It’s well-known that many people who have a chronic physical condition also have a co-existing mental health condition like anxiety or depression. Sometimes the mental health issue stems from dealing with the physical ailment, but in other cases it precedes it. Either way, doctors often find that emotional well-being plays a role in how well (or not) patients manage their physical health.
That’s certainly true when it comes to rheumatoid arthritis (RA). A new study has concluded that having anxiety, depression, or post-traumatic stress disorder (PTSD) increases the likelihood that someone with RA still stop taking medication prescribed for their inflammatory joint condition.
The study, which appears in the journal ACR Open Rheumatology, used data on veterans with RA that was collected between 2004 and 2014.
More than 15,000 veterans had received a prescription for methotrexate during that time period, and that more than 7,000 received a prescription for a TNF inhibitor biologic. Most of these people had not been diagnosed with a mental health problem, but 16 percent of those starting methotrexate and 18 percent of those starting a TNF inhibitor also had depression or anxiety (other than PTSD). Another 16 percent had PTSD.
According to the study findings, veterans with RA who also had a mental health disorder were significantly more likely to discontinue their RA medication earlier. “This heightened risk of earlier treatment discontinuation was similar in those with PTSD compared with those with depression and/or anxiety alone,” the authors wrote.
The association between having a mental health issue and stopping methotrexate or a TNF inhibitor sooner remained strong even after the researchers adjusted for other variables that might play a role. Those included age, sex, race, body mass index, and smoking status.
So what factors could be at play? The authors suggest that one possibility is that worse disease activity in people with anxiety, depression, or PTSD could make patients think the medications are not effective.
“Depression, for example, may contribute to higher pain and measured disease activity and therefore appear to decrease the efficacy of several available treatments,” the authors wrote, also noting that depression and anxiety have been linked with less RA remission over time.
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Desilet LW, et al. Posttraumatic stress disorder, depression, anxiety, and persistence of methotrexate and TNF inhibitors in patients with rheumatoid arthritis. ACR Open Rheumatology. September 13, 2020. doi: https://doi.org/10.1002/acr2.11175.