Patients with depression demonstrate six-fold increased mortality risk in RA
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Depression is associated with a six-fold increased risk for mortality in patients with incident rheumatoid arthritis, according to data presented at the EULAR 2022 Congress.
“In patients with RA, the occurrence of depressive disorder is high. Although antidepressants are used for different indications, we have recently described that in RA, the most frequent for filling antidepressants is depression, and the frequency for filling coincides with depressive disorder previously reported in the scientific literature,” Jens Kristian Pedersen, MD, PhD, of the Odense University Hospital and the Svendborg Hospital, in Denmark, told attendees during the virtual meeting.
To examine mortality rates associated with depression — defined as the first filling of antidepressants — in patients with RA, Pedersen and colleagues analyzed DANBIO registry data for individuals who were diagnosed with incident RA between Jan. 1, 2008, and Sept. 30, 2018. Patients considered for inclusion were also required to have no recorded use of methotrexate or antidepressants within 3 years of RA diagnosis. All included patients were followed through Dec. 31, 2018.
Researchers defined depression as an initial filling of a prescription for antidepressants, while death dates were collected from the Danish Civil Registration System, Pedersen said. All-cause mortality was estimated for two specific periods. The first period spanned from the time of RA diagnosis to the filling of antidepressant medication, and the second was defined as the time after the prescriptions were filled.
In all, 11,071 patients with RA were followed for 56,993 person-years. Among those patients, 1,095 — or 10% — filled prescriptions for antidepressants. According to the researchers, adjusted HRs were highest in the group of patients aged younger than 55 years (HR = 6.66; 95% CI, 2.8-15.85). Rates decreased for those aged 55 to 70 years (HR = 3.3; 95% CI, 2.27-4.8), and in those aged older than 70 years (HR = 2.94; 95% CI, 2.26-3.83). Additionally, men demonstrated a higher rate (HR = 3.7; 95% CI, 2.66-5.14) than women (HR = 2.91; 95% CI, 2.22-3.81), and patients with seropositive RA had higher mortality rates (HR = 3.45; 95% CI, 2.66 – 4.47) than seronegative RA diagnoses (HR = 3.08; 95% CI, 2.17-4.37).
“In conclusion, depression, defined as first filling of antidepressants, was associated with more than six-fold increased mortality risk in patients with incident RA,” Pedersen said. The authors did not analyze whether more severe disease states had an impact on mortality rates in patients with depression and RA, Pedersen noted.
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Pedersen JK, et al. More than six-fold increased mortality risk in patients with incident rheumatoid arthritis and depression in a large cohort with 10-year follow-up. Presented at: EULAR 2022 Congress; June 1-4, 2022 (virtual meeting).
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