Patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS) are at higher risk for acute emergency department (ED) visits and hospitalizations due to mental health conditions, according to study results published in Therapeutic Advances in Musculoskeletal Disease.

Canadian researchers performed 2 retrospective, population-based cohort studies that included patients with RA (n=53,240) in the Ontario RA Dataset, and AS (n=13,964). Patients with RA and AS were age-, sex-, and year-matched with those without RA (n=212,960) and AS (n=55,856), respectively. The primary outcomes of interest after an RA or AS diagnosis included a first ED presentation for a mental health condition that did not require hospitalization or a first hospitalization caused by a mental health condition. The incidence rates for a first ED presentation or hospitalization related to mental illness were calculated per 1000 person-years (PY).

Results indicated that patients with vs without RA had a higher overall crude incidence rate of an ED visit for mental health subsequent to their RA diagnosis (6.59/1000 vs 4.39/1000 PY, respectively). The median time to first ED visit for patients with RA was 6.4 years compared with 7.4 years for those without RA. Patients with vs without RA also had a higher overall crude incidence rate for hospitalizations for mental health (3.11/1000 vs 1.80/1000 PY, respectively). Among the AS cohorts, those with AS had higher rates of ED visits (7.92/1000 vs 5.62/1000 PY) and hospitalizations (3.03/1000 vs 1.94/1000 PY) for mental health.

A diagnosis of RA was associated with a 34% increased risk for hospitalization associated with mental illness (hazard ratio [HR], 1.34; 95% CI, 1.22-1.47). Similarly, patients with AS had a 36% increased risk for hospitalization (HR, 1.36; 95% CI, 1.12-1.63). In the adjusted analysis, the risk for ED presentation due to a mental health condition remained significant in RA (HR, 1.08; 95% CI, 1.01-1.15) and AS (HR, 1.14; 95% CI, 1.02-1.28).

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These studies were limited by the reliance on retrospective health administrative data and the lack of assessment of repeat admissions.

Investigators suggested that “…screening for mental illness should be considered in the management of chronic inflammatory arthritis.”


Kuriya B, Tia V, Luo J, Widdifield J, Vigod S, Haroon N. Acute mental health service use is increased in rheumatoid arthritis and ankylosing spondylitis: a population-based cohort study [published online June 7, 2020]. Ther Adv Musculoskelet Dis. doi:10.1177/1759720X20921710