The results of a population study presented today at the Annual European Congress of Rheumatology (EULAR 2018) demonstrate a significantly increased rate of self-harm attempts in inflammatory arthritis (IA), particularly following a diagnosis of Ankylosing Spondylitis (AS).1
Results of the study showed that individuals with AS were almost twice as likely to self-harm as their comparators (adjusted hazard ratio of 1.59 (95% CI 1.16 to 2.21). Deliberate self-harm was also increased in individuals with rheumatoid arthritis (RA) but only before adjustment for baseline characteristics. The most frequent method of self-harm was poisoning (64% of attempts in AS, 81% in RA) or self-mutilation (36% in AS, 18% in RA).
"Our study is one of the first to document the risk of serious mental health outcomes following a RA or AS diagnosis and highlights the need for routine evaluation of self-harm behaviour as part of the management of patients," said Dr. Nigil Haroon, senior study author, University of Toronto.
Physical aspects of AS include pain, joint stiffness, and a gradual loss of spinal mobility, however, there is also considerable impact on mental health.2 Although a higher prevalence of psychiatric comorbidities, including depressive disorder, has been proven in patients with AS,3 until now there is limited data on the risk of serious mental health outcomes following diagnosis.
"This study is important because understanding the mechanisms that contribute to deliberate self-harm attempts will help tailor future preventative strategies to reduce morbidity associated with this serious mental health outcome," said Professor Thomas Dörner, Chairperson of the Abstract Selection Committee, EULAR.
The study evaluated population-based cohorts of RA (N=53,240) and AS (N=13,964), each matched 1:4 by age, sex, and calendar year (at diagnosis) with non-IA comparator cohorts in Ontario, Canada. Individuals with a history of mental illness or prior episode of deliberate self-harm were excluded. The outcome was a first emergency room presentation for deliberate self-harm, subsequent to RA or AS diagnosis, between April 1, 2002 and March 31, 2016. Hazard ratios were adjusted for demographic, clinical and health service utilisation variables.
This study suggests there is a link between inflammatory arthritis and the development of serious mental health consequences. These findings highlight the need for routine evaluation of self-harm behaviour as part of the management of chronic inflammatory arthritis. Understanding the mechanisms contributing to deliberate self-harm attempts will help inform risk-reduction strategies among individuals living with inflammatory arthritis.
Abstract number: OP0296
NOTES TO EDITORS
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About Rheumatic and Musculoskeletal Diseases
Rheumatic and musculoskeletal diseases (RMDs) are a diverse group of diseases that commonly affect the joints, but can also affect the muscles, other tissues and internal organs. There are more than 200 different RMDs, affecting both children and adults. They are usually caused by problems of the immune system, inflammation, infections or gradual deterioration of joints, muscle and bones. Many of these diseases are long term and worsen over time. They are typically painful and limit function. In severe cases, RMDs can result in significant disability, having a major impact on both quality of life and life expectancy.4
About 'Don't Delay, Connect Today!'
'Don't Delay, Connect Today!' is a EULAR initiative that unites the voices of its three pillars, patient (PARE) organisations, scientific member societies and health professional associations - as well as its international network - with the goal of highlighting the importance of early diagnosis and access to treatment. In the European Union alone, over 120 million people are currently living with a rheumatic disease (RMD), with many cases undetected.5 The 'Don't Delay, Connect Today!' campaign aims to highlight that early diagnosis of RMDs and access to treatment can prevent further damage, and also reduce the burden on individual life and society as a whole.
The European League against Rheumatism (EULAR) is the European umbrella organisation representing scientific societies, health professional associations and organisations for people with RMDs. EULAR aims to reduce the burden of RMDs on individuals and society and to improve the treatment, prevention and rehabilitation of RMDs. To this end, EULAR fosters excellence in education and research in the field of rheumatology. It promotes the translation of research advances into daily care and fights for the recognition of the needs of people with RMDs by the EU institutions through advocacy action.
To find out more about the activities of EULAR, visit: http://www.
1 B Kuriya, J Widdifield, J Luo, et al. The risk of deliberate self-harm in rheumatoid arthritis and ankylosing spondylitis: A population-based cohort study. EULAR 2018; Amsterdam: Abstract OP0296.
2 Dagfinrud H, Mengshoel AM, Hagen KB, et al. Health status of patients with ankylosing spondylitis: a comparison with the general population. Ann Rheum Dis. 2004;63(12):1605-10.
3 Shen CC, Hu LY, Yang AC, et al. Risk of psychiatric disorders following ankylosing spondylitis: A nationwide population-based retrospective cohort study. J Rheumatol. 2016;43(3):625-31.
4 van der Heijde D, et al. Common language description of the term rheumatic and musculoskeletal diseases (RMDs) for use in communication with the lay public, healthcare providers and other stakeholders endorsed bythe European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR). Annals of the Rheumatic Diseases. 2018;doi:10.1136/annrheumdis-2017-212565. [Epub ahead of print].
5 EULAR. 10 things you should know about rheumatic diseases fact sheet. Available at: https:/