Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.

Optimism and Depressive Scores in Early Arthritis Patients Before and After Treatment with Methotrexate and a Tapered High Dose of Prednisone in the IMPROVED Study.

Heimans1,  L., Boer1,  K.V.C. Wevers-de, Visser1,  K., Huizinga1,  Tom W.J., Ronday2,  H.K, Westedt3,  M.L., Molenaar4,  T.H.E.

Leiden University Medical Center, Leiden, Netherlands
Haga Hospital, The Hague, Netherlands
Bronovo Hospital, The Hague, Netherlands
Groene Hart Hospital, Gouda, Netherlands


To assess depression and optimism scores in patients with recent onset arthritis, before and after four months of induction therapy with methotrexate and prednisone.


Patients with recent onset rheumatoid and undifferentiated arthritis were treated with MTX 25mg/week and 60 mg/day of prednisone immediately tapered to 7.5mg/day in seven weeks in the IMPROVED-study. At baseline and four months after start of treatment, patients filled out the Beck Depression Inventory (BDI-II) to assess depression symptom severity (range 0–63) and the Life Orientation Test Revised (LOT-R) to measure optimism (range 0–24). Comparisons were made between scores before and after treatment and between patients who did or did not achieve clinical remission, defined as a Disease Activity Score (DAS) <1.6. Linear multiple regression analysis was used to investigate the relationship between the two questionnaires, DAS and DAS components, visual analogue scales (VAS) for pain, general wellbeing and global health, age, sex, marital status, children, educational level, work, and previous medical history.


210 patients completed the LOT-R and 215 patients completed the BDI-II at both time points. Optimism and depression are related at baseline, but not after four months. Optimism significantly decreased, independent of whether remission was achieved. There was no significant difference in scores at baseline or after four months between both groups (p=0.823). Regression analysis revealed no significant relationship between disease activity and optimism scores. Only (higher) age was an independent predictor of (higher) absolute optimism scores after 4 months of treatment (p<0.001). Overall, the depression scores significantly improved. In patients who achieved remission, the scores after four months treatment were significantly lower than at baseline (from 6.9 to 4.8, p<0.001). In the non-remission group depression scores before and after treatment were similar (baseline 11.2 and 4 months 11.0, p=0.826). Independent predictors of depression scores after four months were a high depression score at baseline (B 0.48, p<0.001), a high DAS (B 2.17, p<0.001) and a history of metabolic disease (B 2.55, p=0.03). A higher baseline score predicted a smaller delta-BDI-II (B-0.51, p<0.001), higher VAS scores for general health (B 0.07, p=0.020) and general wellbeing (B 0.10, p<0.001) predicted a slightly increased delta-BDI-II.


Depression severity scores decrease in early RA and UA patients who achieve remission after 4 months of treatment with methotrexate and prednisone. However, optimism scores also decreased independent of whether remission was achieved and without strong predictors. This suggests that the change in optimism is not related to change in disease activity but maybe to shared characteristics related to diagnosis, trial participation or medication.

To cite this abstract, please use the following information:
Heimans, L., Boer, K.V.C. Wevers-de, Visser, K., Huizinga, Tom W.J., Ronday, H.K, Westedt, M.L., et al; Optimism and Depressive Scores in Early Arthritis Patients Before and After Treatment with Methotrexate and a Tapered High Dose of Prednisone in the IMPROVED Study. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :2207

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