Steep increase of mortality in RA patients with comorbid depression

A large register study in Denmark detected a substantially higher mortality risk for patients with rheumatoid arthritis (RA) who had comorbid depression.

The study was based on 11,071 RA patients, totalling 56,993 person-years of follow-up observations

“In patients with RA, the occurrence of depression is high,” Dr Jens Kristian Pedersen (Odense University Hospital, Denmark) stated1. He presented a cohort study that investigated the mortality risk in patients with incident RA and depression. 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 HAQ  and DAS281 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 ratio 6.66; 95% CI 2.80–15.85). Corresponding HR ratios 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 ratio 3.70) and women (HR ratio 2.91), as well as seropositive (HR ratio 3.45), and seronegative RA (HR ratio 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 Petersen further commented on the Kaplan-Meier-curves for exposed and non-exposed participants. 

1. 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, 1-4 June, Copenhagen, Denmark.