The effect of TNF-alpha blockers on psychometric measures in ankylosing spondylitis patients: a preliminary observation

Abstract

There is a high co-morbidity between chronic inflammatory disorders and depression. Proinflammatory cytokines like TNF-α seem to play a central role in the pathogenesis of these disorders, and its neutralization provides a potent treatment for inflammatory disorders. Few studies showed that TNF-α blockers also caused an improvement in depressive symptoms associated with these chronic inflammatory disorders. To evaluate the effectiveness of TNF-α blockers on symptoms of ankylosing spondylitis (AS), depression, anxiety and quality of life, 9 AS patients resistant to classical therapy were enrolled and followed-up at 2nd and 6th weeks after a TNF-α blocker was started. Hamilton Depression and Anxiety Scales (HAM-D, HAM-A), Hospital Depression and Anxiety Questionnaire (HAD), Quality of Life Scale (SF36) and AS severity index (BASDAI) were applied to the patients at weeks 0, 2 and 6. ESR and CRP were evaluated to monitor biological disease activity. There was a significant reduction in HAM-D (p = 0.00), HAM-A (p = 0.00), HAD anxiety scores (p = 0.02) and a significant improvement in SF36 physical function (p = 0.00), physical role limitations (p = 0.00), bodily pain (p = 0.05), general health (p = 0.01), vitality (p = 0.03) and emotional role limitations (p = 0.00) subscales, BASDAI scores (p = 0.00), ESR (p = 0.00) and CRP (p = 0.00). Change in clinical disease activity (BASDAI) was not correlated with change in depression-anxiety scores, while change in biological disease activity (CRP) was correlated with change in depression-anxiety scores. TNFα blockers may have a potential antidepressant effect besides its anti-inflammatory effect that seems to be independent of its clinical effect.

Psychological status is associated with drug efficacy in patients with ankylosing spondylitis

“…Very interestingly, there was no significant difference between efficacy group and inefficacy group for Etanercept. Consistent with a previous study [22], biologic agents may have an antidepressant efficacy besides their anti-inflammatory effect that is independent of their clinical effect.…”

“…In this study, AS patients in drug inefficacy group have higher degree disease activity than patients in drug efficacy group while disease activity is suspected to be one of the main risk factors of psychological disorders in patients with AS [12]. In addition, drug inefficacy will increase medical costs for patients with AS, while anxiety and depression are significantly associated with increased medical costs [21,22].…”

Tumour necrosis factor-α inhibitor therapy in chronic physical illness: A systematic review and meta-analysis of the effect on depression and anxiety

“…Indeed, TNF-α inhibitors have also been shown to improve depressive symptoms among people with chronic inflammatory disorders [33], though this does not always appear to be the case [34]. More recently, Arisoy and colleagues [35] have shown that patients with ankylosing spondylitis who were treated with TNF-α inhibitors reported a significant decrease in depression which, importantly, was not associated with changes in markers of clinical disease activity. They, and others [36], have suggested that the improvements in depression but not markers of clinical disease activity, provides support for an inflammatory mechanism underpinning the development and maintenance of depression.…”

Patients’ concerns regarding biological agents in rheumatology

“…In addition, after an anti‐depressant therapy, TNF‐α levels were observed to be decreased to similar levels as the control group. Arisoy et al . suggested that TNF‐α inhibitors appeared to have potential anti‐depressant effects; this appears to be independent from their anti‐inflammatory effect.…”