 2023;61(2):86–91. DOI:10.5114/reum/154905.
14. Žagar I, Delimar V, Pap M, Periæ D, Laktašiæ Žerjaviæ N,
Periæ P. Prevalence and correlation of depressive symptoms
with functional scores, therapy and disease activity among
Croatian patients with rheumatoid arthritis: a preliminary
study. Psychiatr Danub. 2018;30(4):452–8.
15. Mena-Vázquez N, Ortiz-Márquez F, Ramírez-García T,
Cabezudo-García P, García-Studer A, Mucientes-Ruiz A, et
al. Impact of inflammation on cognitive function in patients
with highly inflammatory rheumatoid arthritis. RMD Open.
2024;10(2):e004422. DOI:10.1136/rmdopen-2024-004422.
16. Alwhaibi M. Depression, anxiety, and health-related quality
of life in adults with rheumatoid arthritis: findings from a
national survey. J Clin Med. 2025;14(22):7940. DOI:10.3390
/jcm14227940.
17. Snoeck Henkemans SVJ, Vis M, Koc GH, van der Helm-van
Mil AHM, de Jong PHP, van den Bosch F, et al. Association
between depression and anxiety and inability to achieve
remission in rheumatoid arthritis and psoriatic arthritis: results
from a prospective cohort. Rheumatology (Oxford). 2024;63(7)
:2411–21. DOI:10.1093/rheumatology/keae621.
18. Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT,
Bingham CO 3rd, et al. 2010 rheumatoid arthritis classification
criteria: an American College of Rheumatology/European
League Against Rheumatism collaborative initiative. Ann
Rheum Dis. 2010;69(9):1580–1588. DOI:10.1136/ard. 2010.
138461.
19. Ionescu CE, Popescu C, Codreanu C. Impact and prevalence
of depression and anxiety in rheumatoid arthritis—a crosssectional study with self-reported questionnaires. J Clin Med.
2025;14(5):1718. DOI:10.3390/jcm14051718.
20. GBD 2021 Rheumatoid Arthritis Collaborators. Global,
regional, and national burden of rheumatoid arthritis,
1990–2020, and projections to 2050: a systematic analysis of
the Global Burden of Disease Study 2021. Lancet Rheumatol.
2023;5(10):e594–e610. DOI:10.1016/S2665-9913(23)00211-
4
21. Singh G, Mahajan N, Abrol S, Raina A. Anxiety and depression
are common in rheumatoid arthritis and correlate with poor
quality of life in Indian patients. Reumatologia. 2021;59(6):
386–93. DOI:10.5114/reum.2021.112345.
22. Wan X, Xie J, Yang M, Yu H, Hou W, Xu K, et al. Does
having rheumatoid arthritis increase the dose of depression
medications? A Mendelian randomization study. J Clin Med.
2023;12(4):1405. DOI:10.3390/jcm12041405.Uda M, Hashimoto M, Uozumi R, Torii M, Fujii T, Tanaka
M, et al. Factors associated with anxiety and depression in
rheumatoid arthritis patients: a cross-sectional study. Adv
Rheumatol. 2021;61(1):65. DOI:10.1186/s42358-021-00223-
7.
24. Enginar AU, Nur H. The frequency and factors affecting
anxiety and depression in patients with rheumatoid arthritis.
Reumatologia. 2023;61(1):30–7. DOI:10.5114/reum/158750.
25. Alanazi HQ, Alharbi SA, Alghashmari AA, Anzi RN, Alawad
FH, Alhodibi MH. The prevalence and association of
depression, anxiety and sleep disorders amongst adult
rheumatoid arthritis patients in Saudi Arabia and its effect on
health-related quality of life: a multi-centric cross-sectional
study. J Adv Ther in Med Res. 2024;1(1):347–53. DOI:10.
5555/jatm.2024.001.
26. Fragoulis GE, Cavanagh J, Tindell A, Derakhshan M, Paterson
C, Porter D, et al. Depression and anxiety in an early
rheumatoid arthritis inception cohort: associations with
demographic, socioeconomic and disease features. RMD
Open. 2020;6(3):e001470. DOI:10.1136/rmdopen-2020-
001470.
27. Machin AR, Babatunde O, Haththotuwa R, Scott I, BlagojevicBucknall M, Corp N, et al. The association between anxiety
and disease activity and quality of life in rheumatoid arthritis:
a systematic review and meta-analysis. Clin Rheumatol.
2020;39(5):1471–82. DOI:10.1007/s10067-020-05088-3.
28. Haq Z ul, Butt BA, Zafar N, Imran MY, Ahmad F, Saleem S.
Evaluating quality of life across different stages of rheumatoid
arthritis. J Fatima Jinnah Med Univ. 2024;18(3):103–7.
DOI:10.37018/CYIE3425.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Ishma Arif, Anila Nisar, Anum Rasheed, Aanum Misbah Hasanat, Amber Iltaf (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Journal of Bahria University Medical & Dental College is an open access journal and is licensed under CC BY-NC 4.0. which permits unrestricted non commercial use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this license, visit https://creativecommons.org/licenses/by-nc/4.0
