AS patients twice as likely to harm selves

Patients with ankylosing spondylitis (AS) are nearly twice as likely to harm themselves compared with the general population, a Canadian study has shown, highlighting the need for tailored preventive strategies in these patients.

AS is a systemic disease, with symptoms that include pain and stiffness in the low back, buttocks, and hips.  There can be an overgrowth in the bones which can lead to “bony fusion” that may impair a patient’s ability to perform routine activities.

“We have not looked into the cause … it could be due to pain, anxiety, stress, lack of social support, or isolation, all of which can lead to depression,” said senior investigator Dr Nigil Haroon from the University of Toronto in Toronto, Canada. “Depression, we think, really plays a role here.”

Haroon and his team looked into the health records of 53,240 patients with rheumatoid arthritis (RA) and 13,964 with AS to evaluate self-harm among these patients and the number of those presenting to the emergency department. Those with a history of mental illness and who had harmed themselves before their diagnosis were excluded from the analysis. They were matched for age and sex with a cohort from the general population at 1:4 ratio. [EULAR 2018, abstract OPO296]

Results showed that patients with AS were at increased risk of harming themselves vs the matched group (incidence rate [IR], 6.79 vs 3.19/10,000 person-years; adjusted hazard ratio [HR], 1.82; 95 percent confidence interval [CI], 1.26 - 2.62). By comparison, patients with RA were also at increased risk for self-harm before covariate adjustment (IR, 3.51 vs 2.45/10,000 person-years; HR, 1.43; 95 percent CI, 1.16 - 1.75), but not after adjustment (HR, 1.09; 95 percent CI, 0.88 - 1.36).

Poisoning (64 percent in the AS group vs 81 percent in the RA group) and self-mutilation (36 percent in the AS group vs 18 percent in the RA group) were the most frequent methods of self-harm identified in the study. “These are very important events that we as clinicians should be concerned about … we should recognize the signs [of depression] in our patients.”

“For any chronic disease, we need to concentrate on mental health, low mood, and depression,” he said. Haroon also sees the importance of communicating with patients to find out if they were starting to lose interest in activities they used to enjoy before, whether they have stopped exercising, or stopped seeing friends.

For some patients who have become isolated because of their disease, a trip to the clinic can be an important social event, he added.

Understanding the mechanisms that contribute to deliberate self-harm attempts, not only in those presenting to the emergency department but in a wider patient setting, will help tailor future preventive strategies to reduce morbidity associated with this serious mental-health outcome. More studies on depression in AS patients are warranted.