Deadly Depression in RA

Depression in rheumatoid arthritis may boost risk of death

(RxWiki News) Living with rheumatoid arthritis can take a toll on your body and your mind. If you are a rheumatoid arthritis patient living with depression, your mental health could be making your situation worse.

Researchers found that rheumatoid arthritis patients who are depressed may have a higher risk of death than patients who are not depressed.

The researchers found that even when patients did not qualify as depressed, those who had increases in depressive symptoms also had an increased risk of death.

"Tell a doctor if you are depressed."

Patricia Katz, PhD, of the University of California San Francisco, and colleagues studied symptoms of depression in patients with rheumatoid arthritis and how depression affected these patients.

"People with rheumatoid arthritis who were depressed were more likely to die than those with rheumatoid arthritis who were not depressed. We found that seemed to be particularly true for the men. The risk of death for depressed men was twice that for depressed women," said Dr. Katz.

Men in this study had a higher risk of death than women, whether or not they were depressed.

Compared to female patients who were not depressed, male patients who were depressed were five times more likely to die.

To measure depression, the researchers used the Geriatric Depression Scale (GDS) - a tool involving 15 yes-or-no questions. Each question is worth one point. To be considered depressed, a patient must have a score of five or more.

"An increase in the depressive symptom score, even if they didn't cross over that critical line to overt depression, was still associated with a higher level of mortality," said Dr. Katz.

The results of this study suggest that depression and depressive symptoms may pose a significant risk of death in patients with rheumatoid arthritis, even though depression is not necessarily a part of the disease process of rheumatoid arthritis.

"Patients need to be made aware that depression is something to pay attention to in rheumatoid arthritis, and they need to tell their physician about it. Rheumatologists and other healthcare providers need to be aware of the problem of depression in a clinical setting," Dr. Katz concluded.

For their study, the researchers used data from a yearly phone survey of 530 participants with rheumatoid arthritis. To be included in the study, participants had to have been interviewed in 2002 or 2003 and had to have had at least one other interview.

Over the course of the study, 63 participants died.

Depression was associated with an increased risk of death, with a hazard ratio of 3.5.

A hazard ratio explains how much an event happens in one group versus another group. If the hazard ratio is more than 1.0, that event happens more in the first group than the second group. In this case, death occurred more often among depressed patients with rheumatoid arthritis than among patients who were not depressed.

Worsening of GDS scores by two points or more was also associated with an increased risk of death, with a hazard ratio of 2.5.

The research was funded by the National Institute of Arthritis, Musculoskeletal and Skin Diseases.

The study was presented at the American College of Rheumatology's Annual Meeting. Therefore, the research has yet to be peer-reviewed for publication in a scientific journal.

Review Date: 
November 13, 2012