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Citation
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Prior JA, Paskins Z, Whittle R, Abdul-Sultan A, Chew-Graham CA, Muller S, Bajpai R, Shepherd TA, Sumathipala A, Mallen CD. Arthritis Care Res. (2010) 2020; ePub(ePub): ePub. |
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Abstract
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OBJECTIVE: To examine the risk of self-harm in rheumatological conditions
METHODS: Retrospective cohort study using data from the Clinical Practice Research Datalink. Patients with ankylosing spondylitis, fibromyalgia, osteoarthritis or rheumatoid arthritis were identified between 1990-2016 and matched to patients without these conditions. Incident self-harm was defined by medical record codes following a rheumatological diagnosis. Incidence rates (per 10,000 person-years(PY)) were reported for each condition, both overall and year-on-year(2000-2016). Cox regression analysis determined risk (hazard ratios(HR), 95% confidence interval(CI)) of self-harm for each rheumatological cohort compared to the matched unexposed cohort. Initial crude analysis was subsequently adjusted and stratified by age and gender. Due to non-proportionality over time, osteoarthritis was also stratified by disease duration(<1 year, ≥1-<5 years, ≥5-<10 years, ≥10 years).
RESULTS: Incidence of self-harm was highest in patients with fibromyalgia (25.12 (95%CI 22.45,28.11) per 10,000 PY) and lowest for osteoarthritis (6.48 (6.20, 6.76)). There was a crude association with each rheumatological condition and self-harm, except for ankylosing spondylitis. Though attenuated, these associations remained after adjustment for fibromyalgia (HR 2.06(95%CI 1.60,2.65)), rheumatoid arthritis (1.59(1.20,2.11)) and osteoarthritis (1-<5years: 1.12 (1.01,1.24); ≥5-<10 years: 1.35 (1.18,1.54)). Age and gender were weak effect modifiers for these associations.
CONCLUSIONS: Primary care patients with fibromyalgia, osteoarthritis or rheumatoid arthritis (but not ankylosing spondylitis) are at increased risk of self-harm compared to people without these rheumatological conditions. Clinicians need to be aware of the potential for self-harm in patients with rheumatological conditions (particularly fibromyalgia), explore mood and risk with them, and offer appropriate support and management.
Language: en |