Study: Depression Can Exacerbate Rheumatoid Arthritis

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16.8% of RA patients in the study presented with major depression.

Depression has a significant negative impact on the progression of rheumatoid arthritis (RA), according to a recent British study.

Over a 2-year period, poorer mental health in patients with early RA was “associated with reduced improvement in disease activity and disability, suggesting that depression predicts the degree to which RA improves over time,” the study conducted at Kings College London reported.

In addition, the researchers found that patients with a genetic risk for depression had worse mental health as indicted by lower scores on a screening instrument known as the Mental Component Summary Score (MCS). The study cautioned, however, that the “relative importance” of this finding was not clear.

Those with poorer mental health also had greater pain, the findings indicated. “The relationship between pain and mental health appeared bidirectional, with baseline pain associating with lower improvement in MCS and MH (mental health) domain scores and vice versa; this is in keeping with existing studies of musculoskeletal disorders,” Jack Euesden, PhD, and his co-authors wrote. Euesden, pictured, is a post-doctoral researcher at the University of Bristol’s School of Social and Community Medicine and worked on the research while a PhD candidate at Kings College.

The degree of swelling and tenderness in joints is a common way of assessing disease status and progression for RA. In this study, swollen but not tender joints had an association with poorer mental health, although the opposite was true in a different previous study of established RA patients. The researchers suggested that the lack of association between tender joints and mental health in their study might be related to the short disease duration for their study’s patients and the time it takes for pain pathways influenced by mental health to be sensitized.

The association between swollen joints and poor mental health in the study’s cohort could be explained by the “overlapping pro-inflammatory cytokines, which are present in high levels in early active RA” and they “play important roles in mediating both reduced mental health and RA activity,” the researchers wrote.

It is not uncommon for people with rheumatoid arthritis to have mental health issues, with 16.8% of patients presenting with major depression, the study explained.

The researchers analyzed data from 520 early RA patients who were of European ancestry. Sixty-nine percent of the patients were women, and 67 percent had Rheumatoid Factor. At baseline the sample’s population mean level of disease activity was high, disability was moderate, and disease duration was short (mean duration 3.3 months).

Euesden and his team wrote that their study’s strengths included its size and the short disease duration in the patients. The weaknesses included a cohort of severe RA patients, which limits the generalizability of the findings to patients seen in routine clinical practice, they added.

However, the researchers wrote that their findings do support the UK’s National Institute of Health recommendation that RA patients be assessed for co-morbid depression.

“Co-morbid depression…seems to have a detrimental impact on the disease course of RA, being associated with increased healthcare utilization and costs and representing an independent risk factor for non-suicidal related mortality,” the study said.

The Relationship Between Mental Health, Disease Severity and Genetic Risk for Depression in Early Rheumatoid Arthritis” was published online ahead of print in Psychosomatic Medicine on March 9.

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