The Relationship Between Mental Health, Disease Severity, and Genetic Risk for Depression in Early Rheumatoid Arthritis.

Jack Euesden,Matthew Hotopf,Cathryn M Lewis,Ian C Scott,Sophia Steer,Faith Matcham,Andrew P Cope

doi:10.1097/psy.0000000000000462

Abstract

Reduced mental health (MH) is prevalent in rheumatoid arthritis (RA). Although longitudinal studies are limited, there is evidence that depression is associated with worse disease outcomes. We evaluated reciprocal relationships between MH, RA severity, and genetic risks for depression for 2 years in a well-characterized cohort of RA patients. We evaluated 520 early RA patients previously enrolled to two clinical trials. MH was measured using the short form-36 MH domain and mental component summary scores (MCS). MCS/MH associations over 2 years with disease activity (disease activity score on a 28-joint count), disability (health assessment questionnaire), pain visual analog scale scores, and a weighted genetic risk score for depression were tested using linear mixed-effects and regression models. Poorer MH was associated with worse RA outcomes. Lower MCS scores (indicating worse MH) were seen in patients with a greater genetic risk for depression (weighted genetic risk score: coefficient = -1.21, p = .013). Lower baseline MCS was associated with lower 2-year improvements in disease activity score on a 28-joint count (coefficient = -0.02, p < .001), pain (coefficient = -0.33, p < .001), and health assessment questionnaire (coefficient = -0.01, p = .006). Baseline MCS was associated with changes in the swollen joint count (coefficient = -0.09, p < .001) and patient global assessment (coefficient = -0.28, p < .001) but not the tender joint count (p = .983) and erythrocyte sedimentation rate (p = .973). Only baseline pain visual analog scale (coefficient = -0.07, p = .002) was associated with 2-year changes in MCS. Reduced baseline MH was associated with lower improvements in disease activity, disability, and pain for 2 years, supporting current national guidelines recommending screening for depression in RA. Pain had a bidirectional relationship with MH. Depression genetic risk had a significant association with MH.

Highlights

Reduced mental health (MH) is prevalent in rheumatoid arthritis (RA), with major depression present in 16.8% of patients [1]
Our study evaluated the relationship between MH and disease activity, disability, pain, and genetic risk for depression for 2 years in a well-characterized clinical trial cohort of patients with early RA
Lower mental component summary scores (MCS) and MH scores were significantly associated with more active disease, increased disability, and greater pain for 2 years

Summary

Introduction

Reduced mental health (MH) is prevalent in rheumatoid arthritis (RA), with major depression present in 16.8% of patients [1]. The cause of this excess burden of MH impairment is uncertain. Determining the cause and effect of depression in RA is, a key research goal. Research in this area has mainly involved cross-sectional studies in patients with long-standing RA. These identified associations between depression and pain [4], disability [5], and arthritis disease activity [6].

Methods

Results

Discussion

Conclusion