The relationship between disease activity and depressive symptoms severity and optimism--results from the IMPROVED study

Clin Rheumatol. 2013 Dec;32(12):1751-7. doi: 10.1007/s10067-013-2337-9. Epub 2013 Jul 24.


To assess depressive symptoms severity and dispositional optimism in patients with recent onset arthritis both before and after 4 months treatment. Two hundred twenty-two patients with recent onset RA and undifferentiated arthritis in the IMPROVED study filled out the Beck Depression Inventory (BDI-II) to assess depressive symptoms severity and the Life Orientation Test Revised (LOT-R) to measure optimism before and after 4 months of treatment. All patients were treated with methotrexate 25 mg/week and prednisone 60 mg/day (tapered to 7.5 mg/day in 7 weeks). Linear regression analysis was used to assess the association between the disease activity score (DAS) and its components (tender joint count, general well-being measured with a visual analogue scale (VAS), swollen joint count, and erythrocyte sedimentation rate) with the BDI-II an LOT-R scores. In general, depressive symptoms were mild. The DAS was an independent predictor of depressive symptoms scores both at baseline and after 4 months follow-up, in particular tender joint count and VAS global health. Disease activity was not associated with the level of optimism. Nevertheless, patients who achieved clinical remission improved significantly more in both depression score and optimism score than patients who did not. Patients with early arthritis report improvement in depressive symptoms and optimism with improvement in disease activity and achieving clinical remission. Depression scores are associated with pain and unwell being but not with swollen joint counts and inflammatory parameters.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Antirheumatic Agents / administration & dosage
  • Arthritis, Rheumatoid / complications
  • Arthritis, Rheumatoid / drug therapy
  • Arthritis, Rheumatoid / psychology*
  • Attitude*
  • Depression / complications*
  • Female
  • Humans
  • Inflammation
  • Male
  • Methotrexate / administration & dosage
  • Middle Aged
  • Prednisone / administration & dosage
  • Regression Analysis
  • Remission Induction
  • Severity of Illness Index
  • Surveys and Questionnaires


  • Antirheumatic Agents
  • Prednisone
  • Methotrexate

Associated data

  • EudraCT/2006-006186-16
  • ISRCTN/ISRCTN11916566