Home Medizin Besteht bei bestimmten Patientengruppen mit rheumatoider Arthritis ein höheres Risiko für Depressionen?

Besteht bei bestimmten Patientengruppen mit rheumatoider Arthritis ein höheres Risiko für Depressionen?

von NFI Redaktion

A recent study published in JAMA Network Open assessed the risk of depression following a diagnosis of rheumatoid arthritis (RA).


Study: Rheumatoid Arthritis and Depression Risk in South Korea. Image Source: Africa Studio/Shutterstock.com









Study: Rheumatoid Arthritis and Depression Risk in South Korea. Image Source: Africa Studio/Shutterstock.com

RA, a widespread autoimmune disease, is characterized by systemic inflammation. The chronic nature of the disease requires lifelong treatment, often resulting in comorbidities, including depression. Depression is prevalent among RA patients compared to the general population and is associated with increased disease activity, heightened pain, elevated risk of myocardial infarction, lower likelihood of remission, poor health-related quality of life, and greater health care utilization. Therefore, managing and preventing depression is crucial for improving the health and quality of life of RA patients.

About the Study

In the study, researchers explored the relationship between RA and the resulting risk of depression in South Korea. Participants included individuals diagnosed with RA between 2010 and 2017. Seropositive RA (SPRA) was defined using International Classification of Diseases, Tenth Revision (ICD-10) codes and enrollment in the „Rare and Intractable Diseases“ (RID) program.

To enroll in the RID program for SPRA, a positive test result for anti-cyclic citrullinated peptide antibodies or rheumatoid factors and a physician’s report confirming the fulfillment of RA classification criteria were required. Seronegative RA (SNRA) was defined by ICD-10 codes and prescription of disease-modifying antirheumatic drugs (DMARDs) for ≥ 270 days.

The team excluded participants under 20 years old, those with a history of depression, missing data, or those who developed depression within one year of the index date. RA patients were matched with individuals without RA (controls) based on gender, age, and index date. The study’s endpoint was a new diagnosis of depression. Participants were followed up one year after the RA diagnosis until the diagnosis of depression or death, or until December 31, 2019.

To estimate the cumulative incidence of depression, the Kaplan-Meier method was used. Differences between groups were assessed using Log-Rank tests. Cox regression analyzed estimated adjusted hazard ratios and 95% confidence intervals for the risk of depression. The association between the risk of depression and the type of DMARDs used was also examined.

The analyses were adjusted for gender, age, smoking/alcohol status, income, body mass index, physical activity, diabetes, chronic kidney disease, hyperlipidemia, and hypertension. Additionally, stratified analyses by gender, age, comorbidities, and health behaviors were conducted. The differences in restricted mean survival time (RMST) were analyzed between groups based on gender and age.

Results

A total of 230,922 participants with an average age of 54.6 years were included in the analysis. There were 38,487 RA patients and 192,435 controls, with the majority being female (71%). Of the RA patients, 11,645 were seronegative and 26,842 were seropositive. RA patients were more likely to be non-drinkers and less obese. SPRA patients were more likely to be female, older, non-drinkers, and less obese compared to SNRA patients.

The mean follow-up duration was 4.1 years, during which 6,422 RA patients and 20,641 developed new cases of depression. RA patients had a higher risk of depression compared to controls. Additionally, both the SPRA and SNRA groups had an increased risk of depression compared to control groups. Among RA patients with depression, 402 were prescribed biological or targeted synthetic DMARDs, and 6,020 were only prescribed conventional synthetic DMARDs.

Notably, the incidence of depression among RA patients receiving targeted synthetic or biological DMARDs was consistently lower than among non-recipients. Stratified analyses yielded results consistent with the primary analysis. The RMST differences varied among different age groups, with a greater difference in the age group ≥ 60 years.

Conclusions

In conclusion, the researchers observed a 1.66-fold increased risk of depression in RA patients compared to those without RA. There was no significant difference in the risk of depression based on the serological status of RA, with both the SNRA and SPRA groups exhibiting an increased risk. RA patients receiving targeted synthetic or biological DMARDs had a lower risk than those who did not. However, the study has some limitations. Specifically, disease activity was not accessible, leading to a restricted assessment of RA severity.

Furthermore, information on the level of depression at the index date was not available. Additionally, since participation was limited to those undergoing a health examination, participants may have been healthier or exhibited more healthful behaviors than the general population.

Overall, the results suggest an increased risk of depression in RA patients, regardless of serological RA status, age, gender, and behavioral factors, warranting consistent screening of RA patients and comprehensive health care to ensure their physical and mental well-being.

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