Rheumatoid arthritis and depression have a bidirectional association in which having one condition raises the risk of developing the other, a meta-analysis in the Journal of Affective Disorders has found.
Cyrus S.H. Ho, M.B.B.S., M.Sc., of the National University of Singapore and colleagues conducted a meta-analysis of 11 studies that included a total of 39,130 patients with rheumatoid arthritis, 550,782 patients with depression, and 7,802,230 patients who had neither condition when they enrolled (controls). The studies were conducted in six different countries and had a mean or median follow-up period ranging from 3.4 to 15.8 years.
Compared with controls, patients with rheumatoid arthritis had a 47% greater risk of developing depression.
“The mechanisms mediating the development of depression among [rheumatoid arthritis] patients are overlapping and multifactorial. Pain and functional disability form the hallmark features of [rheumatoid arthritis,] leading to impaired quality of life,” the researchers wrote. They added that fatigue is also highly prevalent in patients who have rheumatoid arthritis and that they often experience stress at the onset of disease.
Patients with depression had a 34% greater risk of developing rheumatoid arthritis compared with controls.
“There is a growing body of evidence supporting the molecular role of inflammation in the pathogenesis of depression,” the researchers wrote. They added that depression has also been associated with myriad autoimmune conditions such as systemic lupus erythematosus, psoriasis vulgaris, and Crohn's disease, all of which involve inflammation.
“Clinicians should systematically screen patients with [rheumatoid arthritis] for depression and be vigilant for the possibility of comorbid [rheumatoid arthritis] in persons, especially elderly, with depression,” the researchers wrote. “The use of anti-cytokine therapies in depression also represents a potential alternative for the treatment of depression that is not responsive to conventional therapy.”
For related information, see the Journal of Neuropsychiatry and Clinical Neurosciences article “Biomarkers of Autoimmunity in Acute Psychiatric Disorders.”
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