A study utilizing data from the Multidimensional Health Assessment Questionnaire (MDHAQ) has shown that rheumatoid arthritis (RA) patients who screen positive for anxiety (ANX), depression (DEP), or fibromyalgia (FM) are significantly more likely to report cognitive and quality-of-life symptoms—such as memory issues, poor sleep, and social difficulties—than to test positive for traditional biomarkers like rheumatoid factor (RF) or anti-cyclic citrullinated protein antibodies (ACPA). These findings, presented at ACR Convergence and published in Arthritis & Rheumatology, suggest that noninflammatory symptoms may play a major role in RA disease expression and assessment.

“A symptom checklist and screening indices for anxiety (ANX), depression (DEP), and/or fibromyalgia (FM) on patient questionnaires… facilitate recording symptoms as formal medical history data, not available prior to information technology,” the authors wrote. “The prevalence of non-inflammatory symptoms in RA patients with positive versus negative screens on MDHAQ ANX, DEP, and FM indices was analyzed.”

Researchers conducted a cross-sectional analysis using MDHAQ data from 173 RA patients. The questionnaire included a 60-item symptom checklist and screens for ANX (MAS2), DEP (MDS2), and FM (FAST4). Investigators compared the 15 most commonly reported non-inflammatory symptoms between those who screened positive versus negative for these indices. Inflammatory-related symptoms (e.g., joint swelling, muscle weakness, dry mouth/eyes) were excluded from the comparison.

Key Findings:

• Symptom prevalence: Among all RA patients, 40–50% reported noninflammatory symptoms such as neck pain, headaches, fatigue, memory issues, dyspnea, and mood disturbances.

• High burden in screen-positive patients:

  • Over 70% of patients who screened positive for ANX, DEP, or FM reported problems with memory, thinking, sleeping, and unusual fatigue.

  • These rates exceeded the prevalence of seropositivity (RF or ACPA), which occurs in ~67–69% of RA patients based on meta-analytic data.

• Symptom-based screening utility: Noninflammatory symptoms were reported by >50% of screen-positive patients but by <50% of screen-negative patients.

“Symptoms on a computer checklist can function as clues to the likelihood of ANX, DEP, or FM in patients with RA who may have elevated DAS28, CDAI, or RAPID3, but little or no inflammation, analogous to laboratory tests,” the authors concluded. “The prevalence of symptoms in >70% of RA patients with ANX, DEP, and/or FM is higher than the prevalence of RF or ACPA in RA in a meta-analysis.”

Reference
Pincus T, Schmukler J, Li T. Rheumatoid arthritis (RA) patients who screen positive for anxiety, depression, and/or fibromyalgia are more likely to report problems with sleeping, memory, and/or social activities than to have an abnormal rheumatoid factor or ACPA [abstract]. Arthritis Rheumatol. 2025; 77 (suppl 9). https://acrabstracts.org/abstract/rheumatoid-arthritis-ra-patients-who-screen-positive-for-anxiety-depression-and-or-fibromyalgia-are-more-likely-to-report-problems-with-sleeping-memory-and-or-social-activities-than-to-have
Accessed October 15, 2025.