A stronger association of depression with rheumatoid arthritis in presence of obesity and hypertriglyceridemia

Grayden Shand; Daniel T Fuller; Leon Lufkin; Carly Lovelett; Nabendu Pal; Sumona Mondal; Shantanu Sur

doi:10.3389/fepid.2023.1216497

A stronger association of depression with rheumatoid arthritis in presence of obesity and hypertriglyceridemia

Front Epidemiol. 2023 Dec 15:3:1216497. doi: 10.3389/fepid.2023.1216497. eCollection 2023.

Authors

Grayden Shand^#¹, Daniel T Fuller^#², Leon Lufkin^{3

4}, Carly Lovelett⁵, Nabendu Pal⁶, Sumona Mondal², Shantanu Sur⁷

Affiliations

¹ David D. Reh School of Business, Clarkson University, Potsdam, NY, United States.
² Department of Mathematics, Clarkson University, Potsdam, NY, United States.
³ The Clarkson School, Clarkson University, Potsdam, NY, United States.
⁴ Department of Statistics and Data Science, Yale University, New Haven, CT, United States.
⁵ Saint Lawrence Health, Canton Potsdam Hospital, Potsdam, NY, United States.
⁶ Department of Mathematics, University of Louisiana at Lafayette, Lafayette, LA, United States.
⁷ Department of Biology, Clarkson University, Potsdam, NY, United States.

^# Contributed equally.

Abstract

Background: Rheumatoid arthritis (RA) is an autoimmune disorder characterized by chronic and systemic inflammation. Recent research underscores the role of chronic inflammation in multiple common RA comorbidities such as depression, obesity, and cardiovascular diseases (CVDs), suggesting a potential overlap of the pathogenic mechanisms for RA. However, it is not well understood how the coexistence of these comorbid conditions impacts the risk of RA and whether any such association relates to body's inflammatory state.

Methods: We used data from the 2007-2010 United States National Health and Nutrition Examination Survey (NHANES) database and compared RA prevalence between subsamples with the presence of any two conditions among depression, obesity, and hypertriglyceridemia (HTG). Each subsample was further divided into three categories based on the serum level of the inflammatory marker C-reactive protein (CRP) and analyzed for statistically significant differences using three-way χ² tests of independence.

Results: The study was conducted on 4,136 patients who fulfilled the inclusion criteria (representing 163,540,241 individuals after adjustment for sampling weights). Rates of depression, obesity, and HTG were found to be significantly higher (P < 0.001) among the subjects with RA compared with the control population with no arthritis. The presence of depression along with obesity or HTG showed a noticeably higher RA prevalence but such an association was not observed for the combination of obesity and HTG. The synergistic effect of HTG with depression was found to be most prominent at a medium CRP level (1-3 mg/L), while for obesity, the effect was observed across all CRP levels examined. These findings were further confirmed by the three-way χ² test for independence.

Conclusions: The presence of obesity or HTG in subjects suffering from depression might pose an increased risk of RA. Inflammatory mechanisms potentially play an important underlying role as suggested by the strong dependency of the association to CRP level. Identification of synergistic associations between RA risk conditions could provide useful information to predict the development and progress of RA.

Keywords: NHANES; c-reactive protein; comorbidities; depression; inflammation; interactions; synergistic effect.