Influence of dietary habits on depression among patients with rheumatoid arthritis: A cross-sectional study using KURAMA cohort database

Abstract

Objective Although mental disorder is one of the most common comorbidities of rheumatoid arthritis (RA) and is known as a critical influence on RA remission rates, there is little knowledge regarding a possible therapeutic strategy for depression or anxiety in a RA population. Most recently, clinical evidence of dietary improvement for depression has emerged in a general population, but the relationship between dietary habits and mental disorder has not been investigated in RA. The purpose of this study is to elucidate clinical associations between mental disorder (depression/anxiety), dietary habits and disease activity/physical function in patients with RA. Methods A cross-sectional study was performed with 267 female outpatients from the KURAMA database. Using the Hospital Anxiety and Depression Scale (HADS), we classified the participants into three groups by depression state, and their characteristics were compared. Using the 20-items on the self-reported food frequency questionnaire, we investigated the relationship between dietary habits and depression or anxiety, adopting a trend test and a multivariate standardized linear regression analysis for the HADS score of depression or that of anxiety as a dependent variable. Results According to the classified stage of depression, current disease activity (DAS28-CRP: 28-Joint RA Disease Activity Score-C-reactive protein) and the health assessment questionnaire disability Index (HAQ-DI) were significantly increased. Trend analyses revealed that the depression score was inversely associated with the consumption of three food (fish, vegetables and fruit) out of twenty as was the anxiety score with only fish intake. Furthermore, multiple linear regression analysis revealed that the depression score was negatively associated with frequent fish intake (≥ 3 times per week) (Estimate -0.53, p = 0.033), HAQ-DI score within normal range (Estimate -0.88, p ≤ 0.001) and MTX use (Estimate -0.60, p ≤ 0.023). For the anxiety score, multivariate analysis showed similar but not significant associations with variables except for HAQ-DI score. Conclusions In a RA population, both depression and anxiety had a significant and negative association with HAQ-DI score, and depression rather than anxiety had negative association with frequent fish intake. Modification of dietary habits such as increased fish consumption may have a beneficial effect on the depression state in RA patients.

Depression, A Mental Aspect in Rheumatoid Arthritis Comorbidities

“…6,8 RA is one of the most common autoimmune diseases with joint involvement. 3,4 Rheumatoid arthritis occurs in 0.5 to 1% of the population around the world, covering all ages and 3-4 times more dominant in women. 2,6,8 RA primarily targets joints causing polyarthritis.…”

“…Birgitta Fajarai 1* 1 Faculty of Medicine, Universitas Sriwijaya/ Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia 322 illness 2,3,9 Pathogenesis is a complicated process that includes the interplay of genes and the environment. 4 Possible mechanism of the triggers is by carbamylation, acetylation or, the citrullination of arginine in matrix protein.…”

“…2,5,6,10 People suffering from depression may have poorer adherence rates, and physiological changes linked with depression may compromise drug effectiveness, reducing RA remission. 2,3 In RA, systemic inflammation may lead to a higher risk of depression. Many pro-inflammatory markers linked with rheumatoid arthritis, such as IL-1b, IL-6, TNF-α, IL-18 and others, are often related to inflamed brain neural in depression.…”

“…Pro-inflammatory cytokines are thought to stimulate tryptophan and serotonin-degrading enzymes in the humoral system while increasing the synthesis of glutamatergic NMDA receptor agonists, resulting in serotonin shortage and glutamate overproduction, resulting in depression. 3,6 Furthermore, inflammatory factors reduce neurotrophin and brain-derived neurotrophic factors, which affect neuroplasticity and neurogenesis. Lwin…”

“…1,2 It produces chronic pain, deformities, and a certain degree of physical disabilities and affects mental health, such as depression. 3,4 The RA disability interferes with patients' daily function and activity that will lead to depression. Pro-inflammatory cytokines in RA can also trigger depression; increasing pro-inflammatory cytokines will trigger the activation of the hypothalamic-pituitary-adrenal (HPA) axis.…”