Symptoms of depression and anxiety in patients with axial spondyloarthritis: a pilot study in patients with an active approach to physical activity treatment

Authors: M. Hušáková 1;  A. Levitová 2;  D. Domluvilová 3
Authors‘ workplace: Revmatologický ústav Praha 1;  Fakulta tělesné výchovy a sportu Univerzity Karlovy, Praha 2;  Psychiatrická klinika 1. LF UK a VFN, Praha 3
Published in: Čes. Revmatol., 28, 2020, No. 2, p. 80-90.
Category: Original article


Introduction: Axial spondyloarthritis (axSpA) is an inflam-
matory disease of the spine and joints. In addition to numerous musculoskeletal manifestations, co-morbidities affecting the course of the disease and treatment occur in patients. Symptoms of depression and anxiety occur more frequently in axSpA patients than in the general population and are associated with disease activity. The aim of this study was to assess: 1. the degree of psychological distress in patients with axSpA compared to patients without inflammatory spine involvement, 2. relation of depression and anxiety symptoms to the clinical parameters of axSpA, and 3. the relationship of working abilities and evaluation of depression and anxiety in axSpA.

Methods: A total of 34 patients with axSpA and 26 patients with non-specific back pain were evaluated. All respondents completed the Beck Depression Inventory (BDI-II) and the Beck Anxiety Inventory (BAI) questionnaires. All axSpA patients were evaluated for disease activity and functional ability.

Results: Mean values ​​reflecting depression and anxiety in the BDI-II and BAI questionnaires did not significantly differ between the axSpA group and patients with non-inflammatory back pain. In patients with axSpA, there is a significant positive relationship between BDI-II and disease activity and the rate of functional impairment, both p < 0.05. Higher anxiety is signifi-
cantly associated with shorter disease duration and higher disease activity and poorer functional capabilities (all p < 0.05). There is a negative relationship between quality of life and BDI-II (R = –0.486) and BAI (R = –0.399) both in axSpA and in individuals with non-inflammatory back pain, both p < 0.01. According to regression analysis, women tend to have a more unfavorable BDI-II result than men.

Conclusions: Although the rates of anxiety and depression do not differ between axSpA patients and respondents with non-inflammatory back pain, disease activity, and impaired functional abilities significantly reduce the psychological well-being of axSpA patients.


axial spondylarthritis – disease activity – depression – anxiety – non-specific back pain


1. Sieper, J, Poddubnyy D. Axial spondyloarthritis. Lancet 2017; 390: 73–84.

2. Sieper J, Rudwaleit M, Baraliakos X, Brandt J, Burgos-Vargas R, et al. The Assessment of SpondyloArthritis international Society (ASAS) handbook: a guide to assess spondyloarthritis. Ann Rheum Dis 2009; 68: ii1–ii44.

3. van den Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum 1984; 27: 361–368.

4. Kiltz U, Baraliakos X, Karakostas P, Igelmann M, Kalthoff L, et al. The degree of spinal inflammation is similar in patients with axial spondyloarthritis who report high or low levels of disease activity: a cohort study. Ann Rheum Dis 2012; 71: 1207–1211.

5. Sieper J, Hu X, Black CM, Grootcholten K, Van den Broek RWM, Kachroo S. Systematic review of clinical, humanistic, and economic outcome comparisons between radiographic and non-radiographic axial spondyloarthritis. Semin Arthritis Rheum 2017; 46: 746–753.

6. De Winter JJ, Van Mens LJ, Van der Heijde D, Landewe R, Baeten DL. Prevalence of peripheral and extra-articular disease in ankylosing spondylitis versus non-radiographic axial spondyloarthritis: a meta-analysis. Arthritis Res Ther 2016; 18: 196.

7. Baraliakos X, Braun J. Non-radiographic axial spondyloarthritis and ankylosing spondylitis: what are the similarities and differences? RMD Open 2015; 1: e000053.

8. Derakhshan MH, Goodson NJ, Paskham JC, Sengupta R, Molto A, et al. Increase risk of hypertension associated with spondyloarthritis disease duration: results from the ASAS-COMSPA study. J Rheumatol 2019; 46: 701–709.

9. Lopez-Medina C, Jimenez-Gomez Y, Molto A, Schiotis RE, Marzo-Ortega H, et al. Cardiovascular risk factors in patients with spondyloarthritis from Northern European and Mediterranen countries? An ancillary study of the ASAS-COMSPA project. Joint Bone Spine 2018; 85: 447–453.

10. Martindale J, Smith J, Sutton CJ, Grennan D, Goodacre L, Goodacre JA. Disease and psychological status in ankylosing spondylitis. Rheumatology (Oxford) 2006; 45: 1288–1293.

11. Brionez TF, Assassi S, Reveile JD, Learch TJ, Diekman L, et al. Psychological correlates of self-reported functional limitaion in patients with ankylosing spondylitis. Arthritis res Ther 2009; 11: R182.

12. Baysal O, Durmus B, Ersoy Y, Altay Z, Senel K, et al. Relationship between psychological status and disease activity and quality of life in ankylosing spondylitis. Rheumatol Int 2011; 31: 795–800.

13. Zhao S, Thong D, Miller N, Duffield SJ, Hughes DM, Chadwick L, 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.

14. Garrido-Cumbrera M, Delgado-Dominguez CJ, Galvez-Ruiz D, Blanch Mur C, Navarro Compan V, ATLAS WORKING GROUP. The effect of axial spondyloarthritis on mental health: results from the Atlas. J Rheumatol 2019; Feb 15 [Epub ahead of print].

