The Effect of Axial Spondyloarthritis on Mental Health: Results from the Atlas

Garrido‐Cumbrera, Marco; Delgado-Domínguez, C. J.; Ruiz, David Gálvez; Mur, C.; Navarro-Compán, Victoria

doi:10.3899/jrheum.180868

Cited by 24 publications

(21 citation statements)

References 22 publications

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“…Psychological distress has been demonstrated to lead to poorer disease outcomes by enhancing symptom burden, decreasing adherence to Bold values denote statistical significance at the p < 0.05 level treatment and increasing disability [27]. Additionally, in patients with axSpA, the risk of mood disorders is explained mainly by the degree of disease activity [28].…”

Section: Discussionmentioning

confidence: 99%

Gender differences in patient journey to diagnosis and disease outcomes: results from the European Map of Axial Spondyloarthritis (EMAS)

et al. 2021

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Introduction/objectives To evaluate the journey to diagnosis, disease characteristics and burden of disease in male and female patients with axial spondyloarthritis (axSpA) across Europe. Method Data from 2846 unselected patients participating in the European Map of Axial Spondyloarthritis (EMAS) study through an online survey (2017–2018) across 13 countries were analysed. Sociodemographic characteristics, lifestyle, diagnosis, disease characteristics and patient-reported outcomes (PROs) [disease activity –BASDAI (0–10), spinal stiffness (3–12), functional limitations (0–54) and psychological distress (GHQ-12)] were compared between males and females using chi-square (for categorical variables) and student t (for continuous variables) tests. Results In total, 1100 (38.7%) males and 1746 (61.3%) females participated in the EMAS. Compared with males, females reported considerable longer diagnostic delay (6.1 ± 7.4 vs 8.2 ± 8.9 years; p < 0.001), higher number of visits to physiotherapists (34.5% vs 49.5%; p < 0.001) and to osteopaths (13.3% vs 24.4%; p < 0.001) before being diagnosed and lower frequency of HLA-B27 carriership (80.2% vs 66.7%; p < 0.001). In addition, females reported higher degree of disease activity in all BASDAI aspects and greater psychological distress through GHQ-12 (4.4 ± 4.2 vs 5.3 ± 4.1; p < 0.001), as well as a greater use of alternative therapies. Conclusion The patient journey to diagnosis of axSpA is much longer and arduous in females, which may be related to physician bias and lower frequency of HLA-B27 carriership. Regarding PROs, females experience higher disease activity and poorer psychological health compared with males. These results reflect specific unmet needs in females with axSpA needing particular attention. Key Points• Healthcare professionals’ perception of axSpA as a predominantly male disease may introduce some bias during the diagnosis and management of the disease. However, evidence about male-female differences in axSpA is scarce.• EMAS results highlight how female axSpA patients report longer diagnostic delay and higher burden of the disease in a large sample of 2846 participants of 13 European countries.• Results reflect unmet needs of European female patients. Healthcare professionals should pay close attention in order to accurately diagnose and efficiently manage axSpA cases while further research should be developed on the cause of reported gender differences.

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Section: Discussionmentioning

confidence: 99%

Gender differences in patient journey to diagnosis and disease outcomes: results from the European Map of Axial Spondyloarthritis (EMAS)

et al. 2021

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“…Zhao et al ,27 in a meta-analysis of 16 studies, estimated the prevalence of at least moderate depression in patients with axSpA as 15%, based on a HADS score of ≥11. Garrido-Cumbrera et al ,28 in a sample of 680 patients as part of the Atlas of Axial Spondyloarthritis in Spain, reported that high disease activity was a risk factor for poor mental health, but the current study emphasises that poor mental health independently predicts worse QoL. A meta-analysis of the co-occurrence of fibromyalgia in axSpA estimated a prevalence of 13%,29 compared with a prevalence in the general population of around 2%–5%,30 and we have previously shown within BSRBR-AS that patients who have comorbid fibromyalgia have the same absolute improvement in QoL when treated with anti-TNFα therapy, but their QoL prior to and on treatment remains worse.…”

