Machin, AR, Babatunde, OO, Haththotuwa, R, Scott, IC, Blagojevic-Bucknall, M, Corp, N, Chew-Graham, CA and Hider, SL (2020) The association between anxiety and disease activity and quality of life in rheumatoid arthritis: a systematic review and meta-analysis. Clinical Rheumatology. ISSN 1434-9949

[thumbnail of Machin2020_Article_TheAssociationBetweenAnxietyAn.pdf] Text
Machin2020_Article_TheAssociationBetweenAnxietyAn.pdf - Published Version
Restricted to Repository staff only
Available under License Creative Commons Attribution.

Download (1MB)


OBJECTIVES: In people with rheumatoid arthritis (RA), mental health problems are common, but often not recognized or treated, contributing to increased morbidity and mortality. Most studies examining the impact of mental health problems in RA have focused on depression. We aimed to determine the association between anxiety, and disease activity and quality of life (QoL) in people with RA. METHODS: A systematic review and meta-analysis were performed. A protocol was registered with PROSPERO (CRD2-17062580). Databases (Web of Science, PsycINFO, CINAHL, Embase, Medline) were searched for studies examining the association between anxiety and disease activity and QoL, in adults with RA, from inception to February 2019. Primary outcome measures were DAS28 and SF-36. Eligibility screening and data extraction were completed by two reviewers. Disagreements were resolved by discussion or a third reviewer. Quality assessment was carried out using the Newcastle-Ottawa Scale. RESULTS: From 7712 unique citations, 60 articles were assessed for eligibility. The final review included 20 studies involving 7452 people with RA (14 cross-sectional, 6 cohort). Eleven examined disease activity, 6 reported QoL outcome measures and 3 included both. Anxiety was associated with increased disease activity and worse QoL. Meta-analysis showed anxiety to be correlated with increased DAS28 scores (r = 0.23, CI 0.14, 0.31) and reduced physical (r = - 0.39, CI - 0.57, - 0.20) and mental QoL (- 0.50, CI - 0.57, - 0.43). CONCLUSIONS: Anxiety in people with RA is associated with increased disease activity and worse QoL. Improved recognition and management of comorbid anxiety may help to improve outcomes for people with RA.Key Points• This is the first systematic review and meta-analysis to examine the relationship between anxiety and disease activity and QoL in people with RA.• Anxiety was associated with higher disease activity both cross-sectionally and at up to 12-month follow-up.• Anxiety may have a more significant impact on disease activity in early RA, highlighting the importance of early recognition and management of comorbid anxiety.• People with anxiety had poorer self-reported physical and mental QoL, although there was some heterogeneity in study findings, particularly for physical QoL (I2 = 78.5%).

Item Type: Article
Additional Information: All relevant information and full manuscript can be found at;
Uncontrolled Keywords: Anxiety; Disease activity; Meta-analysis; Quality of life; Rheumatoid arthritis; Systematic review.
Subjects: Q Science > Q Science (General)
R Medicine > R Medicine (General)
Divisions: Faculty of Medicine and Health Sciences > School of Primary, Community and Social Care
Related URLs:
Depositing User: Symplectic
Date Deposited: 28 Feb 2020 14:06
Last Modified: 22 Mar 2021 12:06

Actions (login required)

View Item
View Item