Depression in RA patients treated with anti-TNF is common and under-recognized in the rheumatology clinic

Hider, Samantha L.; Tanveer, Wajeeha; Brownfield, Ann; Mattey, Derek L.; Packham, Jon

doi:10.1093/rheumatology/kep170

Cited by 118 publications

(100 citation statements)

References 14 publications

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“…Since cytokines play a pivotal role in the synovial inflammation in RA and TNF blockers exert strong therapeutic effects, it may be suggested that the cytokine -brain connection is essential in depression in RA. The hypothesis is supported by the observation of persistence of depression in patients with poor disease control by TNF blockers (Hider et al, 2009). However, studies investigating an association between depression in RA and increased CRP have yielded conflicting findings (Margaretten et al, 2011).…”

Section: Rheumatoid Arthritis and Depression-like Symptomsmentioning

confidence: 90%

Depression in Autoimmune Diseases

Pryce

Fontana

2016

Current Topics in Behavioral Neurosciences

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Up to 50% of patients with autoimmune diseases show an impairment of health-related quality of life and exhibit depression-like symptoms. The immune system not only leads to inflammation in affected organs, but also mediates behavior abnormalities including fatigue and depression-like symptoms. This review focuses on the different pathways involved in the communication of the immune system with the neuronal network and the body's timing system. The latter is built up by a hierarchically organized expression of clock genes. As discussed here, the activation of the immune system interferes with high amplitude expression of clock genes, an effect which may play a pivotal role in depression-like behavior in autoimmune diseases.

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Section: Rheumatoid Arthritis and Depression-like Symptomsmentioning

confidence: 90%

Depression in Autoimmune Diseases

Pryce

Fontana

2016

Current Topics in Behavioral Neurosciences

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“…As outlined above, there is abundant reason to assume that depression may actually change the disease and its impact on the patient. Cross-sectional studies provide conflicting results, with most describing an association between depressed mood and objective measures of disease activity, such as CRP and ESR [6,11,81,129,130]; however, others do not find such associations [131,132]. Some authors have found that anxiety does not correlate with ESR or CRP in RA patients [10,133], whereas others show that anxiety and disease activity were positively associated when measured simultaneously and 6 months apart [6].…”

Section: The Das Score and Its Componentsmentioning

confidence: 99%

Psychological Factors Associated with Response to Treatment in Rheumatoid Arthritis

Santiago

Geenen²,

J.W.G.³

et al. 2014

CPD

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This paper presents a comprehensive review of research relating psychological domains with response to therapy in patients with rheumatoid arthritis. A holistic approach to the disease was adopted by incorporating not only disease activity but also dimensions of the impact of disease on patients' lives. Psychological distress, including depression and anxiety, is common among patients with rheumatoid arthritis and has a significant negative impact on response to therapy and on patients' abilities to cope with chronic illness. Evidence regarding the influence of positive psychological dimensions such as acceptance, optimism, and adaptive coping strategies is scarce. The mechanisms involved in these interactions are incompletely understood, although changes in neuro-endocrine-immune pathways, which are common to depression and rheumatoid arthritis, seem to play a central role. Indirect psychological influences on therapeutic efficacy and long-term effectiveness include a myriad of factors such as adherence, placebo effects, cognition, coping strategies, and family and social support. Data suggest that recognition and appropriate management of psychological distress may improve response to treatment and significantly reduce disease burden.

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“…RA patients exhibit deficits in cognitive function (learning and memory) [24] as well as increased anxiety [25] and depression [26]. The cognitive deficits observed in RA patients could be attributed to the high levels of pro-inflammatory cytokine TNF-α in serum [25,27].…”

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confidence: 99%

Tumour necrosis factor - alpha mediated mechanisms of cognitive dysfunction

Baune

Camara²,

Eyre³

et al. 2012

Translational Neuroscience

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Background: Tumour necrosis factor -alpha (TNF-α) is a pro-inflammatory cytokine that combines a plethora of activities in the early stages of an immune response. TNF-α has gained increasing importance given TNF-α upregulation in multiple brain pathologies like neuropsychiatric conditions such as depression, schizophrenia, as well as neuroinflammatory disorder like multiple sclerosis (MS). Aim: The aim of this review is to critically analyse neurobiological, immunological and molecular mechanisms through which TNF-α influences the development of cognitive dysfunction. Principal findings/results: The review presents several lines of original research showing that the immunological properties of TNF-α exacerbate inflammatory responses in the central nervous system such as microglial and endothelial activation, lymphocytic and monocytic infiltration and the expression of downstream pro-inflammatory cytokines and apoptotic factors. Depression, schizophrenia, and MS all manifest symptoms of activated immune response along with cognitive dysfunction, with TNF-α overexpression as a central clinical feature common to these disorders. Furthermore, TNF-α acts negatively on neuroplasticity and the molecular mechanisms of memory and learning (i.e., long-term potentiation and long-term depression). TNF-α also exerts influence over the production of neurotrophins (i.e., nerve growth factor and brain-derived neurotrophic factor), neurogenesis, and dendritic branching. Conclusions/significance: This review outlines that TNF-α and its receptors have a substantial yet underappreciated influence on the development and progression of neuropsychiatric symptoms across several disease entities. An improved understanding of these underlying mechanisms may help develop novel therapeutic targets in the form of drugs specifically targeting downstream products of TNF-α activation within the central nervous system.

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Depression in RA patients treated with anti-TNF is common and under-recognized in the rheumatology clinic

Cited by 118 publications

References 14 publications

Depression in Autoimmune Diseases

Depression in Autoimmune Diseases

Psychological Factors Associated with Response to Treatment in Rheumatoid Arthritis

Tumour necrosis factor - alpha mediated mechanisms of cognitive dysfunction

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