Patients at Higher Risk of Self-Harm After Ankylosing Spondylitis Diagnosis, Study Finds

Self-harm is more common in people diagnosed with ankylosing spondylitis compared with the general population, a study reveals, suggesting the need for better mental health monitoring and support for patients after such a diagnosis.

The data were presented at the 2018 Annual European Congress of Rheumatology (EULAR) in a presentation titled “The risk of deliberate self-harm in rheumatoid arthritis and ankylosing spondylitis: a population-based cohort study.”

Being diagnosed with any disease can be scary, stressful, and overwhelming, and it take a serious toll on a person’s mental health. Understanding who is at the greatest risk for mental illness — especially when it interferes with daily living or results in self-destructive behaviors — can help clinicians better identify and care for the most vulnerable populations.

In this study, cohorts of people diagnosed with ankylosing spondylitis (13,964 people) or rheumatoid arthritis (53,240 people) were matched 1:4 by age, sex, and year at diagnosis with comparison cohorts (i.e. people without an inflammatory arthritic disease). The cohorts were monitored for emergency room visits due to self harm between 2002 and 2016; all participants were from Ontario, Canada.

The rate of emergency room visits for the ankylosing spondylitis (AS) cohort was nearly twice that of the respective comparison cohort (6.79 vs. 3.19 per 10,000 person-years). Emergency room self-harm visits were also more common in the rheumatoid arthritis (RA) cohort compared with its comparison cohort (3.51 vs. 2.45 per 10,000 person-years); however, this association was not statistically significant after the researchers adjusted for the patients’ baseline characteristics.

In both groups, the most common methods of self-harm were poisoning (64% of emergency room visits for AS and 81% for RA), and self-mutilation or cutting (36% for AS and 18% for RA).

“Our study is one of the first to document the risk of serious mental health outcomes following an RA or AS diagnosis and highlights the need for routine evaluation of self-harm behavior as part of the management of patients,” Nigil Haroon, MD, PhD, a professor at the University of Toronto and one of the study’s researchers, said in a press release.

Thomas Dörner, chairperson of the EULAR abstract selection committee, added: “This study is important because understanding the mechanisms that contribute to deliberate self-harm attempts will help tailor future preventive strategies to reduce morbidity associated with this serious mental health outcome.”