The temporal relationship between depression and rheumatoid arthritis disease activity, treatment persistence and response: a systematic review

UMMS Affiliation

Meyers Primary Care Institute; Department of Medicine, Division of Rheumatology; Department of Medicine, Division of Preventive and Behavorial Medicine

Publication Date


Document Type



Arthritis, Rheumatoid; Depression


Immune System Diseases | Musculoskeletal Diseases | Psychiatry and Psychology | Rheumatology


Objective. To determine whether depression has a temporal association with RA disease activity, treatment persistence and response to therapy.

Methods. We performed a systematic review encompassing an electronic database search of all published literature since the availability of biologic response modifiers (beginning in 1998) investigating the impact of depression on downstream RA disease progression and treatment.

Results. Only seven articles that evaluated temporal relationships between depression and RA outcomes comprising disease activity, treatment persistence and response to therapy, were included in the review. Results from these studies suggest that depression may exacerbate pain and disease activity and decrease the efficacy of pharmacological (i.e. biologic and non-biologic DMARDs) and some non-pharmacological (e.g. cognitive behavioural therapy) RA treatments.

Conclusion. Given the available evidence, depression probably has a temporal influence on RA disease progression and treatment. However, it is unclear whether these observed effects are due to a response tendency on patient-reported outcomes created from negative cognitive perceptions, immunologically mediated processes that increase inflammation or behavioural changes that lead to decreased physical activity and a greater sensitivity to pain.

DOI of Published Version



Rheumatology (Oxford). 2012 Dec 11. Link to article on publisher's site

Journal/Book/Conference Title

Rheumatology (Oxford, England)

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Link to Article in PubMed

PubMed ID