Background The Bath Ankylosing Spondylitis Diseases Activity Index (BASDAI) is widely used to assess disease activity in axial spondyloarthritis (axSpA) and is a criterion for initiating anti-TNF therapy. Psychological distress (anxiety/depression) may be related to BASDAI scores (1), which may be an issue when using the BASDAI to decide on treatment strategies. Do stable personality traits like dispositional optimism-a general positive mood or attitude towards the future-also influence BASDAI results?
Objectives To determine if BASDAI scores are influenced by optimism in axSpA.
Methods A cross-sectional study was performed in two tertiary care hospitals and one office-based practice in France (2). Patients had definite axSpA according to the rheumatologist. Auto-questionnaires included the BASDAI and optimism, evaluated through the French version of the Life Orientation Test-Revised (LOT-R) (3). The LOT-R consists of 10 questions:the score ranges from 0 (low optimism) to 24 (high optimism). Analyses included Spearman correlation and multivariate regression analyses to explain BASDAI based on optimism, adjusted on demographic variables and anxiety/depression, evaluated through the Hospital Anxiety and depression scale (HADS).
Results 206 patients were included: mean age, 46.3 years, 49.0% were men. Mean disease duration was 15.5±10.8 yrs, mean BASDAI (0-10) was 3.8±2.0. Optimism was low to moderate: mean LOT-R score was 13.7±4.3. Optimism was significantly though slightly correlated to BASDAI scores: R=-0.15, p=0.04. However, in the multivariate analysis, there was no significant relationship between BASDAI and optimism.
Conclusions Optimism was not associated to BASDAI scores in multivariate analyses. This result confirms that BASDAI is a valid tool, which can be interpreted independently of patients' personality traits like optimism. This result is reassuring in view of the reports of a relationship between anxiety/depression and BASDAI. However, optimism is a stable personality trait through life whereas anxiety and depression are variable psychological states. More work is needed on the best ways to analyse SpA activity; in particular ASDAS should be further evaluated.
Brionez TF, et al. Psychological Correlates of Self-Reported Disease Activity in Ankylosing Spondylitis. J Rheumatol 2010; 37:829-34.
Fabre S, et al. Do Patients with Axial Spondyloarthritis (AxSpA) Perform Enough Physical Activity? a Cross-Sectional Study of 207 Patients. Arthritis Rheum 2014, 66(suppl):S1125.
Scheier MF et al. Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): A re-evaluation of the Life Orientation Test. J Pers Soc Psychol 1994, 67:1063-78.
Disclosure of Interest None declared