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Moudi S, Heidari B, Yousefghahari B, Gholami R, Gholinia H, Babaei M. The prevalence and correlation of depression and anxiety with disease activity in rheumatoid arthritis. Reumatologia 2023; 61:86-91. [PMID: 37223374 PMCID: PMC10201383 DOI: 10.5114/reum/154905] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 09/23/2022] [Indexed: 11/02/2023] Open
Abstract
INTRODUCTION Depression and anxiety share similar symptoms with rheumatoid arthritis (RA) and these conditions are often not diagnosed or overlooked in RA. This study aimed to determine the prevalence of depression/anxiety in RA and their correlation with RA activity. MATERIAL AND METHODS Rheumatoid arthritis patients who presented at a rheumatology clinic were selected consecutively. The diagnosis of RA was confirmed by the ACR/EULAR criteria, disease activity was assessed by Disease Activity Score based on the 28-joint count (DAS28) and patients with DAS28 > 2.6 were considered to have active RA. The diagnosis of depression and anxiety was made by the Hospital Anxiety and Depression Scale (HADS). The Pearson test was used to determine the correlation between DAS28 and HADS scores. RESULTS Two-hundred patients (female, 82%) with a mean age of 53.5 ±10.1 years and mean disease duration of 6.6 ±6.8 years were studied. Depression was diagnosed in 27 (13.5%) patients and anxiety in 38 (19%) patients. The DAS28 score correlated positively with depression (r = 0.173, p = 0.014) and anxiety score (r = 0.229, p = 0.001). In multiple logistic regression analysis after adjustment for all covariates, age < 40 years and female sex were independently associated with RA activity in patients with depression, with OR = 4.21 (p = 0.002) and OR = 3.56 (p = 0.028) respectively. CONCLUSIONS These findings indicate that depression and anxiety are prevalent in RA and correlate positively with active disease in particular in depressive female patients aged < 40 years.
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Affiliation(s)
- Sousan Moudi
- Health Research Center, Master of Biostatistics and Epidemiology, Babol University of Medical Science, Iran
| | - Behzad Heidari
- Clinical Research Development Unit of Rouhani, Babol University of Medical Sciences, Iran
| | - Behnaz Yousefghahari
- Clinical Research Development Unit of Rouhani, Babol University of Medical Sciences, Iran
| | - Reza Gholami
- Student Research Committee, Babol University of Medical Sciences, Iran
| | - Hemmat Gholinia
- Clinical Research Development Unit of Rouhani, Babol University of Medical Sciences, Iran
| | - Mansour Babaei
- Clinical Research Development Unit of Rouhani Hospital, Babol University of Medical Sciences, Iran
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Pathway Phenotypes Underpinning Depression, Anxiety, and Chronic Fatigue Symptoms Due to Acute Rheumatoid Arthritis: A Precision Nomothetic Psychiatry Analysis. J Pers Med 2022; 12:jpm12030476. [PMID: 35330475 PMCID: PMC8950237 DOI: 10.3390/jpm12030476] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/19/2022] [Accepted: 03/08/2022] [Indexed: 12/12/2022] Open
Abstract
Rheumatoid arthritis (RA) is a chronic inflammatory and autoimmune disorder which affects the joints in the wrists, fingers, and knees. RA is often associated with depressive and anxiety symptoms as well as chronic fatigue syndrome (CFS)-like symptoms. This paper examines the association between depressive symptoms (measured with the Beck Depression Inventory, BDI), anxiety (Hamilton Anxiety Rating Scale, HAMA), CFS-like (Fibro-fatigue Scale) symptoms and immune–inflammatory, autoimmune, and endogenous opioid system (EOS) markers, and lactosylcer-amide (CD17) in RA. The serum biomarkers were assayed in 118 RA and 50 healthy controls. Results were analyzed using the new precision nomothetic psychiatry approach. We found significant correlations between the BDI, FF, and HAMA scores and severity of RA, as assessed with the DAS28-4, clinical and disease activity indices, the number of tender and swollen joints, and patient and evaluator global assessment scores. Partial least squares analysis showed that 69.7% of the variance in this common core underpinning psychopathology and RA symptoms was explained by immune–inflammatory pathways, rheumatoid factor, anti-citrullinated protein antibodies, CD17, and mu-opioid receptor levels. We constructed a new endophenotype class comprising patients with very high immune–inflammatory markers, CD17, RA, affective and CF-like symptoms, and tobacco use disorder. We extracted a reliable and replicable latent vector (pathway phenotype) from immune data, psychopathology, and RA-severity scales. Depression, anxiety, and CFS-like symptoms due to RA are manifestations of the phenome of RA and are mediated by the effects of the same immune–inflammatory, autoimmune, and other pathways that underpin the pathophysiology of RA.
