A large matched-cohort study using Czech national inpatient data found that individuals with rheumatoid arthritis or axial spondyloarthritis have an increased risk of developing psychiatric disorders, particularly mood and anxiety disorders.
Published in BMJ Mental Health, the study analyzed data from individuals diagnosed with rheumatoid arthritis (RA) or axial spondyloarthritis (axSpA) between 1999 and 2012, with outcomes tracked through 2017. The analysis identified significant associations between autoimmune arthritides and mental health conditions. Rheumatoid arthritis, in particular, was inversely associated with schizophrenia and Alzheimer’s disease, which the authors suggest may reflect shared etiological mechanisms or the effects of specific medications.
The study cohort included 322,158 individuals with RA (mean age, 61.8 years; 76.1% female) and 56,148 individuals with axSpA (mean age, 53.6 years; 37.8% female). Using stratified Cox proportional hazards models, researchers compared outcomes in these individuals with those in matched counterparts without autoimmune arthritis. The analysis found that individuals with RA were more likely to develop mood disorders (hazard ratio [HR], 1.67) and anxiety disorders (HR, 1.95). Similar associations were observed in individuals with axSpA, with HRs of 1.49 and 1.87, respectively.
Among individuals with RA, the risk of depression was highest in those diagnosed before age 40 (HR, 2.44) and decreased with later onset. RA was also associated with a lower risk of schizophrenia (HR, 0.55) and Alzheimer’s disease (HR, 0.84).
“Common aetiologies might be involved in increasing the risk of developing both RA and depression,” said Tomáš Formánek, MD, PhD, of the Department of Psychiatry, University of Cambridge, UK, and colleagues. “The consistent inverse associations between RA and schizophrenia and between RA and Alzheimer’s disease suggest that at least part of these associations might also be a consequence of shared aetiologies as well as potential medication effects.”
While prior research has identified associations between inflammation and psychiatric disorders, results have been inconsistent. This study, which leveraged a large national dataset, found that the association between RA and depression was strongest in younger individuals and more pronounced than in individuals with other similarly burdensome chronic illnesses, suggesting a disease-specific relationship.
The authors reported that individuals with autoimmune arthritides were more likely to experience mood and anxiety disorders, even compared with matched counterparts with other chronic conditions. They noted that further investigation into the roles of inflammatory cytokines and treatment-related effects may help clarify the mechanisms underlying these associations.
The authors reported no conflicts of interest.