Strong Link Between Rheumatoid Arthritis, Depression in Older Adults

A bidirectional association was observed between rheumatoid arthritis (RA) and depression, which can increase the risk for all-cause mortality particularly among older adults. Findings from this study were published in Journal of Affective Disorders.

Researchers conducted a systematic review and meta-analysis of 11 cohort studies from PubMed, PsycINFO, and Embase that comprised 39,130 individuals with RA; 550,782 with depression; and 7,802,230 controls. All cohort studies evaluated either the risk for RA among individuals with depression or the risk for depression in individuals with RA. The secondary outcome was all-cause mortality among those with RA and depression. Hazard ratios were estimated using the DerSimonian and Laird random effects model.

Individuals with RA were 47% (hazard ratio [HR] 1.47; 95% CI, 1.20-1.79; P ≤.001; I²=89%) more likely to experience incident depression than controls. Subgroup analysis by age revealed statistical significance only in those aged at least 60 years (HR 1.47; 95% CI, 1.33-1.63; P ≤.001; I²=33%). Likewise, individuals with depression were 34% (HR 1.34; 95% CI, 1.17-1.53; P ≤.001; I²=80%) more likely to develop RA, and subgroup analysis by age also revealed statistical significance only in those aged at least 60 years (HR 1.17; 95% CI, 1.01-1.37; P =.04; I²=8%). Individuals with both RA and depression had an 80% (HR 1.80; 95% CI, 1.23-2.62; P =.002; I²=78%) higher risk for all-cause mortality compared with those with RA and without depression.

Limitations of the study included potential heterogeneity in the study outcomes, a small sample size in the RA cohort, an overlap between RA and depression presentation, and an inability to identify mediating mechanisms beneath the association between RA and depression.

The study authors concluded, “[T]here exists a bidirectional association between RA and depression, especially in [older adults]. Patients [with RA] and depression also have an 80% greater risk [for] all-cause mortality.” They continued, “Clinicians should systematically screen patients with RA for depression. 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.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Ng CYH, Tay SH, McIntyre RS, Ho R, Tam WWS, Ho CSH. Elucidating a bidirectional association between rheumatoid arthritis and depression: a systematic review and meta-analysis. J Affect Disord. Published online May 25, 2022. doi:10.1016/j.jad.2022.05.108