Depression risk elevated in both seropositive, seronegative rheumatoid arthritis
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Key takeaways:
- Patients with rheumatoid arthritis who used DMARDs had lower depression risk.
- Screening patients for depression and addressing mental wellbeing is crucial, researchers said.
Patients with rheumatoid arthritis — either seropositive or seronegative — demonstrate a 1.66-fold higher risk for depression vs. healthy controls, according to data published in JAMA Network Open.
However, the researchers additionally found that the risk for depression lowered among patients using biologic or targeted synthetic disease-modifying antirheumatic drugs to treat their RA.
“The presence of comorbid depression in patients with RA has been associated with exacerbation of pain, increased disease activity, poor health-related quality of life, less frequent remission, increased risk of myocardial infarction, higher mortality rates and greater utilization of health care services,” Keun Hye Jeon, MD, of Cha University School of Medicine, in South Korea, and colleagues wrote. “Consequently, preventing and managing depression can be an effective approach to enhancing overall health and quality of life in these patients.
“Although the presence of rheumatoid factor (RF) or anticyclic citrullinated peptide antibodies (ACPA) can serve as markers of disease severity and provide insights into the risk of comorbidities, their effect on the development of depression in individuals with RA has remained unexplored,” they added. “Moreover, there is a lack of data on the effect of biologic agents (eg, biologic disease-modifying antirheumatic drugs [DMARDs] and targeted synthetic DMARDs) on RA-associated depression.”
To analyze the risk for depression among patients with RA, Jeon and colleagues conducted a retrospective cohort study of nationwide, population-based data from the South Korean National Health Insurance Service. The cohort included 38,487 patients first diagnosed with RA between 2010 and 2017, as well as 193,435 controls matched in a 1:5 ratio based on age, sex and index date.
Seronegative RA was determined using ICD-10 codes and DMARD prescription, while seropositive RA was determined with ICD-10 codes and enrollment in a special program requiring RF and ACPA positivity, as well as a report from a physician. The researchers used Cox regression analysis to calculate HRs adjusted for comorbidities as well as sociodemographic and behavioral factors.
During a median follow-up period of 4.1 years, patients with RA demonstrated a significantly higher risk for depression compared with controls (HR = 1.66; 95% CI, 1.61-1.71), according to the researchers. This finding was consistent across both seropositive (adjusted HR = 1.64; 95% CI, 1.58-1.69) and seronegative (HR = 1.73; 95% CI, 1.65-1.81) groups. Meanwhile, among patients with RA, those who used biologic or targeted synthetic DMARDs demonstrated a lower depression risk (HR = 1.33; 95% CI, 1.2-1.47), compared with those who did not (HR = 1.69; 95% CI, 1.64-1.74).
“To the best of our knowledge, the current study is the first investigation to find an association between RA and subsequent depression risk based on RA seropositivity,” Jeon and colleagues wrote. “To fully understand the underlying mechanisms behind these findings, further research with a longer follow-up period than our current study is warranted.
“Clinicians should consistently screen all RA patients for depression and provide comprehensive health care that addresses both mental and physical wellbeing,” they added.
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Jeon KH, et al. JAMA Netw Open. 2024;doi:10.1001/jamanetworkopen.2024.1139.
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