{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T13:30:36Z","timestamp":1791898236812,"version":"4.3.4"},"reference-count":28,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2020,9,10]],"date-time":"2020-09-10T00:00:00Z","timestamp":1599696000000},"content-version":"vor","delay-in-days":9,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["RMD Open"],"accepted":{"date-parts":[[2020,9,5]]},"published-print":{"date-parts":[[2020,9]]},"abstract":"<jats:sec id=\"s1\">\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>Depression and anxiety are linked bi-directionally with inflammatory rheumatic diseases (IRDs) activity, which in turn, depends on subjective patient reported outcomes that can be distorted by comorbid mood disorders. We tested the hypothesis that introduction and\/or switching of biologic agents for IRDs are associated with treatment for depression and\/or anxiety, by analysing real-world data.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"s2\">\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Using a country-wide electronic prescription database (10\u00a0012\u00a0604 registered, 99% population coverage), we captured almost all patients with rheumatoid arthritis (n=12\u00a0002), psoriatic arthritis (n=5465) and ankylosing spondylitis (n=6423) who received biologic disease modifying anti-rheumatic drugs (bDMARDs) during a 2-year period (8\/2016\u20137\/2018). Concomitant antidepressant\/anxiolytic medication use was documented in patients who started or switched bDMARDs and compared with those who remained on conventional synthetic (cs)DMARDs or the same bDMARD, respectively, by multivariate regression analysis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"s3\">\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Two-year data analysis on 42\u00a0815 patients revealed that bDMARD introduction was associated with both antidepressant [OR: 1.248, 95% CI 1.153 to 1.350, p&lt;0.0001] and anxiolytic medication use [OR: 1.178, 95% CI 1.099 to 1.263, p&lt;0.0001]. Moreover, bDMARD switching was also associated with antidepressant [OR: 1.502, 95% CI 1.370 to 1.646, p&lt;0.0001] and anxiolytic medication use [OR: 1.161, 95% CI 1.067 to 1.264, p=0.001]. Notably, all these associations were independent of age, gender, underlying disease diagnosis and concomitant glucocorticoid or csDMARD medication use.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"s4\">\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>In real-world settings, both introduction and switching of bDMARDs in patients with IRDs were associated with the presence of mood disorders. Although a causal relationship is uncertain, the impact of depression and anxiety should always be considered by physicians facing the decision to introduce or switch bDMARDs in patients with active IRDs.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/rmdopen-2020-001303","type":"journal-article","created":{"date-parts":[[2020,9,25]],"date-time":"2020-09-25T09:15:28Z","timestamp":1601025328000},"page":"e001303","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":15,"title":["Introduction and switching of biologic agents are associated with antidepressant and anxiolytic medication use: data on 42 815 real-world patients with inflammatory rheumatic disease"],"prefix":"10.1136","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2162-1362","authenticated-orcid":false,"given":"Vasiliki-Kalliopi","family":"Bournia","sequence":"first","affiliation":[{"name":"Joint Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2238-0975","authenticated-orcid":false,"given":"Maria G","family":"Tektonidou","sequence":"additional","affiliation":[{"name":"Joint Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitrios","family":"Vassilopoulos","sequence":"additional","affiliation":[{"name":"Joint Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katerina","family":"Laskari","sequence":"additional","affiliation":[{"name":"Joint Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stylianos","family":"Panopoulos","sequence":"additional","affiliation":[{"name":"Joint Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kalliopi","family":"Fragiadaki","sequence":"additional","affiliation":[{"name":"Joint Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos","family":"Mathioudakis","sequence":"additional","affiliation":[{"name":"IDIKA SA - e-Government Center for Social Security Services, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anastasios","family":"Tsolakidis","sequence":"additional","affiliation":[{"name":"IDIKA