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Kim H, Lee H, Lee SS. The prevalence and correlates of depression in Korean adults with rheumatoid arthritis: Results from the Korea National Health and Nutrition Examination Surveys. Int J Rheum Dis 2022; 25:454-465. [PMID: 35043586 DOI: 10.1111/1756-185x.14291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/03/2022] [Accepted: 01/09/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE This study aimed to investigate the prevalence and correlates of depression in Korean patients with rheumatoid arthritis (RA). METHODS We analyzed the data of the Korean National Health and Nutrition Examination Survey (KNHANES). The sociodemographic, clinical, and psychiatric variables were compared between the RA group (n = 277) and the gender- and age-matched non-RA group (n = 1068). Participants in the RA group who had a Patient Health Questionnaire-9 (PHQ-9) score of 10 or more were sub-categorized as the depression group (n = 52), and the prevalence of depression with RA was determined. Complex samples logistic regression analysis was performed to clarify the associated factors for depression in patients with RA. RESULTS The prevalence of depression in patients with RA was 17.4%. The RA group experienced more pain, restrictions on usual activities, and stress in their daily lives. RA patients with 3 or more comorbid diseases, extreme pain, problems in usual activities, and moderate to severe perceived stress were more likely to develop depression. Female gender and low income were also associated factors to consider. CONCLUSION Depression is significantly prevalent in Korean RA patients. Along with managing pain and daily life functions, interventions to reduce perceived stress are needed for comprehensive RA management.
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Affiliation(s)
- Hyunseuk Kim
- Department of Psychiatry, Kosin University Gospel Hospital, Busan, South Korea
| | - Haeyoung Lee
- Department of Thoracic and Cardiovascular Surgery, Kosin University Gospel Hospital, Busan, South Korea
| | - Sang-Shin Lee
- Department of Psychiatry, Kosin University Gospel Hospital, Busan, South Korea
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Pezzato S, Bonetto C, Caimmi C, Tomassi S, Montanari I, Gnatta MG, Fracassi E, Cristofalo D, Rossini M, Carletto A, Tosato S. Depression is associated with increased disease activity and higher disability in a large Italian cohort of patients with rheumatoid arthritis. Adv Rheumatol 2021; 61:57. [PMID: 34526144 DOI: 10.1186/s42358-021-00214-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 08/28/2021] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Depression is a quite common comorbidity in patients with rheumatoid arthritis (RA) and is thought to influence its severity. This study aims to estimate, in a large cohort of Italian patients with RA, the prevalence of depression and to investigate the clinical correlates of depression in terms of disease activity and disability. METHODS This is a cross-sectional study enrolling 490 outpatients with RA (80% female, mean age 59.5). The Hospital Anxiety and Depression Scale (HADS) was used to assess the presence of depression with a cut-off of 11. We collected data about disease activity and disability with DAS28, TJC-68, PhGA, PGA, VAS, DAS28, SDAI, CDAI and HAQ. RESULTS Prevalence of depression was 14.3% (95% CI: 11-17%). Depressed patients, when compared with not depressed ones, were found to have higher scores for TJC-68 (p = 0.011), PhGA (p = 0.001), PGA (p = 0.001), VAS (p = 0.001), DAS28 (p = 0.007), SDAI (p = 0.001), CDAI (p = 0.001) and HAQ (p = 0.001). Out of the 70 depressed patients, 30 subjects, already known to be depressed in the past, were still depressed at the time of the assessment, with only 11 (15.7%) under antidepressants. A multivariate analysis showed that male sex, higher PGA score, use of antidepressants and higher HAQ score were significantly associated with an increased risk of depression. CONCLUSIONS Our study shows that depression is common in RA and may affect its activity mainly via an alteration in the perception of the disease. Although its important implications, depression is still under-diagnosed and its management is inadequate.
