Anti‐tumor necrosis factor‐α therapy is associated with less frequent mood and anxiety disorders in patients with rheumatoid arthritis

Abstract

Aims: The purpose of the present study was to examine the current prevalence of mood and anxiety disorders, and factors related to mood and anxiety disorders in patients with rheumatoid arthritis (RA). Method: The study sample included 83 consecutive patients with RA who were admitted to a rheumatology outpatient clinic. Diagnoses of psychiatric disorders were determined using the Structured Clinical Interview for DSM‐IV (SCID‐I). To assess physical disability and disease activity, the Health Assessment Questionnaire and the Disease Activity Score, respectively, were used. Results: The prevalence of any mood or any anxiety disorder was 43.4%. The two most common psychiatric diagnoses were major depression (21.7%) and generalized anxiety disorder (16.9%). Mood and anxiety disorders were unrelated to sociodemographic features, disease‐related factors, and medications for RA except anti‐tumor necrosis factor‐α (TNF‐α). These disorders, however, were identified less frequently in patients with RA receiving anti‐TNF‐α drugs compared to patients who did not receive such medications. Conclusion: Patients with RA frequently have mood and anxiety disorders, and anti‐TNF‐α drugs may be useful for the mental status of these patients.

Effects of Centrally Administered Etanercept on Behavior, Microglia, and Astrocytes in Mice Following a Peripheral Immune Challenge

“…Additionally, no differences between groups were observed for distance travelled in this test, indicating that the behavior observed was representative of anxiety-like responses and not merely locomotor differences. A role for TNF-a in anxiety-like behavior is supported by studies demonstrating that chronic peripheral administration of TNF-a antagonists reduce levels of depression and anxiety in conditions, including chronic pain and RA (Uguz et al, 2009) while genetic knockout of TNF-a lowers anxiety-like behavior in young mice (Camara et al, 2013). The role of TNF-a in regulating emotional responses within the CNS is yet to be determined with suggestions that TNF-a may be involved in the regulation of the serotonin transporter pathway, as well as stimulation of the hypothalamic-pituitary axis, which are involved in generating emotional responses (Bayramgurler et al, 2013;Himmerich et al, 2006;Zhu et al, 2006).…”

Effects of anti-inflammatory drugs on the expression of tryptophan-metabolism genes by human macrophages

“…In humans, IFNα‐based therapy for hepatitis C infection can trigger a major depressive disorder (MDD) resulting in around 30% of patients withdrawing from treatment 6, 7. Conversely, TNFα blockade improves depressive symptoms in patients with rheumatoid arthritis8 and in a subgroup of patients with MDD and elevated levels of C‐reactive protein (an acute phase protein) 9…”

Magnesium in the Central Nervous System

“…Insomnia at baseline and 1 year post--baseline compared with those with no sleep complaints was strongly predictive of a future MD (adjusted odds ratio, OR=39.8; P<0.01) (Ford and Kamerow, 1989). Another study (van den Berg et al, 2007) found a similar association for hypersomnia. Sleep disturbances and neuroendocrine data are correlated, in particular hypercortisolism is correlated with the number of awakenings and reduced SWS (Hubain et al, 1998).…”

“…SSRIs (Eller et al, 2008;O'Brien et al, 2007). Anti--inflammatory agents appear to have anti--depressant effects, as in the case of TNFα--antagonists (Uguz et al, 2009), cyclooxygenase inhibition (Muller et al, 2006) and omega--3 fatty acids .…”

“…The HPA axis has long been recognized as a potential target for antidepressants (Flores et al, 2006;Holsboer, 2000;Jahn et al, 2004). More recently, anti--inflammatory mechanisms like COX--2 inhibitors (Muller et al, 2006) and TNFα--antagonists (Uguz et al, 2009) have been demonstrated. In the following text we report behavioural effects by Mg in animal models as well as human clinical data.…”