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. 2018 Jul 11;4(2):e000670.
doi: 10.1136/rmdopen-2018-000670. eCollection 2018.

Depression as a risk factor for the development of rheumatoid arthritis: a population-based cohort study

Isabelle A Vallerand  1   2 , Ryan T Lewinson  1 , Alexandra D Frolkis  3 , Mark W Lowerison  2 , Gilaad G Kaplan  2   3 , Mark G Swain  3 , Andrew G M Bulloch  2   4 , Scott B Patten  2   4 , Cheryl Barnabe  2   3
Affiliations

Depression as a risk factor for the development of rheumatoid arthritis: a population-based cohort study

Isabelle A Vallerand et al. RMD Open. .

Abstract

Objectives: Major depressive disorder (MDD) is associated with increased levels of systemic proinflammatory cytokines, including tumour necrosis factor alpha. As these cytokines are pathogenic in autoimmune diseases such as rheumatoid arthritis (RA), our aim was to explore on a population-level whether MDD increases the risk of developing RA.

Methods: A retrospective cohort study was conducted using The Health Improvement Network (THIN) database (from 1986 to 2012). Observation time was recorded for both the MDD and referent cohorts until patients developed RA or were censored. Cox proportional hazards models were used to determine the risk of developing RA among patients with MDD, accounting for age, sex, medical comorbidities, smoking, body mass index and antidepressant use.

Results: A cohort of 403 932 patients with MDD and a referent cohort of 5 339 399 patients without MDD were identified in THIN. Cox proportional hazards models revealed a 31% increased risk of developing RA among those with MDD in an unadjusted model (HR=1.31, 95% CI 1.25 to 1.36, p<0.0001). When adjusting for all covariates, the risk remained significantly increased among those with MDD (HR=1.38, 95% CI 1.31 to 1.46, p<0.0001). Antidepressant use demonstrated a confounding effect that was protective on the association between MDD and RA.

Conclusion: MDD increased the risk of developing RA by 38%, and antidepressants may decrease this risk in these patients. Future research is necessary to confirm the underlying mechanism of MDD on the pathogenesis of RA.

Keywords: epidemiology; inflammation; psychiatry; rheumatoid arthritis.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Study flow diagram showing selection of patients from THIN for inclusion in analysis. MDD, major depressive disorder; RA, rheumatoid arthritis.
Figure 2
Figure 2
Kaplan-Meier failure curves with development of RA stratified by depression exposure. Here, it can be seen that study follow-up was up to 25 years and that the probability of developing RA was greater among those with MDD (blue) compared with the general population cohort group (red). MDD, major depressive disorder; RA, rheumatoid arthritis.
See this image and copyright information in PMC

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