BACKGROUND: Rheumatoid arthritis (RA) and axial spondyloarthritis (axSpA) are autoimmune illnesses characterised by chronic inflammation demonstrating differential associations with psychiatric conditions. OBJECTIVE: In this matched-cohort study, we aimed to investigate whether the associations between these inflammatory illnesses and mental disorders are predominantly the consequence of the burden of the former or whether common causes might underpin the susceptibility to both. METHODS: Using Czech national inpatient care data, we identified individuals with RA or axSpA during the years 1999-2012. We investigated the occurrence of psychiatric outcomes up to 2017 using stratified Cox proportional hazards models. In evidence triangulation, we assessed the potential moderation by age at inflammatory illness, the associations relative to counterparts with other similarly burdensome chronic illnesses and the temporal ordering of conditions. FINDINGS: Both RA and axSpA were associated with mood and anxiety disorders and behavioural syndromes. In evidence triangulation, the associations with depression showed a decreasing age-at-inflammatory-illness gradient in RA; the association between RA and depression was stronger than that between other chronic illnesses and depression; and excluding prevalent depression attenuated the RA-depression association. RA showed consistent inverse associations with schizophrenia and Alzheimer's disease. CONCLUSIONS: Common aetiologies might be involved in increasing the risk of developing both RA and depression. The consistent inverse associations between RA and schizophrenia and between RA and Alzheimer's disease suggest that at least part of these associations might also be a consequence of shared aetiologies as well as potential medication effects. CLINICAL IMPLICATIONS: People with autoimmune arthritides are more likely to experience mood and anxiety disorders, even relative to counterparts with other similarly burdensome chronic illnesses.

3rd Faculty of Medicine Charles University Prague Czechia

Cambridgeshire and Peterborough NHS Foundation Trust Cambridge UK

Clinical Center National Institute of Mental Health Klecany Czechia

Department of Clinical Epidemiology Aarhus University and Aarhus University Hospital Aarhus Denmark

Department of Psychiatry Faculty of Medicine in Pilsen Charles University Pilsen Czechia

Department of Psychiatry University of Cambridge Cambridge UK

Department of Public Mental Health National Institute of Mental Health Klecany Czechia

Department of Rheumatology 1st Faculty of Medicine Charles University Prague Czechia

Department of Social Work Faculty of Arts Charles University Prague Czechia

Health Service and Population Research Department Institute of Psychiatry Psychology and Neuroscience King's College London London UK

Institute of Clinical Sciences and MRC Laboratory of Medical Sciences Imperial College London London UK

Institute of Rheumatology Prague Czechia

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