How different is the status of depression and anxiety in patients with rheumatoid arthritis receiving methotrexate with sulfasalazine or hydroxychloroquine?

Background - Depression and anxiety are among the most common clinical manifestations in patients with rheumatoid arthritis (RA). Sulfasalazine and hydroxychloroquine are important medications used to treat these patients. Objective - The goal of this study was to compare the occurrence of depression and anxiety in RA patients taking sulfasalazine or hydroxychloroquine for at least six months. Methods - This study included 300 patients with RA referred to inpatient or outpatient departments of a public hospital in northern Iran who were treated with two combination regimens of methotrexate and sulfasalazine or methotrexate and hydroxychloroquine. Participants were assessed on the standard Hospital Anxiety and Depression Scale (HADS) for symptoms of depression and anxiety. Results - The mean HADS depression subscale score was 6.77 +/- 3.98 in the hydroxychloroquine group and 3.50 +/- 3.53 in the sulfasalazine group (p<0.001). The mean HADS anxiety subscale score was 7.66 +/- 4.43 in the hydroxychloroquine group and 5.34 +/- 4.35 in the sulfasalazine group (p<0.001). Multiple linear regression analysis revealed a significant difference in the incidence of depression and anxiety between the two treatment groups. Conclusion - A higher prevalence of depression and anxiety was observed in RA patients treated with methotrexate and hydroxychloroquine versus those treated with methotrexate with sulfasalazine.