Self-Harm Risk Greater Among Patients with These Rheumatic Diseases

A recent study explored the risk of self-harm among patients with different rheumatic diseases. Patients with rheumatoid arthritis (RA), osteoarthritis (OA), and fibromyalgia may be at greater risk.

This was a retrospective cohort study that included Clinical Practice Research Datalink data on patients with ankylosing spondylitis, fibromyalgia, RA, and OA between 1990 and 2016, who were matched to patients without those diseases. Medical record codes after the rheumatic diagnosis were used to identify incidences of self-harm. For each condition, incidence rates per 10,000 person-years, as an overall measurement and year-on-year from 2000 through 2016. OA patients were further stratified by disease duration <1 year, ≥1 to <5 years, ≥5 to <10 years, and ≥10 years.

Self-harm incidence was highest among patients with fibromyalgia: 25.12 per 10,000 person-years (95% confidence interval [CI], 22.45 to 28.11), and lowest for OA (6.48 per 10,000 person-years; 95% CI, 6.20 to 6.76). Each rheumatic disease was crudely associated with self-harm, with the exception of ankylosing spondylitis.

“Though attenuated, these associations remained after adjustment for fibromyalgia (HR 2.06(95%CI 1.60,2.65)), rheumatoid arthritis (1.59(1.20,2.11)) and osteoarthritis (1‐<5years: 1.12 (1.01,1.24); ≥5‐<10 years: 1.35 (1.18,1.54)),” the authors added.

Reporting in Arthritis Care & Research, the researchers summarized, “Primary care patients with fibromyalgia, osteoarthritis or rheumatoid arthritis (but not ankylosing spondylitis) are at increased risk of self‐harm compared to people without these rheumatological conditions. Clinicians need to be aware of the potential for self‐harm in patients with rheumatological conditions (particularly fibromyalgia), explore mood and risk with them, and offer appropriate support and management.”

Aside from Self-Harm, Mental Health Conditions Also More Common in Rheumatic Diseases

The association between arthritis and mental health conditions like anxiety and depression has been documented previously. Research from the Centers for Disease Control and Prevention (CDC) previously found that arthritis patients are more likely to have anxiety than depression but are more likely to be treated for the latter.

Of adults aged ≥ 18 years who have arthritis, anxiety was reported in 22.5% (95% confidence interval [CI] = 20.8–24.3) and depression in 12.1% (CI = 10.8–13.4)—compared to 10.7% (CI = 10.2–11.2) and 4.7% (CI = 4.4–5.0), respectively, among adults without arthritis.  More adults with arthritis take medications to treat symptoms of depression than anxiety (57.7% [CI = 52.4–62.9] vs 44.3% [CI = 40.4–48.3], respectively). Patients with depressive symptoms were also more likely to report having spoken with a mental health professional in the past year than those with anxiety (42.8% [CI = 37.7–48.1] vs 34.3% [CI = 30.3–38.1], respectively), according to the CDC.

A separate study found an increased risk for anxiety among adults with RA. “Overall, the quantitative meta-analysis suggested that subjects with RA were associated with a significantly increased risk of anxiety incidence (OR, 1.20; 95% CI, 1.03–1.39) than those without,” the researchers found. Based on their findings, the authors concluded that RA patients may be more likely to develop anxiety. They recommended that, looking ahead, studies should “explore whether clinical manifestations of RA are modifiable risk factors for anxiety.”

Among RA patients with depression, they may experience poorer quality of life, found a third study.