Depression in RA
Caffeine Effects

OP0017 Depression Increases the Risk of Mortality in Rheumatoid Arthritis
F Wolfe, HK Choi

The direction of causality between rheumatoid arthritis (RA) and depression and their role in mortality is unclear. The purpose of this study was to assess the relationship between depression and RA. Using National Data Bank for Rheumatic Diseases records from 1981-2000, 1499 RA patients, of which 544 died, had completed 27,773 depression questionnaires from the Arthritis Measurement Impact Scales (AIMS). The relationship of depression (AIMS score >4) to other variables was compared with generalized estimating equations (GEE). Data was adjusted for demographics and duration of disease.

Results: In this group of RA patients, increased education and income were related to less depression. HAQ scores were also strongly related to depression (odds ratio 2.33 (95% CI 2.11, 2.59, p<0.001) as was pain (OR 1.214) and global assessment (OR 1.342). After adjusting for all covariates, the hazard ratio for an AIMS depression score of >4 over the course of the disease was 1.33 (95% CI 1.09, 1.63). In summary, Dr. Wolfe reported that the risk of mortality is 1.5x higher in RA patients that report depression.

Editorial Comment: Depression has been a well-described complication of rheumatoid arthritis. In patients without RA, depression has been linked to poorer surgical outcomes and increased mortality after myocardial infarction. Thus, while it is not surprising that depression in RA is linked to more severe disease leading to excessive mortality, its clear demonstration in this well conceived study is noteworthy. This study highlights the importance of recognition and management of depression in RA.

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FRI0034 Does Heavy Caffeine Ingestion Affect the Efficacy of Methotrexate?
CM Silke, MS Murphy, S Bustee, TB Murphy, M Phelan, MG Molloy

It has been shown in the rat adjuvant arthritis model that the nonselective adenosine receptor antagonist caffeine reverses the anti-inflammatory effects of methotrexate (MTX). (Montesinos, et al. Arthritis Rheum 43:656, 2000) In this study, 91 patients who had received MTX treatment were interviewed. The average dose of methotrexate was 12.5 mg. Patients who drank > 7 cups of coffee per week were classified as a regular coffee drinker, while those that drank < 7 cups were classified as a minimal coffee drinker.

Dr. Silke, et al found that regular coffee drinkers have a higher rate of discontinuation of MTX due to treatment failure than do minimal coffee drinkers (P = 0.02). Regular coffee drinkers also experience fewer side effects from MTX treatment compared to minimal coffee drinkers. The authors suggest that this may account for the use of higher doses of MTX in countries where caffeine consumption is higher. They also suggest that patients on MTX treatment should reduce their caffeine intake.

Editorial Comment: This is an interesting preliminary study with possible practical clinical implications. The investigators need to extend their observations to include cohorts of heavy coffee drinkers to see if there truly is a dose response to caffeine intake. In addition, other caffeinated beverages should be included in the assessment. Is it caffeine or other ingredients in coffee that is responsible for the effect?

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