Incidence of Anxiety and Depression after Achievement of Inactive/low Disease Activity in Axial/Spondyloarthropathy

Abstract

Objectives Axial spondyloarthropathy (axSpA) is a common rheumatic disease in young people and has important physiosocial implications. The purpose of this study is to examine the frequency of anxiety and depression in axSpA patients and to check whether achieving inactive/low disease activity or taking TNF inhibitors has a positive effect on anxiety/depression and quality of life (QOL).

Methods 149 axSpA patients were examined cross-sectionally over a period of two years. Baseline characteristics were recorded. Disease activity is measured using the ASDAS-CRP index. The patients were evaluated in 2 groups according to their disease activity, as inactive-low disease activity or moderate-high disease activity. The treatments they received were analysed into two groups as NSAIDs and TNF inhibitors. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS). Quality of life was measured with the EuroQOL (EQ5D).

Results 33.6% of all axSpA patients were diagnosed with probable anxiety disorder and 47% with probable depression. These rates were similar in inactive-low disease activity patients, with 38% for anxiety and 32% for depression. While the incidence of anxiety and depression did not change between patients with inactive- low disease activity and moderate-high disease activity (for anxiety p=0.173 and for depression p=0.375), there was also no difference between patients receiving TNF inhibitor treatment and NSAIDs (p=0.149 and p=0.235). Radiographic form of axSpA was predictive of probable anxiety and depression. Peripheral arthritis is also predictive of probable depression.

Conclusion Although axSpA patients had inactive-low disease activity and received TNF inhibitors, there was no significant reduction in the incidence of anxiety and depression. In addition to controlling disease activity and inflammation, regular psychosocial assessment should be part of the management of axSpA patients.

