Data indicate that post-traumatic stress disorder (PTSD) appears to be a risk factor for the development of rheumatoid arthritis (RA). Ted R. Mikuls, MD, and colleagues have also found that among US veterans with RA, PTSD is associated with more severe disease. With nearly 1 in 6 of veterans with RA also having PTSD, Dr. Mikuls and colleagues sought to understand whether specific inflammatory molecules are differentially expressed (and could potentially be targeted by treatment) in this patient population.

For a study published in Seminars in Arthritis & Rheumatism, the researchers compared serum cytokine/chemokine (cytokine) concentrations in RA patients with and without PTSD. The study team measured 17 cytokines/chemokines using banked blood samples and used physician diagnoses to identify those who also had PTSD.

The 1,460 participants with RA, had a mean age of 64 years, disease duration of 11 years, 91% were male, 77% were anti-cyclic citrullinated peptide (CCP) positive, and 80% were ever smokers. Among them, 11.6% had PTSD, 23.7% had other depression/anxiety, and 64.7% had neither. PTSD, but not depression/anxiety, was associated with a higher cytokine score and number of high-concentration analytes in adjusted models, though this was limited to anti-CCP-positive subjects. PTSD was associated with heightened expression of more than a dozen cytokines.

“Our study suggests that PTSD could actually influence the course of RA, or conversely, that RA adversely influences PTSD,” says Dr. Mikuls. “Patients with RA and PTSD had evidence of heightened inflammation even after accounting for differences in therapy, emphasizingthe need for a holistic approach to treating patients with RA, understanding that comorbid psychiatric disease (in this case, PTSD) can adversely impact the course of arthritis and that effective management may need to be tailored appropriately.”


Post-traumatic stress disorder and serum cytokine and chemokine concentrations in patients with rheumatoid arthritis