Schizophrenia in Rheumatoid arthritis patients: Management challenges

BACKGROUND: Schizophrenia (SCZ) and rheumatoid arthritis (RA) may remain as co-morbid diseases in clinical setting. In research it has been reported that one will influence the outcome of other disease. Hence, the psychiatrist should be aware of the interactions between immunomodulatory drugs and antipsychotics for better treatment outcomes. AIM: To understand clinically important drug-drug interaction and challenges in management of two middle aged females diagnosed with chronic rheumatoid arthritis and co-morbid schizophrenia. RESULT: We report 2 cases of RA with co morbid SCZ. The first case was maintaining on prednisolone and etanercept for RA and showed poor reponse to risperidone due to interaction with anti-rheumatoid drugs. The patient then improved on clozapine. The second case was being treated with methotrexate and olanzapine was initiated which showed improvement in schizophrenic as well as pain symptoms associated with RA. CONCLUSION: The metabolism of Risperidone can be increased when combined with Etanercept leading to reduced serum antipsychotic level and failure of treatment as found in this case. Also, olanzapine has unique pharmacological properties which can act as an adjunct to other pain medications prescribed for relief in RA patients. In the present cases, clozapine and olanzapine were beneficial respectively and therefore may be preferred over risperidone for management of schizophrenic patients with RA.