Background/Purpose: Rheumatic diseases are frequently linked to a reduced quality of life (QoL), particularly as disease severity escalates. Patients with rheumatic conditions often exhibit high rates of depression and anxiety, which can hinder medication adherence and further diminish QoL. In cases where disease-modifying antirheumatic drugs (DMARDs) are available, suboptimal medication adherence can lead to disease progression, potentially exacerbating both QoL and mental health. However, the precise relationship between rheumatic diseases and mental health disorders remains unclear.

Methods:  This retrospective case-control study examined the association between rheumatic diseases—specifically RA, SLE, PsA, and AS—and mental health disorders (anxiety and depression) in patients treated within the author’s health system. Data was extracted using Epic’s SlicerDicer tool, which facilitates the search and visualization of large patient populations. The study included patients over 18 years old who were seen between September 28, 2010, and May 1, 2024. Rheumatic diseases and mental health disorders were identified using International Classification of Disease, tenth revision (ICD-10) codes. Odds ratios (OR) and 95% confidence intervals were calculated via multivariate logistic regression, adjusting for sex and age using IBM SPSS Statistics 28.0.1.

Results: Of the 3,305,015 patients screened, 0.4% had RA, 0.1% had SLE, 0.08% had PsA, and 0.04% had AS. Anxiety was identified in 4.4% patients, and depression in 3.5%. After adjusting for age and sex, all patients with diagnosis codes for RA, SLE, PsA, and AS showed a statistically significant increase in the odds of anxiety (ORs ranging from 6.15 to 6.74), depression (ORs ranging from 6.39 to 7.34), and concomitant anxiety and depression (ORs ranging from 7.72 to 9.02), with all p-values < 0.001. Subgroup analysis of patients seen specifically at rheumatology clinics within our institution revealed that SLE was associated with anxiety, depression, and concomitant anxiety and depression (ORs 1.42, 1.26, 1.49, respectively, all p-values < 0.001). PsA and AS were linked to depression (ORs 1.18, p=0.008 and 1.32, p=0.003, respectively) and concomitant anxiety and depression (ORs 1.17, p=0.034 and 1.40, p=0.004, respectively). The lower observed OR in this subset of patients likely is a result of patients receiving care for depression and anxiety by providers outside of our institution and, as a result, ICD-10 codes for depression and anxiety were underreported in this subset of patients.

Conclusion: Patients with rheumatic disease face significantly increased incidence of depression and anxiety, which may negatively impact medication adherence and QoL. It is essential to screen these patients for mental health conditions at each visit to ensure comprehensive and high-quality care. Further research is needed to explore the associations and consequences of rheumatic diseases on mental health outcomes.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/associations-between-rheumatic-diseases-and-mental-health-disorders/