SA - e-Government Center for Social Security Services, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Panagiota","family":"Mitrou","sequence":"additional","affiliation":[{"name":"Hellenic Republic Ministry of Health, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petros P","family":"Sfikakis","sequence":"additional","affiliation":[{"name":"Joint Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,9,25]]},"reference":[{"key":"2025090313520864000_6.3.e001303.1","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2018-214676"},{"key":"2025090313520864000_6.3.e001303.2","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1016\/S2215-0366(18)30255-4","article-title":"Rheumatoid arthritis and depression: an inflammatory perspective","volume":"6","author":"Nerurkar","year":"2019","journal-title":"Lancet Psychiatry"},{"key":"2025090313520864000_6.3.e001303.3","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1016\/j.autrev.2018.12.009","article-title":"Systemic rheumatic diseases: from biological agents to small molecules","volume":"18","author":"Sarzi-Puttini","year":"2019","journal-title":"Autoimmun Rev"},{"key":"2025090313520864000_6.3.e001303.4","doi-asserted-by":"publisher","DOI":"10.1159\/000289205"},{"key":"2025090313520864000_6.3.e001303.5","first-page":"579","article-title":"Biologic treatment for rheumatic disease: real-world big data analysis from the Greek country-wide prescription database","volume":"35","author":"Sfikakis","year":"2017","journal-title":"Clin Exp Rheumatol"},{"key":"2025090313520864000_6.3.e001303.6","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1097\/BOR.0000000000000597","article-title":"Depression and the risk of rheumatoid arthritis","volume":"31","author":"Vallerand","year":"2019","journal-title":"Curr Opin Rheumatol"},{"key":"2025090313520864000_6.3.e001303.7","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1186\/s41927-019-0106-3","article-title":"Use of antidepressants and benzodiazepine-related hypnotics before and after initiation of TNF-\u03b1 inhibitors or non-biological systemic treatment in patients with rheumatoid arthritis, psoriatic arthritis or ankylosing spondylitis","volume":"4","author":"Brenner","year":"2020","journal-title":"BMC Rheumatol"},{"key":"2025090313520864000_6.3.e001303.8","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2017-211284"},{"key":"2025090313520864000_6.3.e001303.9","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1186\/s12891-016-1011-1","article-title":"Are depression and anxiety associated with disease activity in rheumatoid arthritis? A prospective study","volume":"17","author":"Matcham","year":"2016","journal-title":"BMC Musculoskelet Disord"},{"key":"2025090313520864000_6.3.e001303.10","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1186\/s13075-018-1644-6","article-title":"The prevalence of depression in axial spondyloarthritis and its association with disease activity: a systematic review and meta-analysis","volume":"20","author":"Zhao","year":"2018","journal-title":"Arthritis Res Ther"},{"key":"2025090313520864000_6.3.e001303.11","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1002\/acr.22249","article-title":"Impact of psychological factors on subjective disease activity assessments in patients with severe rheumatoid arthritis","volume":"66","author":"Cordingley","year":"2014","journal-title":"Arthritis Care Res (Hoboken)"},{"key":"2025090313520864000_6.3.e001303.12","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kev306"},{"key":"2025090313520864000_6.3.e001303.13","doi-asserted-by":"crossref","first-page":"828","DOI":"10.1016\/j.jid.2016.11.032","article-title":"Depression is associated with an increased risk of psoriatic arthritis among patients with psoriasis: a population-based study","volume":"137","author":"Lewinson","year":"2017","journal-title":"J Invest Dermatol"},{"key":"2025090313520864000_6.3.e001303.14","doi-asserted-by":"crossref","first-page":"20647","DOI":"10.1038\/srep20647","article-title":"Bidirectional associations between rheumatoid arthritis and depression: a nationwide longitudinal study","volume":"6","author":"Lu","year":"2016","journal-title":"Sci Rep"},{"key":"2025090313520864000_6.3.e001303.15","doi-asserted-by":"crossref","DOI":"10.1136\/rmdopen-2018-000670","article-title":"Depression as a risk factor for the development of rheumatoid arthritis: a population-based cohort study","volume":"4","author":"Vallerand","year":"2018","journal-title":"RMD