Treatment of Depression/Anxiety in Osteoarthritis Linked to Better Psychological Health But Not Improved Physical Symptoms

Depression and anxiety are common comorbidities of osteoarthritis (OA) of the hip or knee, yet surprisingly, little is known about how pharmacologic treatment for these conditions affects musculoskeletal health.

Jeffrey K. Lange, MD, a hip and knee specialist in the Division of Adult Reconstruction and Total Joint Arthroplasty of the Department of Orthopaedic Surgery at Brigham and Women’s Hospital, Alexander R. Farid, MD, a resident in the Harvard Combined Orthopaedic Surgery Residency Program, and colleagues recently completed the first study of this issue that relied on validated patient-related outcome measures (PROMs).

In the Journal of the American Academy of Orthopaedic Surgeons, they present evidence that pharmacologic treatment of depression/anxiety is associated with improved mental well-being in patients with hip or knee osteoarthritis but doesn’t seem to improve physical function or pain levels.


The team conducted a retrospective study that included 2,960 adults diagnosed with hip or knee OA who had depression or anxiety:

  • 2,630 had not received any pharmacological treatment for their psychiatric illness
  • 134 (4.5%) had received treatment for <1 year
  • 196 (6.6%) had received treatment for >1 year

At their first orthopedic clinic visit, each patient completed at least one of the following:

  • Knee Disability and Osteoarthritis Outcome Score–Physical Function Short Form
  • Hip Disability and Osteoarthritis Outcome Score–Physical Function Short Form
  • Forgotten Joint Score
  • Patient-Reported Outcomes Measurement Information System (PROMIS)-10 Global Mental (PROMIS-Mental)
  • PROMIS-10 Global Physical (PROMIS-Physical)
  • PROMIS Pain Interference
  • PROMIS Pain Intensity
  • PROMIS Depression

The study was not longitudinal; the researchers analyzed only PROM data from the first visit.

Unadjusted Analyses

On initial analyses, patients who had received pharmacologic therapy had significantly lower (worse) scores on two PROMs than those who had not been treated:

  • PROMIS-Physical: 39.8 vs. 42.3 (P<0.001)
  • PROMIS-Mental: 43.5 vs. 48.3 (P<0.001)

Multivariate Analyses

After adjustment for demographics and comorbidities, only the difference in PROMIS-Mental scores remained significant, with pharmacologic treatment associated with lower scores (β, 22.26; P<0.001). The type of antidepressant class did not affect any scores.

Results by Treatment Duration

On secondary analysis stratified by duration of pharmacologic treatment:

  • Patients who had <1 year of treatment scored 4.20 points lower on PROMIS-Mental than untreated patients (P<0.001)
  • Patients who had >1 year of treatment did not show a significant difference on PROMIS-Mental versus untreated patients
  • Length of treatment was not associated with PROMIS-Physical score

Influence of Factors Besides Psychiatric Treatment

Adjusted analyses also showed outcomes were associated with factors other than pharmacologic intervention:

  • PROMIS-Physical and PROMIS-Mental scores were decreased among patients with a higher Charlson Comorbidity Index, those who were unemployed or retired, those who identified as Black, and those who currently smoked
  • Patients receiving treatment for depression or anxiety were more likely than those not receiving treatment to have clinical and demographic characteristics known to predispose people to greater osteoarthritis symptom burden: lower levels of formal education, higher levels of unemployment, and a greater number of comorbid medical conditions

    Holistic Approach Needed

    Managing patients with osteoarthritis who also have depression or anxiety requires consideration of a complex interplay of clinical and demographic factors. Patients with the additional risk factors identified here should be strongly considered for referral to a psychiatrist or other mental health professional.

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