An estimated 1.3 million individuals suffer from rheumatoid arthritis, and 75% of those afflicted are women. In addition to severe pain, depression and anxiety often occur with rheumatic disease…all of which are difficult to treat.

Latest development: A recent study out of Greece finds that people with inflammatory rheumatic joint disease who start or switch to biologic drugs are more likely to be taking an antidepressant or anti-anxiety medication. This is the first study to show a link between the use of biologic drugs and the use of medication for depression or anxiety.

Biologic drugs are newer anti-inflammatory drugs used to treat rheumatic diseases such as rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis. Biologics are started when a conventional disease-modifying antirheumatic drug (DMARD) is not effective. Patients may switch from one biologic to another if treatment is still not effective.

Rheumatic disease often leads to depression or anxiety, and depression may make the disease worse, creating an endless loop. Researchers from the National and Kapodistrian University of Athens, Greece, wanted to find out if patients who started a biologic drug, or switched from one biologic to another, were more likely to eventually take medication for depression or anxiety. Their study was published in the journal RMD Open: Rheumatic & Musculoskeletal Diseases.

The research: Using data from the Greek Government Center for Social Security Services, the researchers identified nearly 43,000 patients with rheumatoid arthritis, psoriatic arthritis or ankylosing spondylitis between 2016 and 2018 who were taking a DMARD or biologic drug. Compared with patients who did not start or change biologics…

  • Patients starting a biologic were about 25% more likely to be taking an antidepressant and 18% more likely to be taking an anti-anxiety medication.
  • Patients switching biologics were about 50% more likely to be taking and antidepressant and 16% more likely to be taking an anti-anxiety medication.

The researchers cite three possible explanations for the link between biologics and mood disorder drugs. First, having a rheumatic disease may cause depression and anxiety due to pain, disability and loss of social activities. Second, depression or anxiety may make rheumatic joint disease worse. Third, depression or anxiety may increase a patient’s perception of pain. This may increase the reported pain scores that doctors use when deciding to start or switch biologics.

Takeaway: The researchers conclude that doctors should consider how mood disorders may affect rheumatic disease before deciding to start or switch a biologic. Worsening of joint symptoms may be due to a mood disorder. Managing a mood disorder may reduce the need to start or change medications.

Source: Study titled “Introduction and Switching of Biologic Agents Are Associated with Antidepressant and Anxiolytic Medication Use: Data on 42,815 Real-World Patients with Inflammatory Rheumatic Disease,” by researchers at National and Kapodistrian University of Athens, Greece, published in RMD Open: Rheumatic & Musculoskeletal Diseases.