Open"},{"key":"2025090313520864000_6.3.e001303.16","doi-asserted-by":"crossref","first-page":"127","DOI":"10.5152\/eurjrheum.2017.16100","article-title":"Rheumatoid arthritis: are psychological factors effective in disease flare?","volume":"4","author":"Y\u0131lmaz","year":"2017","journal-title":"Eur J Rheumatol"},{"key":"2025090313520864000_6.3.e001303.17","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-011-1704-y"},{"key":"2025090313520864000_6.3.e001303.18","doi-asserted-by":"publisher","DOI":"10.1111\/j.1749-6632.2009.04981.x"},{"key":"2025090313520864000_6.3.e001303.19","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0107791","article-title":"Risk of developing depressive disorders following rheumatoid arthritis: a nationwide population-based study","volume":"9","author":"Wang","year":"2014","journal-title":"PLoS One"},{"key":"2025090313520864000_6.3.e001303.20","doi-asserted-by":"crossref","unstructured":"Zusman EZ , Howren AM , Park JYE , et al. Epidemiology of depression and anxiety in patients with psoriatic arthritis: a systematic review and meta-analysis. Semin Arthritis Rheum doi: 10.1016\/j.semarthrit.2020.02.001.","DOI":"10.1016\/j.semarthrit.2020.02.001"},{"key":"2025090313520864000_6.3.e001303.21","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1186\/s13075-014-0418-z","article-title":"The risk for depression in patients with ankylosing spondylitis: a population-based cohort study","volume":"16","author":"Meesters","year":"2014","journal-title":"Arthritis Res Ther"},{"key":"2025090313520864000_6.3.e001303.22","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1186\/s41927-019-0111-6","article-title":"The incidence of depression and anxiety in patients with ankylosing spondylitis: a systematic review and meta-analysis","volume":"4","author":"Park","year":"2020","journal-title":"BMC Rheumatol"},{"key":"2025090313520864000_6.3.e001303.23","doi-asserted-by":"crossref","DOI":"10.1136\/rmdopen-2020-001223","article-title":"Impact of skin, musculoskeletal and psychosocial aspects on quality of life in psoriatic arthritis patients: a cross-sectional study of outpatient clinic patients in the biologic treatment era","volume":"6","author":"Haugeberg","year":"2020","journal-title":"RMD Open"},{"key":"2025090313520864000_6.3.e001303.24","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1093\/rheumatology\/kex528","article-title":"The relationship between depression and biologic treatment response in rheumatoid arthritis: an analysis of the British society for rheumatology biologics register","volume":"57","author":"Matcham","year":"2018","journal-title":"Rheumatology"},{"key":"2025090313520864000_6.3.e001303.25","doi-asserted-by":"publisher","DOI":"10.1007\/s10067-012-2162-6"},{"key":"2025090313520864000_6.3.e001303.26","doi-asserted-by":"crossref","first-page":"1360","DOI":"10.1111\/imj.14046","article-title":"Comorbidity in psoriatic arthritis and rheumatoid arthritis","volume":"48","author":"Sinnathurai","year":"2018","journal-title":"Intern Med J"},{"key":"2025090313520864000_6.3.e001303.27","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1007\/s40744-019-00172-9","article-title":"Comparative disease burden in patients with rheumatoid arthritis, psoriatic arthritis, or axial spondyloarthritis: data from two corona registries","volume":"6","author":"Mease","year":"2019","journal-title":"Rheumatol Ther"},{"key":"2025090313520864000_6.3.e001303.28","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0217412","article-title":"New insights into the prevalence of depressive symptoms and depression in rheumatoid arthritis \u2013 implications from the prospective multicenter VADERA II study","volume":"14","author":"Englbrecht","year":"2019","journal-title":"PLoS One"}],"container-title":["RMD Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/rmdopen-2020-001303","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T20:52:14Z","timestamp":1756932734000},"score":1,"resource":{"primary":{"URL":"https:\/\/rmdopen.bmj.com\/lookup\/doi\/10.1136\/rmdopen-2020-001303"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,9]]},"references-count":28,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2020,9,25]]},"published-print":{"date-parts":[[2020,9]]}},"alternative-id":["10.1136\/rmdopen-2020-001303"],"URL":"https:\/\/doi.org\/10.1136\/rmdopen-2020-001303","relation":{},"ISSN":["2056-5933"],"issn-type":[{"value":"2056-5933","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,9]]}}}