RA Depression Relationship — SCE Rheumatology MCQ
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Correct answer: D — Major depressive disorder affects approximately one in six people with RA, while screening-positive depressive symptoms affect roughly one-third; estimates vary by instrument, and depression is associated with poorer RA outcomes.
Explanation lettering: D = shown as C · E = shown as D · C = shown as E
E is correct. A systematic review found major depressive disorder in 16.8% of adults with RA, while screening-positive depression varied by instrument: approximately 39% with PHQ-9 and 34% with HADS at the lower threshold. The relationship is multifactorial, involving pain, disability, fatigue and psychosocial burden, with inflammatory pathways also biologically plausible. Depression is associated with poorer disease activity, treatment persistence or response, function and mortality, although association should not automatically be interpreted as direct causation. A is incorrect because glucocorticoids are not the sole explanation. B denies the established association with adverse outcomes. C confuses screening-positive symptoms with diagnosed major depression. D is wrong because depression is not restricted to advanced erosive disease and may occur early in RA.
Reference: Matcham F, Rayner L, Steer S, Hotopf M. The prevalence of depression in rheumatoid arthritis: a systematic review and meta-analysis. Rheumatology. 2013;52:2136–2148. https://pubmed.ncbi.nlm.nih.gov/24003249/