Giblon Rachel E, Achenbach Sara J, Myasoedova Elena, Davis John M, Kronzer Vanessa L, Bobo William V, Crowson Cynthia S
R.E. Giblon, MS, Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
S.J. Achenbach, MS, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA.
J Rheumatol. 2025 Mar 1;52(3):210-218. doi: 10.3899/jrheum.2024-0165.
To investigate trends in depression and anxiety over 3 decades among individuals with rheumatoid arthritis (RA).
Patients with incident RA (age ≥ 18 years, meeting 1987 American College of Rheumatology criteria between 1985 and 2014) were identified using the Rochester Epidemiology Project. Individuals with RA were matched 1:1 with non-RA comparators on age, sex, and calendar year of RA incidence. Patients were followed until death, migration, or December 31, 2020. Depression and anxiety were defined using established International Classification of Diseases, 9th and 10th revision code sets. Cox models were used to compare trends in the occurrence of depression and anxiety diagnoses and cooccurring anxiety and depression by decade and RA status, adjusted for potential confounders.
The study included 1012 individuals with RA and 1012 matched controls (mean age 55.9 years, 68.38% female). Hazard ratios (HRs) demonstrated a temporal increase in anxiety and cooccurring anxiety and depression from 2005-2014 compared to 1985-1994 for individuals both with and without RA. Persons with RA exhibited a rising occurrence of anxiety (HR 1.27, 95% CI 0.86-1.88) and concomitant anxiety and depression (HR 1.49, 95% CI 0.96-2.33) compared to controls. Trends were most pronounced in seropositive patients with RA (anxiety: HR 4.01, 95% CI 2.21-7.30).
Anxiety and concomitant anxiety and depression diagnoses are elevated in individuals with RA. The increasing occurrence of anxiety and cooccurring anxiety and depression suggests rising awareness and diagnosis of these disorders. Adding to stable but high rates of depression diagnoses, individuals with RA now have evidence of a widening gap in mental health diagnoses that clinicians should address.
调查类风湿关节炎（RA）患者30年间抑郁和焦虑的变化趋势。
使用罗切斯特流行病学项目确定初发RA患者（年龄≥18岁，在1985年至2014年间符合1987年美国风湿病学会标准）。将RA患者与非RA对照者按年龄、性别和RA发病日历年进行1:1匹配。对患者进行随访直至死亡、迁移或2020年12月31日。使用既定的国际疾病分类第9版和第10版编码集定义抑郁和焦虑。采用Cox模型比较按十年和RA状态划分的抑郁和焦虑诊断以及共病焦虑和抑郁的发生趋势，并对潜在混杂因素进行调整。
该研究纳入了1012例RA患者和1012例匹配对照（平均年龄55.9岁，68.38%为女性）。风险比（HR）显示，与1985 - 1994年相比，2005 - 2014年期间，无论有无RA的个体，焦虑以及共病焦虑和抑郁均呈时间上的增加。与对照组相比，RA患者出现焦虑（HR 1.27，95% CI 0.86 - 1.88）以及共病焦虑和抑郁（HR 1.49，95% CI 0.96 - 2.33）的发生率有所上升。这些趋势在血清学阳性的RA患者中最为明显（焦虑：HR 4.01，95% CI 2.21 - 7.30）。
RA患者的焦虑以及共病焦虑和抑郁诊断有所增加。焦虑以及共病焦虑和抑郁发生率的上升表明对这些疾病的认识和诊断有所提高。除了稳定但较高的抑郁诊断率外，RA患者现在有证据表明心理健康诊断方面的差距在扩大，临床医生应予以关注。
