Rheumatological Conditions and the Risk of Self-harm

Sarfaroj Khan 

June 23, 2020


  • Primary care patients with rheumatological conditions of fibromyalgia, rheumatoid arthritis (RA) or osteoarthritis (OA) were at an increased risk of self-harm compared with without these rheumatological conditions.

  • In contrast, no association was seen between ankylosing spondylitis and self-harm.

Why this matters

  • Physicians need to be aware of the potential for self-harm in patients with rheumatological conditions, especially fibromyalgia and offer appropriate support and management.

Study design

  • This retrospective study included patients with ankylosing spondylitis (n=10,484), fibromyalgia (n=17,546), OA (n=410,384) and RA (n=23,205) and matched unexposed participants using data from the UK Clinical Practice Research Datalink between 1990 and 2016.

  • Funding: National Institute for Health Research School for Primary Care Research and others.

Key results

  • The incidence rate of self-harm per 10,000 person-years was:

    • fibromyalgia cohort: 25.12 (95% CI, 22.45-28.11);

    • ankylosing spondylitis cohort: 11.37 (95% CI, 9.37-13.81);

    • RA cohort: 9.70 (95% CI, 8.32-11.29); and

    • OA cohort: 6.48 (95% CI, 6.20-6.76).

  • The year-on-year incidence of self-harm across each rheumatological condition remained relatively consistent from 2000 to 2016.

  • The adjusted hazard ratio of self-farm associated with each rheumatological condition was:

    • fibromyalgia: 2.06 (95% CI, 1.60-2.65);

    • RA: 1.59 (95% CI, 1.20-2.11);

    • OA:

      • 1 to <5 years: 1.12 (95% CI, 1.01-1.24);

      • ≥5 to <10 years: 1.35 (95% CI, 1.18-1.54);

      • ≥10 years: 1.17 (95% CI, 0.98-1.40); and

    • ankylosing spondylitis: 0.95 (95% CI, 0.69-1.31).

  • Age and gender were weak effect modifiers of the association between all rheumatological cohorts and subsequent self-harm.


  • Possibility of residual confounding.

Prior JA, Paskins Z, Whittle R, Abdul-Sultan A, Chew-Graham CA, Muller S, Bajpai R, Shepherd TA, Sumathipala A, Mallen CD. Rheumatological conditions as risk factors for self-harm: A retrospective cohort study. Arthritis Care Res (Hoboken). 2020 Jun 11 [Epub ahead of print]. doi: 10.1002/acr.24345. PMID: 32526099 Abstract.

This clinical summary first appeared on Univadis, part of the Medscape Professional Network.


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