Rheumatology 2003; 42: 1571-1572
© 2003 British Society for Rheumatology
Letter to the Editor |
Suicides in persons suffering from rheumatoid arthritis
Nihon University School of Medicine, Internal Medicine I, Tokyo, Japan. E-mail: m-2000{at}mbk.ocn.ne.jp
SIR, I read with interest the detailed report by Timonen et al. [1] assessing suicides in patients with rheumatoid arthritis (RA). They studied suicides of RA patients using official death certificates based on forensic medico-legal investigation of Oulu, Finland and found 19 suicide victims to be RA patients. As a result, they concluded that the presence of depressive disorders and a history of at least one suicide attempt were risks for suicide completion. They also observed a unique phenomenon—half of suicidal patients with RA were women. This tendency is not in agreement with suicide cases in non-RA individuals: in general, men are at a higher risk than women. Of the 21 suicide victims, eight patients (female:male, 6:2) had been admitted to hospital owing to psychiatric problems prior to suicide completion. Because patients with systemic lupus erythematosus (SLE) have a relatively high risk for suicide [2–4] and because women are at a higher risk of developing SLE, some of the six RA patients who committed suicide might have had concurrent SLE. In addition, I would like the order of the onset time of the two diseases to be confirmed, i.e. did RA precede psychiatric disease or did psychiatric disease precede RA. When patients with psychiatric disease develop RA and subsequently attempt suicide, it is reasonable to assume that such suicides are related to psychiatric disease. Therefore, I would be very grateful if information on the presence of co-morbid rheumatic diseases and the onset time of both RA and psychiatric disease could be provided. They would be very helpful in understanding the mechanism that induces suicide in patients with rheumatic diseases such as RA and SLE.
References
- Timonen M, Viilo K, Hakko H et al. Suicides in persons suffering from rheumatoid arthritis. Rheumatology 2003;42:287–91.
[Abstract/Free Full Text] - Matsukawa Y, Sawada S, Hayama T, Usui H, Horie T. Suicide in patients with systemic lupus erythematosus: clinical analysis of seven suicidal patients. Lupus 1994;3:31–5.
[Abstract/Free Full Text] - Ishikura R, Morimoto N, Tanaka K et al. Factors associated with anxiety, depression and suicide ideation in female outpatients with SLE in Japan. Clin Rheumatol 2001;20:394–400.[CrossRef][Medline]
- Karassa FB, Magliano M, Isenberg DA. Suicide attempts in patients with systemic lupus erythematosus. Ann Rheum Dis 2003;62:58–60
[Abstract/Free Full Text]
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