An example would be the discovery that individuals with genetically determined elevated cholesterol levels had higher rates of cardiovascular disease. This led to drug development of cholesterol lowering agents leading to reduced rates of cardiovascular disease and mortality.
A recent population-based study from a research team in Taiwan identified an increased risk of bipolar disorder in patients with rheumatoid arthritis.
In their study, 2,570 patients with a diagnosis of rheumatoid arthritis were identified from a national insurance database.
A comparison group of 2,570 patients without rheumatoid arthritis were identified as a control group.
The key finding from the study was an approximate doubling of the risk for a diagnosis of bipolar disorder in those with rheumatoid arthritis (odds ratio 2.13, 95% confidence interval 1.12-4.24). Rheumatoid arthritis patients had additional elevated bipolar riks if they also had asthma, cirrhosis of the liver or an alcohol use disorder.
The research team noted a possible explanation for increased risk of bipolar disorder following rheumatoid arthritis is inflammatory immune dysfunction.
Peripheral markers of inflammation in rheumatoid arthritis have been linked to upregulation of central nervous system inflammation. The authors note peripheral markers of inflammation known as cytokines may reach the brain through blood brain barrier leaks, active transport, activation of endothelial cells or cytokine receptor binding.
The clinical implications of this finding are important. Early active treatment of rheumatoid arthritis may reduce risk for central nervous system complications including bipolar disorder. Clinicians treating patients with rheumatoid arthritis should actively monitor for emergence of mood disorders including bipolar disorder.
One potential confounding issue in this study is the potential for rheumatoid arthritis medications to induce mood symptoms. Corticosteroid drugs such as prednisone are commonly used in rheumatoid arthritis. This class of drug is known to induce insomnia and hypomanic or manic states in some individuals.
Reader with more interest in this topic can access the free full-text manuscript by clicking on the PMID link below.
Photo of water lilies is from the author's files.
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Hsu CC, Chen SC, Liu CJ, Lu T, Shen CC, Hu YW, Yeh CM, Chen PM, Chen TJ, & Hu LY (2014). Rheumatoid arthritis and the risk of bipolar disorder: a nationwide population-based study. PloS one, 9 (9) PMID: 25229610
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