Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Depression is Risk Factor for Development of RA

RMD Open; 2018 Jul 11; Vallerand, Lewinson, et al

Major depressive disorder (MDD) increased the risk of developing rheumatoid arthritis (RA) by 38%, and antidepressants may decrease this risk in these patients, according to a recent study. A retrospective cohort study was conducted using The Health Improvement Network (THIN) database (from 1986 to 2012). A cohort of 403,932 patients with MDD and a referent cohort of 5,339,399 patients without MDD were identified. Observation time was recorded for both the MDD and referent cohorts until patients developed RA or were censored. Cox proportional hazards models were used to determine the risk of developing RA among patients with MDD, accounting for age, sex, medical comorbidities, smoking, body mass index, and antidepressant use. Researchers found:

  • Cox proportional hazards models revealed a 31% increased risk of developing RA among those with MDD in an unadjusted model (HR=1.31).
  • When adjusting for all covariates, the risk remained significantly increased among those with MDD (HR=1.38).
  • Antidepressant use demonstrated a confounding effect that was protective on the association between MDD and RA.


Vallerand IA, Lewinson RT, Frolkis AD, et al. Depression as a risk factor for the development of rheumatoid arthritis: A population-based cohort study. RMD Open. 2018;4(2):e000670. doi:10.1136/rmdopen-2018-000670.