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Affiliation(s)
- Sara Pezzato
- Rheumatology Unit, University of Verona, Policlinico G.B. Rossi, Piazzale Scuro, 10, 37134, Verona, VR, Italy
| | - Chiara Bonetto
- Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Cristian Caimmi
- Rheumatology Unit, University of Verona, Policlinico G.B. Rossi, Piazzale Scuro, 10, 37134, Verona, VR, Italy
| | - Simona Tomassi
- Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Ilaria Montanari
- Rheumatology Unit, University of Verona, Policlinico G.B. Rossi, Piazzale Scuro, 10, 37134, Verona, VR, Italy
| | - Maria Giulia Gnatta
- Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Elena Fracassi
- Rheumatology Unit, University of Verona, Policlinico G.B. Rossi, Piazzale Scuro, 10, 37134, Verona, VR, Italy
| | - Doriana Cristofalo
- Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Maurizio Rossini
- Rheumatology Unit, University of Verona, Policlinico G.B. Rossi, Piazzale Scuro, 10, 37134, Verona, VR, Italy
| | - Antonio Carletto
- Rheumatology Unit, University of Verona, Policlinico G.B. Rossi, Piazzale Scuro, 10, 37134, Verona, VR, Italy.
| | - Sarah Tosato
- Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
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Gharibdoost F, Salari AH, Salesi M, Ebrahimi Chaharom F, Mottaghi P, Hosseini M, Sahebari M, Nazarinia M, Mirfeizi Z, Shakibi M, Moussavi H, Karimifar M, Mowla K, Karimzadeh H, Anjidani N, Jamshidi A. Assessment of Treatment Safety and Quality of Life in Patients Receiving Etanercept Biosimilar for Autoimmune Arthritis (ASQA): A Multicenter Post-marketing Surveillance Study. Adv Ther 2021; 38:1290-1300. [PMID: 33432540 DOI: 10.1007/s12325-020-01611-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 12/16/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Phase IV post-marketing surveillance studies are needed to evaluate the real-world safety and effectiveness of drug products. This study aimed to evaluate the safety and effectiveness of biosimilar etanercept (Altebrel, AryoGen Co., Iran) in patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS), and psoriatic arthritis (PsA). METHODS In this open-label, multicenter, prospective, observational, post-marketing surveillance study, 583 patients received biosimilar etanercept 25 mg twice weekly or 50 mg once weekly and were followed up to 12 months. The primary objective was to evaluate the safety of biosimilar etanercept by documenting all the adverse events in the case report forms throughout the study period. The secondary objective was to evaluate the effectiveness of biosimilar etanercept in study patients, where longitudinal changes in health assessment questionnaire (HAQ), pain, and disease activity scores were assessed. RESULTS A total of 583 patients (44.80 ± 13.09 years of age) were included and followed for an average of 8.12 ± 3.96 months. Among all patients, 172 (29.50%) experienced at least one adverse event, and injection site reaction, abdominal pain, and upper respiratory tract infection were the most common. HAQ scores decreased from 1.32 ± 0.77 at baseline to 0.81 ± 0.61 at 12 months in patients with RA/PsA (p < 0.01) and from 0.82 ± 0.58 at baseline to 0.66 ± 0.63 at 12 months in patients with AS (p = 0.18). Pain scores decreased from 6.49 ± 2.41 at baseline to 3.51 ± 2.39 at 12 months (p < 0.01). CONCLUSION The results demonstrated the real-world safety and effectiveness of biosimilar etanercept in patients with RA, PsA, and AS. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT04582084.
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Affiliation(s)
- Farhad Gharibdoost
- Rheumatology Research Center, Shariati Hospital, Tehran University of Medical, Tehran, Iran
| | - Amir-Hossein Salari
- Department of Rheumatology, Baghiyatollah University of Medical Sciences, Tehran, Iran
| | - Mansour Salesi
- Department of Rheumatology, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Peyman Mottaghi
- Department of Rheumatology, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Maryam Sahebari
- Rheumatic Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammadali Nazarinia
- Shiraz Geriatric Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Mirfeizi
- Rheumatic Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammadreza Shakibi
- Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Hamidreza Moussavi
- Department of Rheumatology, Noor and Aliasghar Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mansour Karimifar
- Department of Rheumatology, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Karim Mowla
- Department of Rheumatology, School of Medicine, Ahvaz Jundishapur Medical Sciences University, Ahvaz, Iran
| | - Hadi Karimzadeh
- Department of Rheumatology, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Ahmadreza Jamshidi
- Rheumatology Research Center, Shariati Hospital, Tehran University of Medical, Tehran, Iran.
