Men with rheumatoid arthritis who have depression or depressive symptoms were significantly more likely to die compared with RA patients who were not depressed, according to data from a longitudinal cohort study of 530 patients. The findings were presented at the annual meeting of the American College of Rheumatology.

The deleterious effect of depression on early mortality also was seen in women with RA, but to a lesser extent.

“Depression is often underdiagnosed in RA,” but the risk of mortality associated with depression in RA has not been well studied, said Patricia Katz, Ph.D., of the University of California, San Francisco.

Dr. Katz and colleagues conducted annual telephone surveys of 530 adults with RA over a 7-year period, with an average of 5 years’ follow-up. The average age of the patients was 60 years, 84% were women, the average disease duration was 19 years, and 46% reported at least one cardiovascular risk factor. Depression was defined as a score of 5 or higher on the 15-item Geriatric Depression Scale (GDS).

“Even though depression is very common in RA, it is not normal.”
A total of 63 patients (12%) died during the study period. The risk of death in depressed men and women with RA was approximately three times that of RA patients who were not depressed (hazard ratio 3.5), according to the results of a bivariate analysis.

“People who were depressed at their last interview were more likely to die,” Dr. Katz said. In a multivariate analysis, depression remained a significant predictor of mortality.

In particular, men with RA who met criteria for depression had the highest risk of mortality.

“Overall, men were two and half times more likely to die than women,” Dr. Katz said, but men with depression had a risk that was six times higher than women with no depression (who served as a reference group), she added. Women with depression had a risk of death of two and half times that of women with no depression.

In addition, a change in depressive symptoms that did not meet the criteria for depression (defined as a worsening of GDS scores by at least 2 points) was associated with an approximately twofold increased risk of death in depressed women compared to women with no depression. Men with an increase in depressive symptom scores had an increase in risk five times that of women with no depression.

“Both depression and an increase in depressive symptoms are significant risk factors for all-cause mortality in RA,” Dr. Katz noted.

“I think it is important to recognize that depression is a treatable condition,” said Dr. Katz. “Even though depression is very common in RA, it is not normal. It needs to be treated, and to be treated it needs to be recognized,” she said.

“This is the clinical challenge; there needs to be some sort of regular monitoring to recognize these changes early, so intervention can happen at an appropriate time,” she added.

The study was funded in part by the National Institute for Arthritis, Musculoskeletal, and Skin Diseases of the National Institutes of Health. Dr. Katz had no financial conflicts to disclose.