Introduction: Rheumatoid arthritis (RA) causes swelling and pain of the joints (mainly the hands, wrists and feet), reducing functional ability. This can have substantial, negative impact on a patient’s physical and mental quality of life. Pharmacotherapy for RA patients may have a positive impact on mental health outcomes by improving pain and stiffness, potentially by targeting inflammatory processes common to RA and depression.
Objectives: The objectives of this review, “The Impact of Targeted Rheumatoid Arthritis Pharmacologic Treatment on Mental Health,” were to ascertain the frequency of mental health assessments in RA pharmacotherapy trials, quantify the efficacy of RA pharmacotherapy for mental health outcomes, and explore the clinical and demographic factors related to mental health outcomes.
Evidence suggesting common inflammatory pathways in RA and depression is increasing (see the full study in Arthritis & Rheumatology for citations). Specifically, the levels of inflammatory cytokines, including tumor necrosis factor (TNF) and interleukin-6 (IL-6), can be elevated in individuals with depressive disorder, and recent evidence suggests that therapies used in RA to target TNF inhibitors may improve mental health outcomes in depressed patients with high levels of inflammation and those with chronic physical illness.
Because low mood is highly prevalent in RA, and psychosocial well-being is important to patients, it might be expected that mental health is commonly assessed as an outcome in RA clinical trials. However, a 2009 systematic review found that mental health outcomes were reported in just 4% of RA clinical studies, increasing to 22% with a broader conceptualization of mood, including mental health components of quality of life, using questionnaires.
These researchers identified and analyzed 71 studies involving 34,706 patients, assessing the frequency of mental health outcome measurement, the impact of RA treatment on mental health and variables associated with the impact of RA treatment on mood outcomes.
Conclusions: Advances in RA treatment have resulted in significant improvements in specific outcomes: the delay of radiographic damage and reduction of inflammation and adverse events. However, this review demonstrates that relying on RA pharmacotherapy alone may not meaningfully improve mental health outcomes. Mental health is treatable in patients with physical illness, and the measurement and management of mental health throughout the course of treatment as part of routine practice is recommended. These results suggest that mental health in patients with RA must be addressed, and that mental health problems are unlikely to resolve with effective pharmacologic management of RA alone. Providing integrated, dedicated mental health care within routine practice is essential to achieve parity of esteem, valuing mental and physical health equally.
Excerpted and adapted from:
Matcham F, Galloway J, Hotopf, et al. The impact of targeted rheumatoid arthritis pharmacologic treatment on mental health. Arthritis Rheumatol. 2018 Sep;70(9):1377–1391.
