Depression and the risk of rheumatoid arthritis

Abstract

Purpose of review: Rheumatoid arthritis (RA) is associated with negative changes in mental health. This is generally attributed to symptoms of inflammation and the adverse impact of RA on quality of life and functioning. Until recently, causal pathways in the opposite direction have not been fully appreciated. This review examines the recent literature on the risk of RA associated with depression.

Recent findings: Current literature links depression with an increased risk of RA and with a more detrimental disease course. These effects are likely to be partially mediated by negative effects of depression on coping with RA and on factors such as medication adherence, both of which lead to poorer disease outcomes. Growing evidence also suggests that inflammation is central both to depression and RA and may account for some of the complex interplay between these conditions.

Summary: Awareness of a bidirectional relationship between depression and RA through a biopsychosocial framework may assist clinicians in maintaining an appropriate index of suspicion about the co-occurrence of these conditions. This review also suggests an important need for integration of rheumatologic and mental health services and generates hypotheses for future research towards a better understanding of both depression and RA.

Box 1

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FIGURE 1

Proposed mechanisms for rheumatoid arthritis resulting from immune, inflammatory and indirect effects of depression. HPA, hypothalamic-pituitary-adrenal axis; IDO, indoleamine 2,3-dioxygenase; βCaMKII, calcium/calmodulin-dependent protein kinases type II; COX-2, cyclo-oxygenase-2; PGE2, prostaglandin E2.