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The Relationship Between Mental Health, Disease Severity, and Genetic Risk for Depression in Early Rheumatoid Arthritis

Research output: Contribution to journalArticle

Original languageEnglish
Pages (from-to)638-645
JournalPsychosomatic Medicine
Issue number6
Publication statusPublished - Jul 2017


King's Authors


Introduction Reduced mental health is prevalent in rheumatoid arthritis (RA). Although longitudinal studies are limited, there is evidence that depression associates with worse disease outcomes. We evaluated reciprocal relationships between mental health, RA severity and genetic risks for depression over 2-years in a well-characterised cohort of RA patients. MethodsWe evaluated 520 early RA patients previously enrolled to two clinical trials. Mental health was measured using the SF-36 mental health (MH) domain and mental component summary scores (MCS). MCS/MH associations over two-years with disease activity (DAS28), disability (HAQ), pain visual analogue scale (VAS) scores, and a weighted genetic risk score (wGRS) for depression, were tested using linear mixed-effects and regression models.ResultsPoorer mental health associated with worse RA outcomes. Lower MCS scores (indicating worse mental health) were seen in patients with a greater genetic risk for depression (wGRS β=-1.21; P=0.013). Lower baseline MCS associated with lower 2-year improvements in DAS28 (β=-0.02; P<0.001), pain (β=-0.33; P<0.001), and HAQ (β=-0.01; P=0.006). Baseline MCS associated with changes in the swollen joint count (β=-0.09; P<0.001) and patient global assessment (β=-0.28; P<0.001), but not the tender joint count (P=0.983) and erythrocyte sedimentation rate (P=0.973). Only baseline pain VAS (β=-0.07; P=0.002) associated with 2-year changes in MCS.ConclusionsReduced baseline mental health associated with lower improvements in disease activity, disability, and pain over two years, supporting current national guidelines recommending screening for depression in RA. Pain had a bidirectional relationship with mental health. Depression genetic risk had a significant association with mental health.

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