Razavi Journal of Medicine

Razavi Journal of Medicine

Comparative study of depressive and anxiety symptoms in rheumatoid arthritis patients treated with conventional or biologic disease-modifying Antirheumatic drugs: A cross-sectional study

Articles in Press

Document Type : Original Article

Authors
Akhtar Taheri 1
Mansour Salesi 2
Mohammad Reza Sharbafchi 2
1 Department of Rheumatology, Isfahan University of Medical Sciences, Isfahan, Iran.
2 Department of Psychiatry, Behavioral Sciences Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
10.30483/rjm.2026.254747.1502
Abstract
Background: The primary treatment for rheumatoid arthritis (RA) consists of disease-modifying antirheumatic drugs (DMARDs), which are divided into two categories: conventional and biologic. Limited evidence suggests that DMARDs may also influence patients' psychological status; however, no specific data are available regarding these effects in Iran. This study aimed to investigate the relationship between treatment with DMARDs and depression and anxiety in patients with RA.

Methods: This cross-sectional study with a descriptive-analytical design was conducted on 110 patients with RA. Patients were divided into two groups according to their pharmacologic treatment: 55 patients who received only conventional synthetic DMARDs (csDMARDs) and 55 patients who received a combination of a csDMARD and a biologic DMARD (bDMARD). Demographic, historical, and laboratory data were recorded. The Hospital Anxiety and Depression Scale (HADS) was used to measure anxiety and depression. Disease severity was assessed using the DAS28 score. Data were analyzed using SPSS version 18.

Results: The bDMARD group had a significantly higher mean age and longer disease duration than the csDMARD group (p = 0.039 and p = 0.004, respectively). Erythrocyte sedimentation rate (ESR) levels were also significantly higher in the bDMARD group (p = 0.009). However, the mean DAS28-ESR was similar between the two groups (p = 0.549). The csDMARD group had significantly higher rates of severe anxiety (47.3% vs. 23.6%; p = 0.009) and depression (52.7% vs. 27.3%; p = 0.016) compared with the bDMARD group. In the csDMARD group, prednisolone was significantly correlated with mild-to-severe anxiety (OR = 13.33; 95% CI, 2.61–68.05). In multivariable analysis, methotrexate and prednisolone were associated with anxiety (OR = 18.09; 95% CI, 2.23–146.99 and OR = 24.02; 95% CI, 3.16–182.46, respectively). In the csDMARD group, administration of either methotrexate or prednisolone was associated with a significant increase in the odds of mild-to-severe depression (OR = 9.75; 95% CI, 2.11–45.00 and OR = 5.33; 95% CI, 1.11–25.64, respectively). In multivariable analysis, only methotrexate was associated with the odds of depression (OR = 26.27; 95% CI, 3.34–206.70).

Conclusion: Our findings revealed a significant association between the administration of conventional synthetic DMARDs and increased anxiety and depression.
Keywords
Rheumatoid arthritis
disease-modifying antirheumatic drugs
anxiety
depression
Subjects

Acknowledgements: We are grateful to the Isfahan University of Medical Sciences for financial support. We would also like to thank all people including patients who have participated in this study.

Availability of data and material: All data generated or analysed during this study are included in this published article.

Funding: Not applicable

Conflicts of interests: The authors declare that they have no conflict of interest.

Consent for publication: Not applicable.

Ethical Considerations:  All the procedures performed in the studies involving human participants were in accordance with the ethical standards of the local ethics committee of Isfahan University of Medical Sciences (IR.MUI.MED.REC.1403.025), as well as the 1964 Helsinki declaration. Written informed consent was obtained from all patients and healthy subjects.

Author contributions: Akhtar Taheri and Mansour Salesi contributed to the study conception and designed the questionnaire for this study. Akhtar Taheri and Mohammad Reza Sharbafchi collected data. Mohammad Reza Sharbafchi analyzed data and interpreted results. Mohammad Reza Sharbafchi prepared, wrote and edited the manuscript. Mansour Salesi and Akhtar Taheri critically revised the manuscript. All authors read and approved the final manuscript.

Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/

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Razavi Journal of Medicine

Articles in Press, Accepted Manuscript
Available Online from 14 October 2026