Anxiety and Depressive Symptoms and Illness Perceptions in Psoriatic Arthritis and Associations With Physical Health-Related Quality of Life KONSTANTINOS KOTSIS, 1 PARASKEVI V. VOULGARI, 1 NIKI TSIFETAKI, 1 MYRELA O. MACHADO, 2 ANDRE ´ F. CARVALHO, 2 FRANCIS CREED, 3 ALEXANDROS A. DROSOS, 1 AND THOMAS HYPHANTIS 1 Objective. Symptoms of psychological distress, including anxiety and depressive symptoms, and illness perceptions are important in determining outcome in patients with rheumatic disease. We aimed to compare psychological distress in psoriatic arthritis (PsA) and rheumatoid arthritis (RA) and to test whether the association between psychological variables and health-related quality of life (HRQOL) was similar in the 2 forms of arthritis. Methods. In 83 PsA patients and 199 RA patients, we used the Patient Health Questionnaire 9 (PHQ-9), the Symptom Checklist-90-Revised, and the Brief Illness Perception Questionnaire to assess psychological variables and the World Health Organization Quality of Life Instrument, Short Form to assess HRQOL. We used hierarchical regression analysis to determine the associations between psychological variables and HRQOL after adjusting for demographic variables and disease parameters. Results. The prevalence of moderate to severe levels of depressive symptoms (PHQ-9 score >10) was 21.7% in PsA patients, 25.1% in RA patients, and 36.7% in those PsA patients with polyarthritis. After adjustment for severity of disease and pain, anxiety ( 0.28) and concern about bodily symptoms attributed to the illness ( 0.33) were independent correlates of physical HRQOL in PsA. In RA, depressive symptoms ( 0.29) and concern about the consequences of the arthritis ( 0.27) were independent correlates of physical HRQOL. Conclusion. These findings suggest strongly that psychological factors are important correlates of HRQOL in PsA as well as in RA. Attention to patients’ anxiety and their concern about numerous bodily symptoms attributed to the illness may enable rheumatologists to identify and manage treatable aspects of HRQOL in PsA. INTRODUCTION Psoriatic arthritis (PsA) is a unique inflammatory arthritis (peripheral arthritis and/or spondylitis) associated with psoriasis (1). Its exact prevalence is unknown. Estimates in the general population vary from 0.04% to 1.2% (2,3). Clinical manifestations include cutaneous psoriatic le- sions (4), a predominantly distal joint disease, arthritis mutilans, oligoarthritis, polyarthritis, and spondylarthritis (4). The course varies, but approximately 20% of the pa- tients develop a destructive disabling form of arthritis (5). The disease burden is evident both in terms of progression of clinical damage and health-related quality of life (HRQOL), which is impaired compared to patients with psoriasis alone or healthy controls (6). In long-term medical conditions, including rheumatic disorders, psychological distress, especially depressive symptoms, contributes significantly to the impairment of health status (7,8). The prevalence of current major depres- sive disorder (MDD) in rheumatic disorders is generally 17% to 22.5% (9 –12), but the prevalence of lifetime MDD is much higher, rising up to 47% (13). In rheumatoid arthritis (RA), 28% of the patients met the criteria for lifetime depression and another 26.6% met the criteria for lifetime definite depression with medical attribution and/or subthreshold depression (14). Although both life- time and current depressive disorders make unique con- tributions to health outcomes in these patients, few studies have investigated the prevalence and severity of depres- sive symptoms in PsA. Previous estimates of depression are based on patients’ reports regarding a diagnosis of depression or on use of antidepressants (15,16). Two re- cent studies reported that 11.6% and 17.6% of patients 1 Konstantinos Kotsis, MD, MSc, Paraskevi V. Voulgari, MD, Niki Tsifetaki, MD, Alexandros A. Drosos, MD, FACR, Thomas Hyphantis, MD: Medical School, University of Ioannina, Ioannina, Greece; 2 Myrela O. Machado, MD, Andre ´ F. Carvalho, MD: Federal University of Ceara ´, For- taleza, Ceara ´ , Brazil; 3 Francis Creed, MD, FMedSci: Medical School, University of Manchester, Manchester, UK. Address correspondence to Thomas Hyphantis, MD, De- partment of Psychiatry, Medical School, University of Ioan- nina, Ioannina 45110, Greece. E-mail: tyfantis@cc.uoi.gr. Submitted for publication November 11, 2011; accepted in revised form April 20, 2012. Arthritis Care & Research Vol. 64, No. 10, October 2012, pp 1593–1601 DOI 10.1002/acr.21725 © 2012, American College of Rheumatology ORIGINAL ARTICLE 1593