Disease Activity in Axial Spondyloarthritis Linked to Mental Disorder Risk

ankylosing spondylitis spine
Study identifies several disease-specific factors associated with the risk of mental disorders in patients with axial spondyloarthritis.

High disease activity, in combination with a sociodemographic profile including sex, job status, and membership in a patient association, may indicate the level of risk for mental disorders in patients with axial spondyloarthritis (axSpA), according to research published in Journal of Rheumatology.

Researchers used the results of a 2016 survey of patients (N=680) with axSpA who were interviewed for the Atlas of Axial Spondyloarthritis in Spain. The interview assessed risk for mental disorders using the 12-item General Health Questionnaire scale, and researchers analyzed multiple variables (sociodemographic characteristics, disease status, and previous mental health diagnoses) linked with the risk for mental disorders.

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In total, 474 patients (age 45.4±10.7 years and 49.1% men) had valid questionnaire data and were part of the final evaluation for the study. Mean General Health Questionnaire-12 scores were 18.3±8.0 and 65.4% of patients were classified as having a risk for a mental disorder; 34.6% were classified as having no risk.

Bivariate analyses indicated that mental health had a statistically significant association with a number of variables, including older age, being a man, anxiety and/or depression diagnosis, high level of disease activity, a high degree of cervical and lumbar spinal stiffness, and worse functional limitations.

Disease activity as measured by the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), functional limitation, and age had the highest correlation coefficients (r=0.543; r=0.378; and r= -0.174, respectively; P ≤.001 for all).

Results of a stepwise regression analysis found that 4 variables (BASDAI, functional limitations in daily activities, membership in a patient association, and cervical stiffness) illustrated the variance in patient’s risks and contributed to a significant change in R² (P <.001 for all but cervical stiffness; P =.03 for cervical stiffness). Of these variables, the BASDAI had “remarkably more explanatory power” (R²=.875; P <.001).

Researchers noted the importance of “adequate assessment” of patient-provided information since perception can guide intervention design, resource allocation, and pharmacological treatments. “The results of our study add to the evidence supporting the relationship between disease status…psychosocial factors…and the mental health status of patients with axSpA,” they wrote. “However, it is important to understand the mechanism underlying this type of relationship before considering how to use this knowledge in clinical practice.”

Study limitations include the use of “previously nonvalidated scales or indices” for assessing some factors, including daily functional limitations and stiffness; the bidirectional features of the relationships, which do not allow investigators to establish causality due to the cross-sectional approach; and a possible overlap between the General Health Questionnaire-12 and the diagnosis of anxiety and depression.

“About 1 of every 2 patients with axSpA reports risk of mental disorders,” the researchers of the study concluded. “[T]his risk…seems to be explained to a great extent by the degree of disease activity and to a lesser extent to such factors as the degree of functional limitation…cervical stiffness, and patient association membership.”

The researchers continued, “These findings highlight the benefit of rheumatologists promoting psychiatric evaluations of patients with high disease activity and risk of mental disorders. It is posited that this will contribute to a more integral treatment strategy.”

Disclosure: This study was funded by Novartis, Spain.


Garrido-Cumbrera M, Delgado-Domínguez CJ, Gálvez-Ruiz D, Blanch Mur C, Navarro-Compán V; Atlas Working Group. The effect of axial spondyloarthritis on mental health: results from the Atlas [published online February 15, 2019]. J Rheumatol. doi:10.3899/jrheum.180868