Takeaway
- Primary care patients with rheumatological conditions of fibromyalgia, rheumatoid arthritis (RA) or osteoarthritis (OA) were at an increased risk of self-harm compared with without these rheumatological conditions.
- In contrast, no association was seen between ankylosing spondylitis and self-harm.
Why this matters
- Physicians need to be aware of the potential for self-harm in patients with rheumatological conditions, especially fibromyalgia and offer appropriate support and management.
Study design
- This retrospective study included patients with ankylosing spondylitis (n=10,484), fibromyalgia (n=17,546), OA (n=410,384) and RA (n=23,205) and matched unexposed participants using data from the UK Clinical Practice Research Datalink between 1990 and 2016.
- Funding: National Institute for Health Research School for Primary Care Research and others.
Key results
- The incidence rate of self-harm per 10,000 person-years was:
- fibromyalgia cohort: 25.12 (95% CI, 22.45-28.11);
- ankylosing spondylitis cohort: 11.37 (95% CI, 9.37-13.81);
- RA cohort: 9.70 (95% CI, 8.32-11.29); and
- OA cohort: 6.48 (95% CI, 6.20-6.76).
- The year-on-year incidence of self-harm across each rheumatological condition remained relatively consistent from 2000 to 2016.
- The adjusted hazard ratio of self-farm associated with each rheumatological condition was:
- fibromyalgia: 2.06 (95% CI, 1.60-2.65);
- RA: 1.59 (95% CI, 1.20-2.11);
- OA:
- 1 to <5 years: 1.12 (95% CI, 1.01-1.24);
- ≥5 to <10 years: 1.35 (95% CI, 1.18-1.54);
- ≥10 years: 1.17 (95% CI, 0.98-1.40); and
- ankylosing spondylitis: 0.95 (95% CI, 0.69-1.31).
- Age and gender were weak effect modifiers of the association between all rheumatological cohorts and subsequent self-harm.
Limitations
- Possibility of residual confounding.
Prior JA, Paskins Z, Whittle R, Abdul-Sultan A, Chew-Graham CA, Muller S, Bajpai R, Shepherd TA, Sumathipala A, Mallen CD. Rheumatological conditions as risk factors for self-harm: A retrospective cohort study. Arthritis Care Res (Hoboken). 2020 Jun 11 [Epub ahead of print]. doi: 10.1002/acr.24345. PMID: 32526099. Abstract.
This clinical summary first appeared on Univadis, part of the Medscape Professional Network.
