Comorbid depression comes with a profoundly higher mortality risk in RA

According to a large, Danish register analysis, the risk of mortality rises markedly for patients with rheumatoid arthritis (RA) who are also diagnosed with depression. In those younger than 55 years, the risk was increased more than 6 times.

A high prevalence of depressive disorders and links between depression and various long-term outcomes in RA have been observed [1]. “Although antidepressants are used for different indications, we have recently described that, in RA, the most frequent indication for filling antidepressants is depression,” Dr Jens Kristian Pedersen (Odense University Hospital, Denmark) stated [2,3]. The presented cohort study investigated the mortality risk in patients with incident RA and depression [3]. Data was collected from various nationwide Danish registries. The presence of depression was defined as the first filling of an antidepressant prescription. The follow-up period for the all-cause mortality risk was from January 2008 to December 2018. Included in the analysis was data on 11,071 RA patients equalling 56,993 person-years of follow-up.

About 10% of the participants (n=1,095) had a filling of antidepressants during the follow-up period. The median age was 61 years, 66% were women, and 64% had seropositive RA. There was some variance between those with and without exposure to antidepressants. “In those exposed, the age distribution was different, the fraction of women was higher, a lower fraction had seropositive RA, and the median Health Assessment Questionnaire Disability Index (HAQ) and Disease Activity Score-28 (DAS28) were higher than in those not exposed,” Dr Pedersen pointed out.

The results of the adjusted analysis for mortality hazard in RA patients with or without depression revealed the highest risk for exposed patients under the age of 55 years (HR 6.66; 95% CI 2.80–15.85). Corresponding HR for the other age groups receiving antidepressants were 3.3 for 55–70 years and 2.94 for >70 years old. Mortality was increased by depression in men (HR 3.70) and women (HR 2.91), as well as seropositive (HR 3.45) and seronegative RA (HR 3.08). “According to exposure status (to antidepressants), the cumulative mortality followed 2 clearly different paths: the mortality curves separated early and already within the first and second year of follow-up,” Dr Pedersen commented on the Kaplan-Meier curves for exposed and non-exposed participants.

1. Matcham F, et al. Rheumatology. 2013;52:2136–2148.
2. Pedersen JK, et al. Scand J Rheumatol. 2022;51:173–179.
3. Pedersen JK, et al. More than six-fold increased mortality risk in patients with incident rheumatoid arthritis and depression in a large cohort with 10-year follow-up. OP0067, EULAR 2022 Congress, 1-4 June, Copenhagen, Denmark.

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Posted on 21 July 202217 May 2024