Patients with AS have 59% increased risk for deliberate self-harm

Nigil Haroon

AMSTERDAM — Patients with inflammatory arthritis have a significantly increased rate of self-harm attempt, and the risk for self-harm is particularly high following a diagnosis of ankylosing spondylitis, according to findings presented at the EULAR Annual Congress.

“For individuals who have any chronic illness, there are effects on their mood, especially with rheumatoid arthritis (RA) and ankylosing spondylitis (AS),” Nigil Haroon, MD, PhD, of the University of Toronto and the University Health Network, said during a press conference. “There is a significant element of pain, stress, anxiety, social isolation, and these all compound the physical illness that these patients have.”

To determine the risk for deliberate self-harm among patients with AS and RA vs. the general population, Haroon and colleagues conducted a population-based cohort study. They enrolled 53,240 patients with RA and 13,964 with AS in Ontario, Canada, each matched 1:4 by age, sex and calendar year at the time of diagnosis to control patients without inflammatory arthritis. Patients with a history of mental illness prior to an attempt at deliberate self-harm were excluded from the study.

Figure 1. Patients with inflammatory arthritis have a significantly increased rate of self-harm attempt, and the risk for self-harm is particularly high following a diagnosis of ankylosing spondylitis, according to researchers.

Source: Shutterstock

The primary outcome was first emergency department visit for deliberate self-harm following a diagnosis of RA or AS between April 1, 2002, and March 31, 2016. The researchers estimated hazard ratios and confidence ratios for RA and AS separately, compared with the control groups, adjusting for demographic, clinical and health-service-use variables.

According to Haroon, patients with AS were more likely to attempt deliberate self-harm, with an incidence rate of 6.79 per 10,000-person years, compared with 3.19 per 10,000-person years among the control individuals (HR = 1.82; 95% CI, 1.26-2.62). This represents a 59% increase in the risk for deliberate self-harm among patients with AS, Haroon said.The risk for deliberate self-harm among patients with RA was not increased following covariate adjustment.

Haroon added that although their results suggest that inflammation may play a role in self-harm, it remains unclear why patients with AS demonstrate a particularly high risk.

“Perhaps inflammation may play a role in self-harm, but there is no causal relationship here,” Haroon said. “The most important thing to keep in mind is that we should be aware of this outcome, and also be aware of the potential for a high number of patients who have depression among those who have these diseases.”

According to Haroon, the most frequent method of self-harm among patients is poisoning, which accounted for 64% of attempts among patients with AS, and 81% of attempts among those with RA. This, he said, was due to the patients’ access to multiple prescription medications related to their condition. Because of this, physicians can play a role in prevention, he said.

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“More than two-thirds of patients were discharged following their self-harm attempt — so what happens next?” Haroon said. “In addition, rheumatologists and primary care physicians can and should screen for self-harm behavior.” – by Jason Laday

Reference:

Haroon N. Abstract OP0296. Presented at: EULAR Annual Congress; June 13-16, 2018; Amsterdam.

Disclosure: Haroon reports funding from the Krembil Foundation, the TGTW Foundation and the Canadian Institutes of Health Research.