Rheumatoid Arthritis With PTSD, Anxiety and Depression

Stress and anxiety can wreak havoc on one's health and hinder recovery, particularly for patients with chronic conditions, such as rheumatoid arthritis.

In an article published online Sept. 13 in ACR Open Rheumatology, Joshua F. Baker, M.D., and colleagues report the results of study that finds veterans with rheumatoid arthritis and comorbid PTSD, depression, or anxiety, have poor persistence of methotrexate and TNFi therapies leading to worse outcomes.

This was a retrospective cohort study of national VA data. Comorbid PTSD, depression and anxiety were associated with a higher risk of earlier DMARD discontinuation in rheumatoid arthritis. Depression and anxiety, but not PTSD, were found to be significantly associated with a greater risk of poor adherence to methotrexate and tumor necrosis factor inhibitors.

"This is the first study to date to comprehensively examine the relationship between PTSD and disease‐modifying antirheumatic drug (DMARD) persistence in US veterans with rheumatoid arthritis," the authors wrote.

In an interview with Rheumatology Network, Dr. Baker, an assistant professor at the University of Pennsylvania who holds a position with the VA hospital, said: "There's been prior evidence that shows patients with anxiety and depression are more likely to discontinue their therapies for rheumatoid arthritis. And, we've also studied this in PTSD and those patients tend to have higher inflammatory markers and evidence of higher disease activity. So we were interested to see whehther our patients with PTSD were more likely to discontinue therapies early as compared to people without PTSD.

"We found that people with PTSD, like people with anxiety and depression, were more likely to discontinue therapies early. We also looked at adherence to therapy. Among people who stayed on therapy for some period of time we found that people with anxiety and depression had poor adherence. And, people with PTSD showed poor adherence over time. We suspect that the reason people with PTSD, anxiety and depression discontinue early, is that they are not adhering to their therapy as well as people without those (mental health) conditions."

In this interview, Dr. Baker shares more details about the study.