title: Depression Is Associated with an Increased Risk of Psoriatic Arthritis among Patients with Psoriasis: A Population-Based Study.
abstract: The factors that contribute to the development of psoriatic arthritis (PsA) among patients with psoriasis are not well known; however, systemic inflammation is believed to be important. On the basis of recent laboratory work demonstrating that major depressive disorder (MDD) is associated with increased systemic inflammation, we hypothesized that patients with psoriasis who develop MDD are at increased risk of subsequently developing PsA. We utilized The Health Improvement Network, a primary care medical records database, to identify 73,447 individuals with psoriasis. Patients were followed up to 25 years until the development of the primary outcome of PsA or the censor date. The exposure of interest was the development of MDD. Cox proportional-hazards models showed that patients with psoriasis who developed MDD were at significantly increased risk of subsequently developing PsA compared with patients who did not develop MDD, even after accounting for numerous covariates (hazard ratio 1.37, 95% confidence interval 1.05-1.80, P = 0.021). This result was maintained through numerous sensitivity analyses. These data support the hypothesis that MDD increases the risk of developing PsA among patients with psoriasis, suggesting a need for heightened prevention and management of MDD in patients with psoriasis.
authors.affiliation: Leaders in Medicine Program, Cumming School of Medicine, Calgary, Alberta, Canada; Biomedical Engineering Program, Schulich School of Engineering, Calgary, Alberta, Canada.
authors.forename: Ryan T
authors.initials: RT
authors.lastname: Lewinson
authors.affiliation: Leaders in Medicine Program, Cumming School of Medicine, Calgary, Alberta, Canada; Department of Community Health Sciences, Cumming School of Medicine, Calgary, Alberta, Canada.
authors.forename: Isabelle A
authors.initials: IA
authors.lastname: Vallerand
authors.affiliation: Department of Community Health Sciences, Cumming School of Medicine, Calgary, Alberta, Canada.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Lowerison
authors.affiliation: Division of Dermatology, Cumming School of Medicine, Calgary, Alberta, Canada.
authors.forename: Laurie M
authors.initials: LM
authors.lastname: Parsons
authors.affiliation: Leaders in Medicine Program, Cumming School of Medicine, Calgary, Alberta, Canada; Department of Community Health Sciences, Cumming School of Medicine, Calgary, Alberta, Canada.
authors.forename: Alexandra D
authors.initials: AD
authors.lastname: Frolkis
authors.affiliation: Department of Community Health Sciences, Cumming School of Medicine, Calgary, Alberta, Canada; Division of Gastroenterology, Cumming School of Medicine, Calgary, Alberta, Canada.
authors.forename: Gilaad G
authors.initials: GG
authors.lastname: Kaplan
authors.affiliation: Department of Community Health Sciences, Cumming School of Medicine, Calgary, Alberta, Canada; Department of Psychiatry, Cumming School of Medicine, Calgary, Alberta, Canada; Department of Physiology and Pharmacology, Cumming School of Medicine, Calgary, Alberta, Canada.
authors.forename: Andrew G M
authors.initials: AGM
authors.lastname: Bulloch
authors.affiliation: Division of Gastroenterology, Cumming School of Medicine, Calgary, Alberta, Canada.
authors.forename: Mark G
authors.initials: MG
authors.lastname: Swain
authors.affiliation: Department of Community Health Sciences, Cumming School of Medicine, Calgary, Alberta, Canada; Department of Psychiatry, Cumming School of Medicine, Calgary, Alberta, Canada.
authors.forename: Scott B
authors.initials: SB
authors.lastname: Patten
authors.affiliation: Department of Community Health Sciences, Cumming School of Medicine, Calgary, Alberta, Canada; Division of Rheumatology, Cumming School of Medicine, Calgary, Alberta, Canada. Electronic address: ccbarnab@ucalgary.ca.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Barnabe
mesh_terms: D000328:Adult; D000368:Aged; D015535:Arthritis, Psoriatic / Q000150:complications / Q000175:diagnosis / Q000523:psychology*; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D003865:Major Depressive Disorder / Q000209:etiology* / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011565:Psoriasis / Q000150:complications / Q000175:diagnosis / Q000523:psychology*; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018434:Sickness Impact Profile; D013315:Stress, Psychological; D006113:United Kingdom