Abstract
IntroductionThe mainstay of pharmacologic therapy for rheumatoid arthritis includes the use of disease-modifying agents like sulfasalazine and methothrexate, and more recently, anti-tumor necrosis factor-α agents. Depression remains a major co-morbidity in patients with rheumatoid arthritis and is thought to contribute to disability and mortality in these patients. Evidence now suggests that a biologic link exists between substrates responsible for inflammatory conditions and mood disorders. Most of this evidence comes from preclinical studies. Nevertheless, more research into this area is helping us to understand the possible mechanisms through which these conditions interact with each other.Case presentationWe describe a 60-year-old Indian man with rheumatoid arthritis diagnosed 15 years ago who had minimal response to multiple therapies with disease-modifying agents and whose arthritis symptoms surprisingly remitted when he was started on a specific serotonin reuptake inhibitor antidepressant, three years ago, for co-morbid major depression. This remission has been maintained with this medication, and the patient is currently not taking any antirheumatoid medications.ConclusionPossible mechanisms linking substrates of mood disorders and inflammation are reviewed in this case report, particularly the serotonergic system. Evidence seems to suggest a significant interaction between the serotonergic systems and inflammation. This interaction seems to be bidirectional. An understanding of this relation is most important to gain insight not only into pathophysiological mechanisms underlying this condition, but also into how treatments for these conditions may complement each other and possibly provide greater therapeutic options in both of these disabling conditions.
Highlights
The mainstay of pharmacologic therapy for rheumatoid arthritis includes the use of diseasemodifying agents like sulfasalazine and methothrexate, and more recently, anti-tumor necrosis factor-a agents
Case presentation: We describe a 60-year-old Indian man with rheumatoid arthritis diagnosed 15 years ago who had minimal response to multiple therapies with disease-modifying agents and whose arthritis symptoms surprisingly remitted when he was started on a specific serotonin reuptake inhibitor antidepressant, three years ago, for co-morbid major depression
Possible mechanisms linking substrates of mood disorders and inflammation are reviewed in this case report, the serotonergic system
Summary
We see that treatment of co-morbid depression with an SSRI led to complete remission of arthritis in a 60-year-old individual. Further studies are required to elucidate the mechanisms involved in this relation. Consent Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Author details 1Sackler Institute of Psychobiological Research, University of Glasgow, Southern General Hospital, Glasgow, G51 4TF, UK. Authors’ contributions RVK was involved in collating the information, review of literature, and preparation of the manuscript. RTK was involved in collating information regarding the case and getting informed consent from the patient. JC was involved in review of literature and revising the manuscript critically. All authors read and approved the final manuscript. Competing interests The authors declare that they have no competing interests
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