{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T12:08:36Z","timestamp":1777378116601,"version":"3.51.4"},"reference-count":28,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2020,12,30]],"date-time":"2020-12-30T00:00:00Z","timestamp":1609286400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["acrjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthritis Care &amp; Research"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To examine the risk of self\u2010harm in rheumatic conditions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a retrospective cohort study using data from the Clinical Practice Research Datalink. Patients with ankylosing spondylitis, fibromyalgia, osteoarthritis, or rheumatoid arthritis were identified from 1990 to 2016 and matched to patients without these conditions. Incident self\u2010harm was defined by medical record codes following a rheumatic diagnosis. Incidence rates (per 10,000 person\u2010years) were reported for each condition, both overall and year\u2010on\u2010year (2000\u20132016). Cox regression analysis determined risk (hazard ratio [HR] and 95% confidence interval [95% CI]) of self\u2010harm for each rheumatic cohort compared to the matched unexposed cohort. Initial crude analysis was subsequently adjusted and stratified by age and sex. Due to nonproportionality over time, osteoarthritis was also stratified by disease duration (&lt;1 year, \u22651 to &lt;5 years, \u22655 to &lt;10 years, and \u226510 years).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The incidence of self\u2010harm was highest in patients with fibromyalgia (HR 25.12 [95% CI 22.45\u201328.11] per 10,000 person\u2010years) and lowest for osteoarthritis (HR 6.48 [95% CI 6.20<jats:bold>\u2013<\/jats:bold>6.76]). There was a crude association with each rheumatic condition and self\u2010harm, except for ankylosing spondylitis. Although attenuated, these associations remained after adjustment for fibromyalgia (HR 2.06 [95% CI 1.60\u20132.65]), rheumatoid arthritis (HR 1.59 [95% CI 1.20\u20132.11]), and osteoarthritis (1 to &lt;5 years HR 1.12 [95% CI 1.01\u20131.24]; \u22655 to &lt;10 years HR 1.35 [95% CI 1.18<jats:bold>\u2013<\/jats:bold>1.54]). Age and sex were weak effect modifiers for these associations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Primary care patients with fibromyalgia, osteoarthritis, or rheumatoid arthritis (but not ankylosing spondylitis) are at increased risk of self\u2010harm compared to people without these rheumatic conditions. Clinicians need to be aware of the potential for self\u2010harm in patients with rheumatic conditions (particularly fibromyalgia), explore mood and risk with them, and offer appropriate support and management.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acr.24345","type":"journal-article","created":{"date-parts":[[2020,6,11]],"date-time":"2020-06-11T13:01:19Z","timestamp":1591880479000},"page":"130-137","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Rheumatic Conditions as Risk Factors for Self\u2010Harm: A Retrospective Cohort Study"],"prefix":"10.1002","volume":"73","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9213-2796","authenticated-orcid":false,"given":"James A.","family":"Prior","sequence":"first","affiliation":[{"name":"Keele University, Newcastle, and Midlands Partnership NHS Foundation Trust  Stafford UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7783-2986","authenticated-orcid":false,"given":"Zoe","family":"Paskins","sequence":"additional","affiliation":[{"name":"Keele University, Newcastle, and Haywood Academic Rheumatology Centre Midlands Partnership NHS Foundation Trust  Stoke\u2010on\u2010Trent UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rebecca","family":"Whittle","sequence":"additional","affiliation":[{"name":"Keele University  Newcastle UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alyshah","family":"Abdul\u2010Sultan","sequence":"additional","affiliation":[{"name":"Keele University  Newcastle UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carolyn A.","family":"Chew\u2010Graham","sequence":"additional","affiliation":[{"name":"Keele University, Newcastle, and Midlands Partnership NHS Foundation Trust  Stafford UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara","family":"Muller","sequence":"additional","affiliation":[{"name":"Keele University  Newcastle UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1227-2703","authenticated-orcid":false,"given":"Ram","family":"Bajpai","sequence":"additional","affiliation":[{"name":"Keele University  Newcastle UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tom A.","family":"Shepherd","sequence":"additional","affiliation":[{"name":"Keele University  Newcastle UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Athula","family":"Sumathipala","sequence":"additional","affiliation":[{"name":"Keele University, Newcastle, and Midlands Partnership NHS Foundation Trust  Stafford UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian D.","family":"Mallen","sequence":"additional","affiliation":[{"name":"Keele University  Newcastle UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,12,30]]},"reference":[{"key":"e_1_2_7_2_1","unstructured":"World Health Organization.World health statistics 2016: monitoring health for the SDG\u2019s sustainable development goals.2016.URL:https:\/\/www.who.int\/gho\/publications\/world_health_statistics\/2016\/Annex_B\/en\/."},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12888-016-0753-5"},{"key":"e_1_2_7_4_1","unstructured":"World Health Organization.Assessment for self harm\/suicide in persons with priority mental neurological and substance use disorders. URL:http:\/\/www.who.int\/mental_healt\u200bh\/mhgap\/\u200bevide\u200bnce\/suici\u200bde\/q1\/en\/."},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychores.2008.10.013"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.rhu.0000221817.46231.18"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/ket169"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afw001"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-016-3584-9"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/jdv.14175"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychores.2004.10.004"},{"key":"e_1_2_7_12_1","first-page":"2S","article-title":"Pain management in rheumatology research, training, and practice","volume":"35","author":"Borenstein DG","year":"2017","journal-title":"Clin Exp Rheumatol"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychores.2012.05.010"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychores.2014.08.017"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1177\/0141076814522033"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjd.14633"},{"key":"e_1_2_7_17_1","volume-title":"The burden of musculoskeletal conditions at the start of the new millenium","author":"World Health Organization","year":"2003"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyv098"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2013-003389"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyz032"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2018.12.001"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1742-1241.2007.01638.x"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pain.2006.09.004"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.20328"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291715001804"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1080\/13548506.2018.1476724"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.berh.2009.08.009"},{"key":"e_1_2_7_28_1","first-page":"411","article-title":"Coping styles and disability in patients with hand osteoarthritis","volume":"55","author":"Liu R","year":"2016","journal-title":"Rheumatology (Oxford)"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1080\/13607863.2015.1099610"}],"container-title":["Arthritis Care &amp; Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Facr.24345","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/acr.24345","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/acr.24345","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/acrjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/acr.24345","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,2]],"date-time":"2025-10-02T17:06:05Z","timestamp":1759424765000},"score":1,"resource":{"primary":{"URL":"https:\/\/acrjournals.onlinelibrary.wiley.com\/doi\/10.1002\/acr.24345"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,12,30]]},"references-count":28,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,1]]}},"alternative-id":["10.1002\/acr.24345"],"URL":"https:\/\/doi.org\/10.1002\/acr.24345","archive":["Portico"],"relation":{},"ISSN":["2151-464X","2151-4658"],"issn-type":[{"value":"2151-464X","type":"print"},{"value":"2151-4658","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,12,30]]},"assertion":[{"value":"2020-03-24","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-06-02","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-12-30","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}