Impact of Depression and Anxiety on the Components of Minimal Disease Activity (MDA) in Patients with Psoriatic Arthritis
Bibliographic record
Abstract
Objectives To investigate whether the presence of depression and anxiety affects the components of Minimal Disease Activity (MDA) in patients with Psoriatic Arthritis (PsA). Methods We included adult patients diagnosed with PsA and meeting CASPAR criteria, prospectively followed from 2008 to 2024. We defined the presence of depression/anxiety by 1 of 3 criteria: (1) a score of ≤38 on the SF-36 Mental Component Summary (MCS), (2) a score of ≤56 on the SF-36 Mental Health domain, or (3) a rheumatologist’s report of a diagnosis or treatment for depression/anxiety. Generalized Estimating Equations (GEE) were utilized to evaluate the association between depression/anxiety and being in a state of MDA, as well as each of the following components of MDA: tender joint count (TJC) ≤1, swollen joint count (SJC) ≤1, Psoriasis Activity and Severity Index (PASI) ≤1 or body surface area (BSA) ≤3%, pain Visual Analog Scale (VAS) score ≤15, global disease activity VAS score ≤20, tender entheseal points ≤1, and Health Assessment Questionnaire (HAQ) score ≤0.5, as well as C-reactive protein (CRP). Results We analyzed data from 1130 PsA patients. Among them, 238 (22.2%) were identified with depression/anxiety according to definition 1, 242 (22.5%) according to definition 2, and 107 (9.6%) according to definition 3. In total, 267 patients (23.8%) met at least 1definition. The presence of depression and anxiety was associated with a 66% lower likelihood of being in MDA (OR 0.34, 95% CI 0.28-0.41, p<0.001). Patients with depression or anxiety were significantly less likely to meet several MDA components. The odds of achieving TJC ≤1 were reduced by 29% (OR 0.71, 95% CI 0.62-0.81, p<0.001), SJC ≤1 by 24% (OR 0.76, 95% CI 0.64-0.89, p<0.001), pain VAS ≤15 by 63% (OR 0.37, 95% CI 0.29-0.47, p<0.001), global VAS ≤20 by 73% (OR 0.27, 95% CI 0.22-0.33, p<0.001), and tender entheseal points ≤1 by 47% (OR 0.53, 95% CI 0.43-0.64, p<0.001). Additionally, patients had a 75% lower likelihood of achieving HAQ score ≤0.5 (OR 0.25, 95% CI 0.21-0.31, p<0.001). No significant association was found between depression/anxiety and PASI or BSA (OR 0.95, 95% CI 0.80-1.13, p=0.589), nor with CRP (OR 0.90, 95% CI 0.75-1.08, p=0.255). Conclusion In PsA patients, the presence of depression/anxiety reduces the odds of being in MDA. Both clinician-reported (TJC, SJC, enthesitis, PASI) and patient-reported (pain VAS, global VAS, HAQ) components of MDA are affected, with a greater impact seen in subjective domains.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".