Where Mental Health & Rheumatology Overlap

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Because rheumatologists and mental health experts both treat patients with depression, anxiety, pain, disability and sleep disorders, provider cross-training may benefit patients and providers themselves.

“When a patient has active psychosocial distress, this has a negative effect on their physical function. Similarly, if a patient has active physical symptoms, like a rheumatoid arthritis flare, this has a negative effect on their mental health,” explains Hanna Zembrzuska, MD, MME, clinical assistant professor in the Departments of Internal Medicine and Psychiatry at University of Iowa Health Care, Iowa City.

Like rheumatologists, psychiatrists treat disorders that are associated with systemic inflammation. “This is an exciting area of research,” Dr. Zembrzuska says.

In 2021, results from a study by Kelly et al. supported a causal association between interleukin (IL) 6 signaling and depression. The study analyzed data from more than 89,000 participants in the UK Biobank, with the authors noting the findings add to prior evidence implicating IL-6 signaling in depression.¹

Dr. Zembrzuska

A separate study by Ye et al. reported that CRP concentration was associated with depressive and anxiety symptoms, and with diagnoses of depression and generalized anxiety disorder. However, further analysis of the data from nearly 145,000 UK Biobank participants found that higher IL-6 activity was associated with increased risk for depressive symptoms, although higher CRP concentration was associated with decreased risks of depressive and anxiety symptoms.²

Earlier this year, Graham-Engeland et al. found higher CRP levels in participants with both higher negative affect and either higher pain intensity or pain interference. The findings from the 212-patient study were consistent after accounting for demographic factors and body mass index. The authors noted that the findings add to the literature suggesting that negative affect, pain and inflammation are related.³

Numerous Overlaps

Along with the association of pro-inflammatory markers with the presence and severity of both rheumatic diseases and mood disorders, rheumatology and psy­chiatry overlap in other ways, says Alfred Kim, MD, PhD, assistant professor of medicine in the Division of Rheumatology at Washington University in St. Louis.

“Many rheumatologic conditions, such as systemic lupus erythematosus and psoriatic arthritis, exhibit both high frequency and severity of mood disorders,” Dr. Kim says. “Both disciplines are more ‘old school’ in their clinical approach: the signs and symptoms drive clinical decision making rather than labs and imaging.” Systemic lupus erythematosus (SLE) is a clinical diagnosis with laboratory results providing supportive evidence, and mood disorders, such as depression, are purely a clinical diagnosis, he explains.