Sustained remission of rheumatoid arthritis with SSRI antidepressant: a case report and review of literature

Krishnadas, R. , Krishnadas, R. and Cavanagh, J. (2011) Sustained remission of rheumatoid arthritis with SSRI antidepressant: a case report and review of literature. Journal of Medical Case Reports, 5(112), (doi: 10.1186/1752-1947-5-112)

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The mainstay of pharmacological therapy of Rheumatoid Arthritis includes the use of disease modifying agents (DMARDS) like sulphasalazine and methothrexate, and more recently anti TNF alpha agents. Depression remains a major co-morbidity in patients with Rheumatoid arthritis and is thought to contribute to disability and mortality in these patients. There is now evidence to suggest that a biological link exists between substrates responsible for inflammatory conditions and mood disorders. Most of this evidence comes from preclinical studies. Nevertheless, more research into this area is helping us understand the possible mechanisms through which these conditions interact with each other. Case presentation: We describe a 60 year old Indian man with rheumatoid arthritis diagnosed 15 years ago who had minimal response to multiple therapies with DMARDs, whose arthritis symptoms surprisingly remitted when he was started on an specific serotonin reuptake inhibitor (SSRI) antidepressant, 3 years ago, for co-morbid major depression. This remission has been maintained on this medication and the patient is currently not on any antirheumatoid medications. Conclusion: Possible mechanisms linking substrates of mood disorders and inflammation are reviewed in this case report, particularly the serotonergic system. There seems to be evidence for a significant interaction between the serotonergic systems and inflammation. This interaction seems to be bidirectional. An understanding of this relationship is most important to gain insight not only into pathophysiological mechanisms underlying these condition, but also into how treatments for these conditions may compliment each other and possibly provide greater therapeutic options in both these disabling conditions.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Krishnadas, Dr Rajeev and Cavanagh, Professor Jonathan
Authors: Krishnadas, R., Krishnadas, R., and Cavanagh, J.
Subjects:R Medicine > R Medicine (General)
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Mental Health and Wellbeing
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Clinical Specialities
Journal Name:Journal of Medical Case Reports
Publisher:BioMed Central
ISSN (Online):1752-1947
Published Online:19 March 2011
Copyright Holders:Copyright © 2011 The Authors
First Published:First published in Journal of Medical Case Reports 5:112
Publisher Policy:Reproduced in accordance with the copyright policy of the publisher

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