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Ingegnoli F, Buoli M, Antonucci F, Coletto LA, Esposito CM, Caporali R. The Link Between Autonomic Nervous System and Rheumatoid Arthritis: From Bench to Bedside. Front Med (Lausanne) 2020; 7:589079. [PMID: 33365319 PMCID: PMC7750536 DOI: 10.3389/fmed.2020.589079] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/30/2020] [Indexed: 12/25/2022] Open
Abstract
Neuronal stimulation is an emerging field of research focused on the management and treatment of various diseases through the reestablishment of physiological homeostasis. Electrical vagus nerve stimulation has recently been proposed as a revolutionary therapeutic option for rheumatoid arthritis (RA) in combination with or even as a replacement for conventional and biological drugs. In the past few years, disruption of the autonomic system has been linked to RA onset and activity. Novel research on the link between the autonomic nervous system and the immune system (immune-autonomics) has paved the way for the development of innovative RA management strategies. Clinical evidence supports this approach. Cardiovascular involvement, in terms of reduced baroreflex sensitivity and heart rate variability-derived indices, and mood disorders, common comorbidities in patients with RA, have been linked to autonomic nervous system dysfunction, which in turn is influenced by increased levels of circulating pro-inflammatory cytokines. This narrative review provides an overview of the autonomic nervous system and RA connection, discussing most of the common cardiac and mental health-related RA comorbidities and their potential relationships to systemic and joint inflammation.
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Affiliation(s)
- Francesca Ingegnoli
- Division of Clinical Rheumatology, Gaetano Pini Hospital, Milan, Italy.,Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Università degli Studi di Milano, Milan, Italy
| | - Massimiliano Buoli
- Department of Neurosciences and Mental Health, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Flavia Antonucci
- Department of Medical Biotechnology and Translational Medicine (BIOMETRA), Università degli Studi di Milano, Milan, Italy
| | - Lavinia Agra Coletto
- Division of Clinical Rheumatology, Gaetano Pini Hospital, Milan, Italy.,Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Università degli Studi di Milano, Milan, Italy
| | - Cecilia Maria Esposito
- Department of Neurosciences and Mental Health, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Roberto Caporali
- Division of Clinical Rheumatology, Gaetano Pini Hospital, Milan, Italy.,Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Università degli Studi di Milano, Milan, Italy
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Kojima M, Kojima T, Waguri-Nagaya Y, Takahashi N, Asai S, Sobue Y, Nishiume T, Suzuki M, Mitsui H, Kawaguchi Y, Kuroyanagi G, Yasuoka M, Watanabe M, Suzuki S, Arai H. Depression, physical function, and disease activity associated with frailty in patients with rheumatoid arthritis. Mod Rheumatol 2020; 31:979-986. [PMID: 33066713 DOI: 10.1080/14397595.2020.1838402] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To investigate the clinical and psychosocial backgrounds of frailty in rheumatoid arthritis (RA) patients. METHODS Patients with RA between 40 and 79 years of age who visited university hospitals in an urban area were recruited. Well-validated self-reported questionnaires were used to evaluate patient physical function (Health Assessment Questionnaire, HAQ), depressive symptoms (Beck Depression Inventory-II, BDI-II), and frailty (Kihon Checklist). A 28-point Disease Activity Score (DAS-28) was calculated to evaluate RA disease activity. RESULTS A total of 375 RA patients, 323 of whom were women, were enrolled (average age: 65.2 ± 9.7 years; average disease duration: 16.6 ± 11.9 years). The prevalence rates of frailty, working-age (40-64 years), young-old (65-74 years), and old-old (≥75 years) patients were 18.5, 28.8, and 36.6%, respectively. Higher age and longer disease duration were associated with frailty. Multivariable logistic regression analysis revealed that HAQ, DAS-28, and BDI-II scores were independently associated with frailty in RA patients. CONCLUSION Frailty is common, even among working-age RA patients. Physical function, disease activity, and depressive symptoms were independently associated with frailty. A multidisciplinary intervention approach, along with adequate pharmacological therapy, may promote successful aging in patients with RA.
