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Interleukin 6, interleukin 17, disease-related and contextual factor association with depression, and its severity in patients with rheumatoid arthritis

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Abstract

Objective

Depression is very prevalent in rheumatoid arthritis (RA) compared with the general population and may be associated with poor clinical outcomes. Identifying factors associated with depression could improve outcomes for this at risk group. However, few studies have comprehensively examined the association of contextual and disease-related factors as well as pro inflammatory cytokines interleukin 6 (IL-6) and interleukin 17 (IL-17) with depression in RA. Therefore, we aimed to identify the factors significantly associated with depression and severe depression in RA, thus providing a reference for applying clinical care interventions for patients with RA.

Methods

An observational cross-sectional study was conducted on 120 RA patients. Potential determinants included contextual and disease-related factors and laboratory variables. Enzyme-linked immunosorbent assay was used to measure serum IL-6 and IL-17 levels. Depression was assessed using the Arabic version of the Beck Depression Inventory-II questionnaire.

Results

A total of 120 patients were included, and up to 67.5% had some degree of depression with 60% having moderate to severe depression. The severity of disease activity of RA (DAS28-ESR (OR, 1.63; 95% CI, 0.899-3.755), HAQ scores (OR, 1.27; 95% CI, 0.702-2.933), and VAS scores for pain (OR, 2.2; 95% CI, 1.251–5.223)), besides elevated serum IL-6 (OR, 1.51; 95% CI, 0.832-3.475), IL-17 (OR, 1.28; 95% CI, 0.706-2.947), and CRP levels (OR, 1.20; 95% CI, 0.923-2.882) were significantly associated with depression and its severity in the multivariate analysis.

Conclusion

Depression is frequent in RA and is strongly associated to elevated serum IL-6, IL-17, CRP levels, and disease activity-related factors.

Key Points

• RA patients are at increased risk of developing depression, particularly if their level of disease activity scores, serum IL-6, and IL-17 levels increases.

• Patient characteristics associated with depression in RA include living without family, without employments, and with co-morbid hypertension, while RA disease factors are pain, functional disability, and high disease activity.

• A multidisciplinary cooperative approach to RA patient care with regular assessments of these factors associated with depression should be incorporated into routine care programs to improve patients’ self care capabilities and mitigate or prevent depression in these patients.

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Author information

Authors and Affiliations

  1. Department of Internal Medicine, Faculty of Medicine (For Girls), Al-Azhar University, Cairo, Egypt

    Eman Salah Albeltagy & Sally Said Abd Elhamed

  2. Department of Psychiatry, Faculty of Medicine (For Girls), Al-Azhar University, Cairo, Egypt

    Shaimaa Younes Abd Elaziz

  3. Department of Clinical Pathology, Faculty of Medicine (For Girls), Al-Azhar University, Cairo, Egypt

    Sarah Younes Abozaid

  4. Department of Rheumatology and Rehabilitation, Faculty of Medicine (For Girls), Al-Azhar University, Cairo, Egypt

    Hala Mohamed El Zomor

Authors
  1. Eman Salah Albeltagy
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  2. Shaimaa Younes Abd Elaziz
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  3. Sarah Younes Abozaid
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  5. Sally Said Abd Elhamed
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Correspondence to Eman Salah Albeltagy.

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Participants were in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments and approved by the Research Ethics Committee of Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt (approval number 202005250, May 2020).

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All procedures performed in this study involve human. Informed consent was obtained from all individuals for being included in the study.

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Albeltagy, E.S., Elaziz, S.Y.A., Abozaid, S.Y. et al. Interleukin 6, interleukin 17, disease-related and contextual factor association with depression, and its severity in patients with rheumatoid arthritis. Clin Rheumatol 40, 895–904 (2021). https://doi.org/10.1007/s10067-020-05326-7

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  • DOI: https://doi.org/10.1007/s10067-020-05326-7

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