Background Axial spondyloarthritis (axSpA) comprises a heterogeneous group of diseases which predominantly involve axial skeleton and have many overlapping clinical features. In axSpA, many of the symptoms and clinical features (i.e. reduced spinal mobility, stiffness, pain, fatigue, sleep disturbances) may contribute to functional limitations, physical disability, reduced quality of life and psychological distress. Psychological distress including depression and anxiety is frequently reported in patients with rheumatic disorders and is considered as an important factors affecting the outcome measures.
Objectives The aim of this study was to investigate the psychiatric status in axSpA and its relationship with self-reported outcome measures and clinical parameters.
Methods Patients with axSpA were recruited from our spondyloarthritis cohort at Erciyes University. All of the patients met Assessment of SpondyloArthritis International Society (ASAS) classification criteria for axial SpA and assessed by using validated instruments including VAS-pain, BASDAI, BASFI, ASQoL and ASDAS-CRP. Psychological status was evaluated by the Hospital Anxiety and Depression Scale (HADS) which included the depression (HADS-D) and anxiety subscales (HADS-A). Multiple regression analysis was used to determine the associations between psychological variables and clinical parameters after adjusting for confounding demographic variables and disease parameters.
Results Of the 239 patients with axial SpA (nr-axSpA=104, AS=135), 111 (46.4%) had high risk for depression and 54 (22.6%) for anxiety. There was no difference in HADS-D and HADS-A scores between patients with AS and nr-axSpA. Patients with high risk for depression and anxiety had higher scores BASDAI, BASFI, ASDAS-CRP and also poorer scores in VAS pain and ASQoL. HADS-D scores significantly correlated with clinical parameters including BASMI (r:0.13, p:0.046), ASQoL (r:0.55, p<0.0001), BASDAI (r: 0.38, p<0.0001), BASFI (r: 0.42, p<0.0001), VAS pain (r:0.26,p<0.0001) and ASDAS-CRP (r: 0.29, p<0.0001). Also, educational level of the patients negatively correlated with HADS-D and HADS-A scores (r: -0.20, p=0.001; r: -0.18, p=0.006, respectively). Multivariate logistic regression analysis revealed that the ASDAS-CRP, ASQoL, BASDAI, smoking and educational level were factors that influence the risk of depression whereas the ASQoL and educational level were factors that influence the risk of anxiety (Table 1).
Conclusions Patients with nr-axSpA and AS may have similar burden of psychological distress. ASDAS-CRP, ASQoL, BASDAI, smoking and educational level were estimated as the important risk factors for psychological distress in patients with axSpA. Therefore psychological status should not been overlooked in the assessment of patients with axial SpA.
Baysal O, et al. Rheumatol Int. 2011 Jun;31(6):795-800.
Disclosure of Interest None declared