Depression More Common in AAV, Linked to Pain, Lower Quality of Life

Depression is more common in people with primary systemic vasculitides, including in those with ANCA-associated vasculitis (AAV), than in healthy people, a review study has found. 

Depression in vasculitis patients was also significantly associated with a poorer quality of life, more pain, fatigue, and use of more steroid medications. 

The study, “The prevalence and impact of depression in primary systemic vasculitis: a systematic review and meta-analysis,” was published in the journal Rheumatology International.

Primary systemic vasculitides (PSV) is an umbrella term for a group of conditions characterized by inflammation of blood vessels. The hallmark of AAV is the inflammation of small blood vessels, but other vasculitis disorders exist that damage small, medium, and large blood vessels.

Despite advances in treatment, regimens can be intense and often have significant side effects. Anti-inflammatory agents like glucocorticoids increase the risk of developing many co-conditions such as bone fractures and mood disturbances.

Also, long-term treatment may involve multiple medications, appointments with different specialists, and the potential for life-threatening relapses. As such, living with these conditions may have an impact on a patient’s quality of life and mental health. 

Given that depression is more common among people with chronic diseases, improving the understanding of depression in people with vasculitis disease is essential to support patient treatment programs.

Researchers based at the University of Liverpool in the United Kingdom conducted a review of the current literature to assess the number of people (prevalence) with depression among those with vasculitis, compare the prevalence according to type of vasculitis, and investigate the impact of depression on patient outcomes. 

The team used key search terms and a filtering process to identify 17 eligible vasculitis studies, of which 15 analyzed the prevalence of depression, and two investigated the impact of depression. 

Of these, 10 studies focused on people with small blood vessel vasculitis, most of which studied AAV in particular. The other studies investigated vasculitis conditions associated with medium and large blood vessels.

The prevalence of depression in those with small vessel vasculitis, like AAV, was 28%, and ranged from 14% to 55%. There was a high degree of variability (93%), and subdividing patients into different subtypes did not improve the variability. Studies using patient-reported depression scores reported a higher prevalence. Similar results were found in people with large vessel vasculitis.

Two studies that compared depression in vasculitis patients to those without vasculitis found an increased risk of depression among patients with the AAV subtype granulomatosis with polyangiitis (GPA), which is characterized by vessel inflammation in various tissues, typically the lungs, kidneys, sinuses, eyes, and ears.

Although not statistically significant, depression was more prevalent in AAV patients (9%) than in those with conditions like rheumatoid arthritis (4%) and chronic kidney disease (1%). 

Studies comparing depression and disease outcomes in those with small and medium blood vessel vasculitis found depression was significantly associated with quality of life, more pain, and a negative perception about their illness. Also, depressive symptoms independently predicted non-adherence to medication.

“It is imperative to address depression or depressive symptoms to optimise vasculitis management,” the researchers wrote.

In patients with GPA, no links were identified between depression scores and disease activity, disease damage, or glucocorticoid treatment. However, in these patients, depression significantly associated with fatigue. 

Depression and anxiety scores were higher in patients who used more steroid medications. These patients also reported a worse quality of life and more frequent sleep problems than those without depression or anxiety. Likewise, AAV patients with depression were at higher risk for poor quality of life. 

Finally, in a separate AAV study, depression was independently associated with unemployment.

“Depression is highly prevalent among patients with primary systemic vasculitis and associated with poorer outcomes across a range of measures in studies of small vessel disease,” the researchers concluded. 

“However, these findings were mostly in small-vessel vasculitides and more studies are needed for medium and large vessel disease,” they said.