Rheumatoid Arthritis, Depression, and the Role of Celecoxib
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MEDICINE
Rheumatoid Arthritis, Depression, and the Role of Celecoxib Nadeen Al-Baz 1 & Mustafa Abdul Karim 1,2 Accepted: 18 August 2020 # The Author(s) 2020
Abstract Rheumatoid arthritis (RA) is a chronic autoimmune disease, causing joint destruction and associated physical, mental, and financial distress. Depression is not uncommonly found in patients with RA as both disorders share sociodemographic, functional, and biologic factors. There is growing evidence on the role of anti-inflammatory agents in managing depression, particularly celecoxib, which has been shown to significantly alleviate depressive symptoms as an augmenting agent. Compared with traditional nonsteroidal anti-inflammatory drugs (tNSAIDs), however, celecoxib offers modest improvement in clinical symptoms, with uncertain results for pain management, physical function, and adverse effects in patients with RA. Further research is needed to assess the effectiveness of celecoxib in the management of RA, particularly in patients suffering from comorbid depression. Keywords Rheumatoid arthritis . Depression . Inflammation . Celecoxib
Abbreviations BSRBR British Society for Rheumatology Biologics Register CBT Cognitive behavioral therapy DALY Disability adjusted life years DMARDS Disease-modifying antirheumatic drugs HAM-D Hamilton Depression Rating Scale HRQOL Health-related quality of life IL Interleukin RA Rheumatoid arthritis RCT Randomized controlled trial SNRIs Serotonin-norepinephrine reuptake inhibitors SSRIs Selective serotonin reuptake inhibitors T1DM Type 1 diabetes mellitus TCAs Tricyclic antidepressants TNF-α Tumor necrosis factor-alpha
This article is part of the Topical Collection on Medicine * Mustafa Abdul Karim [email protected] Nadeen Al-Baz [email protected] 1
Hamad Medical Corporation, Doha, Qatar
2
Weill-Cornell Medicine-Qatar, Ar-Rayyan, Qatar
tNSAIDs US
Traditional nonsteroidal anti-inflammatory drugs United States
Introduction Rheumatoid arthritis (RA) is a chronic, autoimmune disease that causes joint destruction and affects patients physically, mentally, and financially [1–3]. It is a multifactorial disease, with a sequela of genetic and environmental interactions [2]. About 1.3 million adults suffer from RA in the United States (US) [4], and studies in Northern Europe and North America estimate a prevalence of 0.5–1% [2]. In a 15-year prospective study in the Netherlands, the mortality rate in patients with RA was 54% higher compared with the general population, with a standardized mortality ratio of 1.54 (95% CI 1.41–1.67) [5]. Patients with RA are more likely to suffer from depression and anxiety, with onset of psychological distress associated with RA-related disability [6]. The British Society for Rheumatology Biologics Register (BSRBR) found 1491 (19%) out of 7818 patients receiving disease-modifying antirheumatic drugs (DMARDs) to suffer from depression [7]. Abdul Rahim et al. reported 23.3% depression rate in patients who attended the RA clinic in Malaysia [8], and a 2013 systematic review by Matcham et al. inclu
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