Key words

anxiety - Axial-SPA - depression - QOL - inactive-low disease activity

Schlüsselwörter

Angst - Axial-SPA - Depression - QOL - inaktiv – geringe Krankheitsaktivität

Publication History

Article published online:
28 September 2023

• References

• 1 Smolen JS, Braun J, Dougados M. et al. Treating spondyloarthritis, including ankylosing spondylitis and psoriatic arthritis, to target: recommendations of an international task force. Ann Rheum Dis 2014; 73: 6-16
• 2 Anderson JJ, Baron G, van der Heijde D. et al. Ankylosing spondylitis assessment group preliminary definition of short-term improvement in ankylosing spondylitis. Arthritis Rheum 2001; 44: 1876-1886
• 3 Machado P, Landewe R, Lie E. et al. Ankylosing Spondylitis Disease Activity Score (ASDAS): defining cut-off values for disease activity states and improvement scores. Ann Rheum Dis 2010; 70: 47-53
• 4 Depression and Other Common Mental Disorders: Global Health Estimates. Geneva: World Health Organization; 2017. Licence: CC BY-NC-SA 3.0 IGO
• 5 Ferrari AJ, Charlson FJ, Norman RE. et al. Burden of depressive disorders by country, sex, age, and year: findings from the global burden of disease study 2010. PLoS Medicine 2013; 10: e1001547
• 6 Prina AM, Ferri CP, Guerra M. et al. Prevalence of anxiety and its correlates among older adults in Latin America, India and China: cross-cultural study. Br J Psychiatry 2011; 199: 485-491
• 7 Moffitt TE, Caspi A, Taylor A. et al. How common are common mental disorders? Evidence that lifetime prevalence rates are doubled by prospective versus retrospective ascertainment. Psychol Med 2010; 40: 899-909
• 8 Marrie RA, Hitchon CA, Walld R. et al. Increased burden of psychiatric disorders in rheumatoid arthritis. Arthritis Care Res (Hoboken) 2018; 70: 970-978
• 9 Kamalaraj N, El-Haddad C, Hay P. et al. Systematic review of depression and anxiety in psoriatic arthritis. Int J Rheum Dis 2019; 22: 967-973
• 10 Shen CC, Hu LY, Yang AC. et al. Risk of psychiatric disorders following ankylosing spondylitis: a nationwide population-based retrospective cohort study. J Rheumatol 2016; 43: 625-631
• 11 Meesters JJ, Bremander A, Bergman S. et al. The risk for depression in patients with ankylosing spondylitis: a population-based cohort study. Arthritis Res Ther 2014; 16: 418
• 12 Strigo IA, Simmons AN, Matthews SC. et al. Association of major depressive disorder with altered functional brain response during anticipation and processing of heat pain. Arch Gen Psychiatry 2008; 65: 1275-1284
• 13 Rudwaleit M, van der Heijde D, Landewé R. et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis 2009; 68: 777-783
• 14 Lambert RG, Bakker PA, van der Heijde D. et al. Defining active sacroiliitis on MRI for classification of axial spondyloarthritis: update by the ASAS MRI working group. Ann Rheum Dis 2016; 75: 1958-1963
• 15 Heuft-Dorenbosch L, Spoorenberg A, vanTubergen A. et al. Assessment of enthesitis in ankylosing spondylitis. Ann Rheum Dis 2003; 62: 127-132
• 16 Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983; 67: 361-370
• 17 GROUP TE. EuroQol— a new facility for themeasurement of health-related quality of life. Health Policy 1990; 16: 199-208
• 18 Zhao S, Thong D, Miller N. et al. The prevalence of depression in axial spondyloarthritis and its association with disease activity: a systematic review and meta-analysis. Arthritis Res Ther 2018; 20: 140
• 19 Martindale J, Smith J, Sutton CJ. et al. Disease and psychological status in ankylosing spondylitis. Rheumatology. 2006; 45: 1288-1293
• 20 Xu X, Shen B, Zhang A. et al. Anxiety and depression correlate with disease and quality-of-life parameters in Chinese patients with ankylosing spondylitis. Patient Prefer Adherence 2016; 10: 879-885
• 21 Costantino F, Talpin A, Said-Nahal R. et al. Prevalence of spondyloarthritis in reference to HLA-B27 in the French population: results of the GAZEL cohort. Ann Rheum Dis 2015; 74: 689-693
• 22 Stolwijk C, Boonen A, van Tubergen A. et al. Epidemiology of spondyloarthritis. Rheum Dis Clin N Am 2012; 38: 441-476
• 23 Kekow J, Moots R, Khandker R. et al. Improvements in patient-reported outcomes, symptoms of depression and anxiety, and their association with clinical remission among patients with moderate-to-severe active early rheumatoid arthritis. Rheumatology 2011; 50: 401-409
• 24 Ho RCM, Fu EHY, Chua ANC. et al. Clinical and psychosocial factors associated with depression and anxiety in Singaporean patients with rheumatoid arthritis. International Journal of Rheumatic Diseases 2011; 14: 37-47
• 25 Overman CL, Bossema ER, van Middendorp H. et al. The prospective association between psychological distress and disease activity in rheumatoid arthritis: a multilevel regression analysis. Annals of the Rheumatic Diseases 2012; 71: 192-197
• 26 Kaster MP, Gadotti VM, Calixto JB. et al. Depressive-like behavior induced by tumor necrosis factor-α in mice. Neuropharmacology. 2012; 62: 419-426
• 27 Clark IA, Alleva LM, Vissel B. The roles of TNF in brain dysfunction and disease. Pharmacol Ther 2010; 128: 519-548
• 28 Zhu CB, Blakely RD, Hewlett WA. The proinflammatory cytokines interleukin-1beta and tumor necrosis factor-alpha activate serotonin transporters. Neuropsychopharmacology. 2006; 31: 2121-2131
• 29 Lu S, Peng H, Wang L. et al. Elevated specific peripheral cytokines found in major depressive disorder patients with childhood trauma exposure: a cytokine antibody array analysis. Compr Psychiatry 2013; 54: 953-961
• 30 Miller DB, O’Callaghan JP. Depression, cytokines, and glial function. Metabolism. 2005; 54: 33-38
• 31 Zhu CB, Blakely RD, Hewlett WA. The proinflammatory cytokines interleukin-1beta and tumor necrosis factor-alpha activate serotonin transporters. Neuropsychopharmacology. 2006; 31: 2121-2131
• 32 Wichers M, Maes M. The psychoneuroimmuno-pathophysiology of cytokine-induced depression in humans. Int J Neuropsychopharmacol 2002; 5: 375-388
• 33 Ertenli I, Ozer S, Kiraz S. et al. Infliximab, a TNF-alpha antagonist treatment in patients with ankylosing spondylitis: the impact on depression, anxiety and quality of life level. Rheumatol Int 2012; 32: 323-330
• 34 Arısoy O, Bes C, Cifci C. et al. The effect of TNF-alpha blockers on psychometric measures in ankylosing spondylitis patients: a preliminary observation. Rheumatol Int 2013; 33: 1855-1864
• 35 Raison CL, Rutherford RE, Woolwine BJ. et al. A randomized controlled trial of the tumor necrosis factor antagonist infliximab for treatment-resistant depression: the role of baseline inflammatory biomarkers. JAMA Psychiatry 2013; 70: 31-41
• 36 Zhao SS, Jones GT, Hughes DM. et al. Depression and anxiety symptoms at TNF inhibitor initiation are associated with impaired treatment response in axial spondyloarthritis. Rheumatology (Oxford) 2021; 60: 5734-5742
• 37 Hider SL, Tanveer W, Brownfield A. et al. Depression in RA patients treated with anti-TNF is common and under-recognized in the rheumatology clinic. Rheumatology (Oxford) 2009; 48: 1152-1154
• 38 Lord PA, Farragher TM, Lunt M. et al. BSR Biologics Register. Predictors of response to anti-TNF therapy in ankylosing spondylitis: results from the British Society for Rheumatology Biologics Register. Rheumatology (Oxford) 2010; 49: 563-570