15. Zhou Q, Jiang Y, Mu F, Sho Y, Fang Y. Correlation of axial spondyloarthritis with anxiety and depression. Med Sci Monit 2016; 22: 3202–3208.

16. Nusselder WJ, Cambois EM, Wapperom D, Mesle F, Looman CWN, et al. Women’s excess unhealhty life years: disentangling the unhealhty life years gap. Eur J Public Health 2019; 29: 914–919.

17. Rusman T, van Vollenhoven RF, van der Horst-Bruinsma IE. Gender differences in axial spondyloarthritis: women are not so lucky. Curr Rheumatol Rep 2018; 20: 35.

18. van der Heijde D, Ramiro S, Landewe R, Baraliakos X, van den Bosch F, Sepriano A, et al. 2016 update of ASAS-EULAR management recommendations for axial spondyloarthritis. Ann Rheum Dis 2017; 76: 978–991.

19. Millner JR, Barron JS, Beinke KM, Butterworth RH, Chasle BE, Dutton LJ, et al. Exercise for ankylosing spondylitis: an evidence-basd consensus statement. Semin Arthritis Rheum 2016; 45: 411–427.

20. van der Heijde D, Lie E, Kvien TK, Sieper J, Van den Bosch, Listing J, et al. Assessment of SpondyloArthritis international Society (ASAS). ASDAS, a highly discriminatory ASAS-endorsed disease activity score in patients with ankylosing spondylitis. Ann Rheum Dis 2009; 68: 1811–1818.

21. Calin A, Garrett S, Whitelock H, Kennedy LG, O’Hea J, Mallorie P, et al. A new approach to defining functional ability in ankylosing spondylitis: the development of the Bath Ankylosing spondylitis Functional Index. J Rheumatol 1994; 21: 2281–2285.

22. Rabin R, SE Charro F. EQ-5D: a measure of health status from the EuroQol Group. Ann Med 2001; 33: 337–343.

23. Beck AT, Steer RA, Carbin MG. Psychometric properties if the beck Depression Inventory: twenty-fice years of evaluation. Clin Psychol Rev 1988; 8: 77–100.

24. Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol 1988; 56(6): 893–897.

25. Kamarádová D, Praško J, Látalová K, Panáčková L, Švancara J, Ociskova M, et al. Validizace české verze Beckova inventáře úzkosti. Čes. a slov. Psychiat. 2016; 112(4): 153–158.

26. Ptáček R, Raboch J, Vňuková M, Hlinka J, Anders M. Beckova škála deprese BDI-II – standardizace a využití v praxi. Čes. a slov. Psychiat. 2016; 112: 270–274.

27. Julian LJ. Measures of anxiety. Arthritis Care Res (Hoboken) 2011; 63(S 11): S467–S472.

28. Park JS, Jang HD, Hong JY, Park YS, Han K, Suh SW, et al. Impact of ankylosing spondylitis on depression: a nationwide cohort study. Sci Rep 2019; 9: 6736.

29. Shen CC, Hu LY, Yang AC, Kuo BI, Chiang YY, Tsai SJ. Risk of psychiatric disorders following ankylosing spondylitis: a nationwide population-based retrospective cohort study. J Rheumatol 2016, 43: 625–631.

30. Sundquist K, Li X, Hemminki K, Sundquist J. Subsequent risk of hospitalization for neuropsychiatric disorders in patients with rheumatic diseases: a nationwide study from Sweden. Arch Gen Psychiatry 2008; 65: 501–507.

31. Redeker I, Hoffmann F, Callhoff J, Haibel H, Sieper J, Zink A, et al. Determinants of psychological well-being in axial spondyloarthritis: an analysis based on linked claims and patient-reported survey data. Ann Rheum Dis 2018; 77: 1017–1024.

32. Yildirim T, Solmaz D, Emul M, Akgol G, Yalvac D, Ersoy Y. Affective temperament profile in ankylosing spondylitis patients using TEMPS-A. J Phys Ther Sci 2017; 29: 394–400.

33. Esen SA, Karabulut Y, Esen I, Atmis V. Effects of the disease characteristics and the treatment on psychological status in patients with rheumatoid arthritis and ankylosing spondylitis. Curr Rheumatol Rev 2018; 14: 271–278.

34. Milutinovic S, Veljkovic K, Zlatanovic M, Radunovic G, Damjanov N. Depression/anxiety symptoms in axial spondyloarthritis and psoriatic arthritis patients in Serbia: a pilot study. Rheumatol Int 2019; 39: 1595–1605.

35. Formanek T, Kagstrom A, Cermakova P, Csemy L, Mlada K, Winkler P. Prevalence of mental disorders and associated disability: results from the cross-sectional CZEch mental health Study (CZEMS). Eur Psychiatry 2019; 60: 1–6.

36. Kuehner C. Why is depression more common among women than among men? Lancet Psychiatry 2017; 4: 146–158.

37. de Jong H, Paramarta JE, de Winter J, Baeten D, van de Sande M. Differences between females and males in axial spondyloarthritis: data from a real-life cross-sectional cohort. Scand J Rheumatol 2019; 49(1): 1–5.

38. Lubrano E, Perrotta FM, Manara M, D’Angelo S, Addimanda O, Ramonda R, et al. The sex influence on response to tumor necrosis factor-alpha inhibitors and remission in axial spondyloarthritis. J Rheumatol 2018; 5: 195–201.

39. Zhang L, Wu Y, Liu S, Zhu W. Prevalence of depression in ankylosing spondylitis: a systematic review and meta-analysis. Psychiatry Investig 2019; 16: 565–574.

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