Depression worsens quality of life, function for patients with axial spondyloarthropathy

In patients with axial spondyloarthropathy, depression appears to have a negative impact on quality of life and function, though it is not associated with advanced structural disease, according to findings presented at the American College of Rheumatology Annual Meeting.

“The association of depression with poor health outcomes in rheumatic diseases such as rheumatoid arthritis is well established. However, the impact of depression on disease outcomes in axial spondyloarthropathy is less well defined,” Gillian Fitzgerald, MD, Rheumatology Specialist Registrar at St. James’s Hospital in Dublin, and colleagues wrote. “The aim of this study is to determine the prevalence of depression in a well characterized axial spondyloarthropathy cohort and explore relationships.”

Fitzgerald and colleagues completed a standardized clinical assessment on all patients in the cohort (n = 564; 78.2% men; mean age, 47.1 years) and entered data from these assessments into the Ankylosing Spondylitis Registry of Ireland, which was initiated in 2013 to collect epidemiological data about patients in Ireland with the disease and to establish a registry for future studies. The researchers evaluated disease activity with the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), spinal mobility with the Bath Ankylosing Spondylitis Metrology Index (BASMI), function with the Bath Ankylosing Spondylitis Functional Index (BASFI) and Health Assessment Questionnaire (HAQ), and quality of life with Ankylosing Spondylitis Quality of Life (ASQoL) scores. Structured interviews were completed to collect patient-reported data, which included the presence of depression diagnosed by a physician. Statistical analysis was done using SPSS.

Mean disease duration was 20.8 years; mean delay to diagnosis was 8.6 years. About a quarter of patients (23.9%) had early disease and most (78%) fulfilled modified New York criteria. The mean disease-related outcomes were BASDAI, 3.9; BASFI, 3.7; BASMI, 3.2; HAQ, 0.55; and ASQoL, 6.4.

Depression was reported 11.9% of patients, with no significant variance observed between men and women. Depression was reported more often in patients with peptic ulcer disease (25.5% vs. 10.6%; P = .002) and late disease (68% vs. 13.5%; P = .042), as well as in smokers (16.6% vs. 10%; P = .032). The mean delay to diagnosis was higher in patients with depression than without (10.9 ± 8.9 vs. 8.3 ± 7.9 years; P = .02). Patients with depression had higher mean ASQoL (9.7 ± 5.6 vs. 5.9 ± 5.3; P < .001) and HAQ (0.79 ± 0.57 vs. 0.51 ± 0.51; P < .001) scores.

The researchers also reported a trend toward increased rates of depression among patients with diabetes (23.1% vs. 11.3%; P = .071), although there was no association between depression and BASDAI, BASMI or BASFI scores.

In multiple regression analyses, peptic ulcer disease and ASQoL continued to be significantly associated with depression, with a trend toward an association with current smoking.

“Twelve percent of this axial spondyloarthropathy population have depression,” the researchers wrote. “[Patients with axial spondyloarthropathy] should be actively screened for depression.” – by Julia Ernst, MS

Reference:

Fitzgerald G, et al. Abstract 2752. Presented at: American College of Rheumatology Annual Meeting; Nov. 11-16, 2016; Washington.

Disclosures: Fitzgerald reports no relevant financial disclosures. Please see the full study for a list of all other researchers’ relevant financial disclosures.