Inflammatory arthritis is a common condition causing inflamed joints and affecting 1 in 100 people. The main types of inflammatory arthritis are ‘rheumatoid arthritis’, ‘psoriatic arthritis’, and ‘axial spondyloarthritis’. Despite taking medications to control joint inflammation many patients with inflammatory arthritis continue to have daily pain.
Depression and anxiety are common problems in patients with inflammatory arthritis . Many studies have shown that depression can worsen pain in inflammatory arthritis, but the impact of anxiety on pain is unclear. It is also not known if depression and anxiety affect how patients with inflammatory arthritis use NHS services for their pain.
Our study will investigate this by looking at the amount of pain medicines given, and the number of times people see doctors or nurses in primary care about their pain:
1. In patients with inflammatory arthritis with and without a diagnosis of depression and/or anxiety.
2. In patients with inflammatory arthritis before and after they are diagnosed with depression and/or anxiety.
3. In patients with inflammatory arthritis and depression and/or anxiety before and after they start medicines for their mental health condition(s).
Together with information from other studies by our research team these findings will help develop our understanding of the relationship between pain and depression and anxiety in people with inflammatory arthritis. This could improve patient care by helping to plan how doctors look for depression and anxiety in people with inflammatory arthritis.
Background
Despite advances in the treatment of inflammatory arthritis (IA), many patients with IA continue to experience significant pain. Studies have demonstrated that depression and chronic pain are inter-related in IA and there is a bi-directional effect. However, the extent to which anxiety relates to pain in patients with IA is uncertain, as are the impacts of depression and anxiety on pain-related healthcare utilisation. This study will address these uncertainties. Its findings will be considered alongside data from other studies to understand the need for, and potential benefits of assessing patients with IA for depression and anxiety.
Aim
To describe pain-related healthcare utilisation in adults with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and axial spondyloarthritis (SpA) with/without and before/after a coded diagnosis of depression and/or anxiety, and before/after the initiation of anti-depressant/anxiolytic prescriptions.
Objectives
To describe in patients with RA, PsA, and axial SpA the:
1. Annual prevalence of analgesic prescriptions and rates of musculoskeletal (MSK)-pain consultations in patients with/without depression and/or anxiety.
2. Quarterly prevalence of analgesic prescriptions and MSK-pain consultation rates for 24 months before/after an incident coded depression/anxiety diagnosis.
3. Quarterly prevalence of analgesic prescriptions and MSK-pain consultation rates for 24 months before/after the initiation of anti-depressant/anxiolytic prescriptions at/following a diagnosis of depression/anxiety.
Methods
Repeated cross-sectional analyses (1/1/2012 to 31/12/2021) will describe prevalence of analgesic prescriptions and MSK-pain consultation rates (1) annually comparing all patients with RA with/without a coded diagnosis of depression/anxiety; (2) quarterly in patients with RA before/after an incident coded depression/anxiety diagnosis for 24 months; and (3) quarterly in patients with RA with depression/anxiety before/after the initiation of an anti-depressant/anxiolytic prescription for 24 months. Analyses will be repeated for PsA and axial SpA, and stratified by type of mental health diagnosis, co-morbid fibromyalgia status, age group, gender, Index of Multiple Deprivation quintiles, and ethnicity.
Analgesic prescriptions; MSK-pain related consultations.
Ian Scott - Chief Investigator - Keele University
Natasha Cox - Corresponding Applicant - Keele University
Helen Twohig - Collaborator - Keele University
James Bailey - Collaborator - Keele University
Saeed farooq - Collaborator - Keele University
Sara Muller - Collaborator - Keele University
Ian Scott - Collaborator - Keele University
Patient Level Index of Multiple Deprivation;CPRD Aurum Ethnicity Record