Increased Risk for Mental Disorders Noted in Patients With Axial Spondyloarthritis

In patients with axial spondyloarthritis (axSpA), the prevalence of mental disorders is high and is linked with level of disease activity and certain sociodemographic profiles, according to study results published in The Journal of Rheumatology.¹

The Atlas of Spondyloarthritis 2017 is a Spanish national initiative that seeks to better understand the current state of individuals with axSpA.² It uses an integrative approach that is based on scientific evidence, expert knowledge, and patient opinion. The Atlas population represents the entire spectrum of patients with axSpA and is equally distributed in gender.

The General Health Questionnaire-12 scale was used to evaluate risk for mental disorders. Furthermore, the investigators also explored the variables associated with the risk for mental disorders, including socioeconomic features (age, gender, relationship, educational level, job status, and association membership), disease status (Bath Ankylosing Spondylitis Disease Activity Index, functional limitation, and spinal status), and prior diagnosis of mental disorders (depression and anxiety).

Overall, 45.6% of the patients evaluated were at risk for mental disorders. All of the variables that were explored, other than thoracic stiffness and educational level, were significantly associated with risk for mental disorder. The highest associations were demonstrated for disease activity (r=0.543, P <.001), functional limitation (r=0.378, P <.001), and age (r=0.174, P <.001).

Among the variables explored, 4 were responsible for the majority of the discrepancy in risk for mental disorders: disease activity, functional limitation, association membership, and cervical stiffness. Disease activity exhibited the highest explanatory degree (P <.001).

The investigators noted that the results of this study emphasize the high prevalence of mental disorders among patients with axSpA and its relationship with disease status. Approximately 1 of every 2 patients with axSpA reports a risk for mental disorders, which may be explained by the degree of disease activity, degree of functional limitations in everyday life, cervical stiffness, and patient association memberships. These findings underscore the significance of rheumatologists encouraging psychiatric assessments of patients with axSpA who have high levels of disease activity and are at risk for mental disorders, thus contributing to a more integral therapeutic strategy.

References

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

2.  Garrido-Cumbrera M, Navarro-Compán V, Zarco P, et al. Atlas of axial spondyloarthritis in Spain 2017: study design and population [published online October 3, 2018]. Reumatol Clin. doi: 10.1016/j.reuma.2018.08.003