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Affiliation(s)
- Masayo Kojima
- Department of Frailty Research, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Toshihisa Kojima
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuko Waguri-Nagaya
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.,Center of Joint Surgery for Rheumatic Diseases and Osteoporosis, Nagoya City East Medical Center, Nagoya, Japan
| | - Nobunori Takahashi
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shuji Asai
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasumori Sobue
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of Orthopaedic Surgery, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan
| | - Tsuyoshi Nishiume
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of Orthopaedic Surgery, Okazaki City Hospital, Okazaki, Japan
| | - Mochihito Suzuki
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroto Mitsui
- Department of Orthopaedic Surgery, Aichi Medical University, Nagoya, Japan
| | - Yohei Kawaguchi
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Gen Kuroyanagi
- Department of Rehabilitation Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Mikako Yasuoka
- Department of Frailty Research, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Miki Watanabe
- Department of Public Health, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Sadao Suzuki
- Department of Public Health, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Obu, Japan
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Kuriya B, Tia V, Luo J, Widdifield J, Vigod S, Haroon N. Acute mental health service use is increased in rheumatoid arthritis and ankylosing spondylitis: a population-based cohort study. Ther Adv Musculoskelet Dis 2020; 12:1759720X20921710. [PMID: 32550868 PMCID: PMC7278302 DOI: 10.1177/1759720x20921710] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 02/29/2020] [Indexed: 11/15/2022] Open
Abstract
Background Rheumatoid arthritis (RA) and ankylosing spondylitis (AS) are associated with mental illness. Whether acute mental health (MH) service utilization (i.e. emergency visits or hospitalizations) is increased in RA or AS is not known. Methods Two population-based cohorts were created where individuals with RA (n = 53,240) or AS (n = 13,964) were each matched by age, sex, and year to unaffected comparators (2002-2016). Incidence rates per 1000 person-years (PY) were calculated for a first MH emergency department (ED) presentation or MH hospitalization. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated, adjusting for demographic, clinical, and health service use variables. Results Individuals with RA had higher rates of ED visits [6.59/1000 person-years (PY) versus 4.39/1000 PY in comparators] and hospitalizations for MH (3.11/1000 PY versus 1.80/1000 PY in comparators). Higher rates of ED visits (7.92/1000 PY versus 5.62/1000 PY in comparators) and hospitalizations (3.03/1000 PY versus 1.94/1000 PY in comparators) were also observed in AS. Overall, RA was associated with a 34% increased risk for MH hospitalization (HR 1.34, 95% CI 1.22-1.47) and AS was associated with a 36% increased risk of hospitalization (HR 1.36, 95% CI 1.12-1.63). The risk of ED presentation was attenuated, but remained significant, after adjustment in both RA (HR 1.08, 95% CI 1.01-1.15) and AS (HR 1.14, 95% CI 1.02-1.28). Conclusions RA and AS are both independently associated with a higher rate and risk of acute ED presentations and hospitalizations for mental health conditions. These findings underscore the need for routine evaluation of MH as part of the management of chronic inflammatory arthritis. Additional research is needed to identify the underlying individual characteristics, as well as system-level variation, which may explain these differences, and to help plan interventions to make MH service use more responsive to the needs of individuals living with RA and AS.
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Affiliation(s)
- Bindee Kuriya
- Division of Rheumatology, Sinai Health System, University of Toronto, 60 Murray Street, Room 2-008, Toronto, Ontario M5T 3L9, Canada
| | - Vivian Tia
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Jin Luo
- ICES, Toronto, Ontario, Canada
| | | | | | - Nigil Haroon
- Krembil Research Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
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9
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Abstract
Purpose of review Rheumatoid arthritis (RA) is associated with negative changes in mental health. This is generally attributed to symptoms of inflammation and the adverse impact of RA on quality of life and functioning. Until recently, causal pathways in the opposite direction have not been fully appreciated. This review examines the recent literature on the risk of RA associated with depression. Recent findings Current literature links depression with an increased risk of RA and with a more detrimental disease course. These effects are likely to be partially mediated by negative effects of depression on coping with RA and on factors such as medication adherence, both of which lead to poorer disease outcomes. Growing evidence also suggests that inflammation is central both to depression and RA and may account for some of the complex interplay between these conditions. Summary Awareness of a bidirectional relationship between depression and RA through a biopsychosocial framework may assist clinicians in maintaining an appropriate index of suspicion about the co-occurrence of these conditions. This review also suggests an important need for integration of rheumatologic and mental health services and generates hypotheses for future research towards a better understanding of both depression and RA.
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Affiliation(s)
| | - Scott B Patten
- Department of Community Health Sciences.,Department of Psychiatry
| | - Cheryl Barnabe
- Department of Community Health Sciences.,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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