Prevalence, Severity and Measures of Anxiety in Rheumatoid Arthritis: A Systematic Review

Objectives

Many studies have reported high rates of anxiety in adults with Rheumatoid Arthritis (RA). The aim of this systematic review was to examine those findings and determine the overall prevalence, severity, and commonly used measures of anxiety in individuals with RA.

Methods

Six databases were searched from January 2000 without restrictions on language/location, study design, or grey literature. All identified studies that examined anxiety prevalence and severity in adults with RA, as assessed with clinical diagnostic interview and/or standardised self-report measures, were considered for inclusion. Quality assessment of included studies was conducted using a modified Newcastle-Ottawa Evaluation Scale, and the findings were synthesised via a narrative approach.

Results

Across the 47 studies (n =11,085) the sample size ranged from 60 to 1321 with seven studies including healthy controls or groups with other health conditions. The studies were conducted across 23 countries and anxiety prevalence ranged from 2.4% to 77% predominantly determined with standardised self-report measures, of which Hospital Anxiety and Depression scale was used most frequently; only eight studies used a clinical diagnostic interview to confirm a specific anxiety diagnosis. Notable associations with anxiety in RA were physical disability, pain, disease activity, depression, and quality of life.

Conclusions

The reported prevalence of anxiety in RA varied widely potentially due to use of different self-report measures and cut-off points. Such cut-off points will need to be standardised to clinical thresholds to inform appropriate interventions for anxiety comorbidity in RA.

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