PTSD, Anxiety, Depression Increase RA Medication Discontinuation Risk

Veterans with posttraumatic stress disorder (PTSD), anxiety, and depression on medication for rheumatoid arthritis (RA) may be more likely to discontinue RA therapy, adversely impacting their disease outcomes, according to a study.

Prior research has observed a correlation between PTSD and worse RA, in terms of severity and symptoms, but the reason for this is unclear, the researchers explained.

“In other chronic disorders, PTSD has been associated with reduced medication adherence, suggesting that suboptimal adherence or decreased drug persistence could serve as an explanation for these earlier observations,” they suggested. They added, “The relationship between related psychiatric conditions such as depression/anxiety and disease‐modifying antirheumatic drug (DMARD) discontinuation has been studied with conflicting results.”

For the present study, the researchers collected Veterans Affairs administrative data spanning 2005 through 2014 for veterans with RA who received methotrexate and tumor necrosis factor inhibitors (TNFi). Using diagnosis codes, patients were stratified into three groups: PTSD (with/without depression/anxiety), depression/anxiety without PTSD, and neither PTSD nor depression/anxiety. Time to DMARD discontinuation was defined as a lapse in refill >90 days. Medication nonadherence was defined as proportion of days covered <0.8.

A total of 15,081 methotrexate dispensing episodes and 8,412 TNFi dispensing episodes were identified. An independent correlation was identified between PTSD and early discontinuation of methotrexate (hazard ratio [HR]=1.15; 95% confidence interval [CI], 1.10 to 1.21) and TNFi (HR=1.20; 95% CI,1.13 to 1.28). Discontinuation risk was similar among patients with depression/anxiety for methotrexate (HR=1.14; 95% CI, 1.10 to 1.19) and TNFi (HR=1.16; 95% CI, 1.10 to 1.22). Patients with depression/anxiety had higher nonadherence rates for methotrexate (odds ratio [OR]=1.12; 95% CI, 1.03 to 1.22) and TNFi (OR=1.14; 95% CI, 1.02 to 1.27), but this correlation was not observed in patients with PTSD.

The study was published in ACR Open Rheumatology.

The researchers concluded that “PTSD, depression, and anxiety are associated with a greater likelihood of MTX and TNFi discontinuation in US veterans with RA after adjusting for pertinent covariates. Poor adherence may play a role in this association; however, other underlying factors likely contribute and warrant further investigation.”