Vol.23 No.5

Original Article

Depression is improved when low-dose tacrolimus is given to rheumatoid arthritis patients showing an inadequate response to biologic agents

Authors

Yusuke Miwa1 , Michio Hosaka2 , Kumiko Ohtsuka1 , Michihito Sato1 , Ryo Takahashi1 , Kuninobu Wakabayashi1 , Tsuyoshi Odai1 , Nobuyuki Yajima1 , Tsuyoshi Kasama1

  • Division of Rheumatology, Department of Internal Medicine, Showa University School of Medicine, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
  • Katsuyama Clinic, Yamanashi, Japan
Received:

1 June 2012

Accepted:

29 August 2012

Published online:

19 September 2012

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Abstract

Purpose Depression in rheumatoid arthritis (RA) patients
is more severe than in healthy people. Herein, we report
improved depression in RA patients using biologic agents.
We examined whether depression was improved by tacrolimus
combination therapy when biologic agents were
ineffective.
Method The study included 13 RA patients who used
biologic agents. The following methods were used before
the initiation of tacrolimus combination therapy and at
14 and 30 weeks after treatment initiation: the Zung selfrating
depression scale (SDS) to evaluate depression state,
disease activity score 28/erythrocyte sedimentation rate
(DAS28), tender joint counts, swollen joint counts, a
patient global assessment to evaluate RA disease activity,
and the modified health assessment questionnaire (mHAQ)
to evaluate quality of life.
Results The SDS scores before the initiation of tacrolimus
combination therapy and at 14 and 30 weeks after
treatment initiation were 45.2 ± 10.6, 44.8 ± 12.8, and
41.6 ± 11.2 (p = 0.047), respectively, indicating significant
improvement. The DAS28 was 5.0 ± 1.3 prior to
treatment, 3.8 ± 1.3 at 14 weeks, and 3.5 ± 0.9 at
30 weeks, demonstrating significant improvement at both
14 and 30 weeks (p\0.001). The mHAQ score changed
from 0.60 ± 0.45 at baseline to 0.54 ± 0.52 and 0.38 ±
0.43 at 14 and 30 weeks, respectively. The mHAQ score
was significantly lower at 30 weeks when compared to
baseline (p = 0.013).
Conclusion Tacrolimus combination therapy does not
directly improve depression in RA patients, but it is possible
that the observed improvement in depression
accompanies the improvement in the secondary failure of
RA.

Key words

Rheumatoid arthritis, Tacrolimus, Depression, Biologic agent therapy