Background/Purpose: Depression and anxiety are common in patients with inflammatory arthritis (IA), and have been reported as risk factors for various inflammatory diseases. The study objective was to estimate the risk of IA in patients with newly diagnosed depression or anxiety (mental health disorders [MHD]), relative to matched controls.

Methods: The MHD population consisted of veterans with ≥2 International Classification of Diseases (ICD) codes for a MHD between 1/1/2007-12/31/2019, with at least 2 years of active VA system use prior to date of their initial MHD ICD code (index date). Control group patients had no MHD ICD codes and were matched to the MHD patients on gender, age, and date of VA enrollment. Control group patients were assigned the same index date as their corresponding match. Patients were excluded if they had an ICD code for IA (rheumatoid arthritis, psoriatic arthritis, or ankylosing spondylitis) prior to their index date. The cumulative IA incidence was depicted with Kaplan-Meier analysis. Hazard ratios (HR) were adjusted by race, ethnicity, body mass index, smoking status, Charlson Comorbidity Index, and socioeconomic status.

Results: The population consisted of 1,378,462 veterans (689,231 MHD & 689,231 controls). The mean age was 61.1, and 92.5% were male. The cumulative incidence of IA increased linearly for up to 13 years after the initial MHD diagnosis (Figure). The incident rate per 1000 patient years was higher in the MHD group than the control group for all IA (2.74 vs. 1.71) and for subsets with RA (2.09 vs 1.32), PsA (0.35 vs 0.22), and AS (0.29 vs 0.16) (Table 1). The adjusted HR for IA in veterans with vs. without a MHD was 1.59 for all IA, 1.56 for RA, 1.60 for PsA, and 1.77 for AS. All comparisons between MHD and control groups yielded a p-value < 0.001.

Conclusion: Veterans with depression or anxiety have an elevated risk for developing IA. These finding may inform future efforts to identify shared risk factors and characterize the mechanistic relationships between MHD and IA.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/increased-risk-for-inflammatory-arthritis-in-veterans-with-depression-or-anxiety/