Risk of Self-Harm Elevated in Patients With Ankylosing Spondylitis

June 20, 2018

This study suggests a link between inflammatory arthritis and the development of serious mental health consequences.

Canadian researchers found a significantly increased rate of self-harm attempts in patients with inflammatory arthritis, particularly those who had received a diagnosis of ankylosing spondylitis (AS). The results of the population study were presented at the Annual European Congress of Rheumatology (EULAR 2018) on June 14 in Amsterdam, The Netherlands.

Patients with AS were almost twice as likely to self-harm as their comparators (adjusted hazard ratio of 1.59 (95% CI, 1.16 to 2.21). Deliberate self-harm was also increased in individuals with rheumatoid arthritis (RA) but only before adjustment for baseline characteristics. The most frequent method of self-harm was poisoning (64% of attempts in AS, 81% in RA) or self-mutilation (36% in AS, 18% in RA).

“Our study is one of the first to document the risk of serious mental health outcomes following an RA or AS diagnosis and highlights the need for routine evaluation of self-harm behavior as part of the management of patients,” said Dr. Nigil Haroon, senior study author, University of Toronto, Ontario, Canada.

AS has a considerable impact on mental health. Although a higher prevalence of psychiatric comorbidities-including depressive disorder-has been found among patients with AS, until now there have been limited data on the risk of serious mental health outcomes following diagnosis.

The study evaluated population-based cohorts of RA (N = 53,240) and AS (N = 13,964), each matched 1:4 by age, sex, and calendar year (at diagnosis) with non-IA comparator cohorts in Ontario, Canada. Individuals with a history of mental illness or prior episode of deliberate self-harm were excluded. The outcome was a first emergency department presentation for deliberate self-harm, subsequent to RA or AS diagnosis, between 2002 and 2016. Hazard ratios were adjusted for demographic, clinical and health service utilization variables.

This study suggests there is a link between inflammatory arthritis and the development of serious mental health consequences. These findings highlight the need for routine evaluation of self-harm behavior as part of the management of chronic inflammatory arthritis. Understanding the mechanisms contributing to deliberate self-harm attempts will help inform risk-reduction strategies among patients with inflammatory arthritis.

References:

Kuriya B, Widdifield J, Luo J, et al. The risk of deliberate self-harm in rheumatoid arthritis and ankylosing spondylitis: a population-based cohort study. Presented at: EULAR 2018; 13-16 June 2018; Amsterdam, The Netherlands. Abstract OP0296.