Section: Discussionmentioning

confidence: 99%

Determining factors related to poor quality of life in patients with axial spondyloarthritis: results from the British Society for Rheumatology Biologics Register (BSRBR-AS)

et al. 2019

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ObjectiveTo determine modifiable factors associated with poor quality of life (QoL) in patients with axial spondyloarthritis (axSpA).MethodsAnalysis of data from the British Society for Rheumatology Biologics Register in Ankylosing Spondylitis (BSRBR-AS) and validation of a previous model using data from 1810 patients with axSpA recruited during 2012–2017. Data collected included clinical and patient-reported measures. QoL was assessed using the Ankylosing Spondylitis Quality of Life (ASQoL) measure. Linear regression models predicting ASQoL scores were used first to validate a previous model from a national study, to extend this with additional information available in BSRBR-AS and finally to identify a ‘de novo’ model from BSRBR-AS of which factors impact on poor QoL.ResultsFour out of five factors included in a previous model of poor QoL in patients with axSpA were confirmed: Bath Ankylosing Spondylitis Disease Activity Index and Bath Ankylosing Spondylitis Functional Index, fatigue and widespread pain, although the performance of the model was improved by the addition of measures of mood and sleep disturbance. In a de novo model in BSRBR-AS, there were six factors (other than disease activity and function) that predicted ASQoL: depression (β=0.16), sleep disturbance (β=0.08), activity impairment (β=0.04), fibromyalgia (Symptom Severity Scale (β=0.24) and Widespread Pain Index (β=0.10)) and tobacco smoking (β=0.66).ConclusionThis study confirms that poor QoL in patients with axSpA, in addition to high disease activity and poor function, is independently influenced by sleep disturbance, mood and widespread pain. These additional factors are not considered targets for treatment in current European League Against Rheumatism (EULAR) guidelines for managing the condition.

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“…The methodology of the EMAS study is described in detail elsewhere. 2 For the purpose of this analysis on mental health, data from Spain were excluded as they have been previously published, 9 therefore our final sample size presented here is 2,166.…”

Section: Methodsmentioning

confidence: 99%

“…To determine mental disorder risk among patients with axSpA, the Likert scale was transformed to 0, 0, 1, 1, and the threshold for mental disorder risk set at ≥3 as supported by literature. 9 The GHQ-12 is a screening measure for identifying minor psychiatric disorders in the general population, used to encompass common symptoms of anxiety social dysfunction and loss of confidence. 12 It is not a diagnostic instrument.…”

Section: Patient-reported Outcome Measuresmentioning

confidence: 99%

Impact of axial spondyloarthritis on mental health in Europe: results from the EMAS study

et al. 2021

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ObjectiveTo determine the presence of mental disorder risk and associated factors in European patients with axial spondyloarthritis (axSpA).MethodsData from 2,166 patients with axSpA in 12 European countries were collected from 2017 to 2018 through the European Map of Axial Spondyloarthritis online survey. Risk of mental disorders was assessed using the 12-item General Health Questionnaire. Possible predictors included age, gender, relationship status, patient organisation membership, job status, educational level, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), functional limitation (0–54) and self-reported depression or anxiety. Bivariate analyses were conducted to determine predictors of risk of mental disorders (Mann-Whitney and χ2) and multivariable analysis identified factors associated with risk of mental disorders.Results60.7% of patients reported risk of mental disorders: they were younger (41.7 vs 46.0 years), more likely female (68.2% vs 57.9%), unemployed (7.5% vs 2.7%), on temporary (15.9% vs 5.4%) or permanent sick leave (13.2% vs 8.0%), reported depression (45.2% vs 14.2%) or anxiety (41.3% vs 12.5%), higher disease activity (BASDAI ≥4; 87.6% vs 62.3%) and functional limitation (16.5 vs 10.8). The factors most associated with risk of mental disorders were disease activity (OR=2.80), reported depression (OR=2.42), anxiety (OR=2.39), being unemployed or on sick leave (OR=1.98), functional limitation (OR=1.02) and younger age (OR=0.97).ConclusionsCompared with the general population, patients with axSpA show disproportionately worse mental health associated mainly with disease activity and employment status. Healthcare professionals should pay close attention to patients with high disease activity and address internally or refer to specialist services, where appropriate to ensure optimal patient outcomes.

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The Effect of Axial Spondyloarthritis on Mental Health: Results from the Atlas

Cited by 24 publications

References 22 publications

Gender differences in patient journey to diagnosis and disease outcomes: results from the European Map of Axial Spondyloarthritis (EMAS)

Gender differences in patient journey to diagnosis and disease outcomes: results from the European Map of Axial Spondyloarthritis (EMAS)

Determining factors related to poor quality of life in patients with axial spondyloarthritis: results from the British Society for Rheumatology Biologics Register (BSRBR-AS)

Impact of axial spondyloarthritis on mental health in Europe: results from the EMAS study

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