Rheumatoid arthritis is a common systemic inflammatory disorder primarily affecting synovial joints. Peripheral inflammation can up-regulate neuroinflammation, inducing neurological damage that can affect mood and cognition. Chronic neuroinflammation has been proposed to be a contributory factor in the development of bipolar disorder, with studies demonstrating elevated inflammatory markers in people with the disorder.

What is the evidence for rheumatoid arthritis?

Moderate quality evidence finds a medium-sized increased risk of bipolar disorder in people with rheumatoid arthritis compared to people without rheumatoid arthritis.

October 2021

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People with schizophrenia show increased rates of co-occurring conditions, including various disorders affecting the musculoskeletal system. Common disorders include; osteoporosis and the less severe osteopenia, which occur when bones lose minerals more quickly than the body can replace them, causing a loss of bone thickness; rheumatoid arthritis and systemic lupus erythematosus result from a malfunctioning immune system that mistakenly attacks healthy tissue; and ankylosing spondylitis is a type of inflammatory arthritis that mainly affects the spine.

What is the evidence for comorbid musculoskeletal and connective tissue abnormalities?

Moderate quality evidence finds small to medium-sized increased rates of fractures and osteoporosis in people with schizophrenia compared to controls. However, there are reduced rates of rheumatoid arthritis and ankylosing spondylitis. No significant differences were found in rates of osteopenia or systemic lupus erythematosus.

June 2020

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