Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Rheumatology, University Medicine Cluster, National University Health System, Singapore.
J Affect Disord. 2022 Aug 15;311:407-415. doi: 10.1016/j.jad.2022.05.108. Epub 2022 May 25.
Rheumatoid arthritis (RA) and depression are conditions which commonly co-exist. Recent longitudinal studies now suggest a bidirectional association between these disorders, with inconsistent results. We conducted a systematic review and meta-analysis to examine this relationship.
Three electronic databases (PubMed, Embase and PsycINFO) were searched from inception to September 4, 2021 for cohort studies evaluating either the risk of depression in RA patients or the risk of RA in patients with depression, as well as the secondary outcome of all-cause mortality risk in RA patients with depression. A random effects model was used to summarize the included studies.
Eleven cohort studies were included, comprising a total of 39,130 RA patients, 550,782 patients with depression and 7,802,230 controls. RA patients had a 47% greater risk of incident depression compared to controls, while patients with depression had a 34% greater risk of developing RA. Subgroup analysis by age was only significant in the ≥60 years old age group. RA patients with depression had an 80% increased risk of all-cause mortality compared to those without depression.
The results may have been confounded by factors such as differing methods of depression ascertainment across studies and overlap in presentation between the two conditions.
There exists a bidirectional association between RA and depression especially in the elderly which increases mortality risk. This invites the need for clinicians to screen and be vigilant for the presence of these conditions.
类风湿性关节炎（RA）和抑郁症是两种常见的共存病症。最近的纵向研究表明，这两种疾病之间存在双向关联，但结果并不一致。我们进行了系统评价和荟萃分析来检验这种关系。
从建库到 2021 年 9 月 4 日，我们在三个电子数据库（PubMed、Embase 和 PsycINFO）中搜索了评估 RA 患者患抑郁症风险或抑郁症患者患 RA 风险的队列研究，以及 RA 患者伴发抑郁症的全因死亡率风险这一次要结局。我们使用随机效应模型来总结纳入的研究。
共纳入 11 项队列研究，总计纳入 39130 例 RA 患者、550782 例抑郁症患者和 7802230 例对照。与对照组相比，RA 患者发生抑郁的风险增加了 47%，而抑郁症患者发生 RA 的风险增加了 34%。按年龄进行的亚组分析仅在≥60 岁年龄组有意义。与无抑郁症的 RA 患者相比，伴发抑郁症的 RA 患者全因死亡率增加了 80%。
结果可能受到不同研究中抑郁症确定方法的差异以及两种疾病表现重叠等因素的混杂。
RA 和抑郁症之间存在双向关联，特别是在老年人中，这种关联会增加死亡率风险。这就需要临床医生对这些病症进行筛查并保持警惕。
