Higher Anxiety Levels Reported Prior to Biologics Initiation Among Patients With Psoriatic Arthritis

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Researchers studied anxiety levels before and during treatment with biologic agents among patients with psoriatic arthritis.

Anxiety levels are higher among patients with psoriatic arthritis (PsA) initiating treatment with a biologic disease-modifying antirheumatic drug (bDMARD) vs those in the general population, according to study results published in Clinical Rheumatology.

Anxiety is an important comorbidity in patients with PsA; however, data in this area are limited.

Researchers sought to understand anxiety rates prior to bDMARD initiation and the changes in anxiety levels associated with treatment.

Data from patients with PsA in the Hacettepe University biologic database (HUR-BIO), established in 2005 in Ankara, Turkey, were evaluated for high levels of anxiety.

Patients with PsA with a “high anxiety level” were defined using an anxiety score of 4 and higher, with the patient self-reported measure of anxiety on a numeric scale of 0 to 10, included in the Psoriatic Arthritis Impact of Disease (PSAID-12) questionnaire. Rates and scores of anxiety levels were established prior to initiating bDMARD therapy (ie, at the first visit within 6 months).

Of a total of 520 patients who were registered, 147 (mean age, 43.3 years; 70.7% women) were included in the current analysis who had both baseline and their first visit within 6-month anxiety score evaluation. Overall, 63.9% (n=94) of the patients had a high level of anxiety. The bDMARDs administered to the participants were adalimumab, etanercept, infliximab, golimumab, and certolizumab.

Both the frequency of high anxiety levels and participants’ mean scores decreased at the first visit (63.9% vs 41.4% and 4.8±3.4 vs 3.2±31, respectively; P <.001 for both) after a mean follow-up of 105.7±22.2 days. According to baseline disease activity parameters and outcome measures, significant differences were reported in mean Health Assessment Questionnaire Disability Index (HAQ-DI; P =.003), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI; P =.003), Bath Ankylosing Spondylitis Functional Index (BASFI; P =.015), Dermatological Life Quality Index (DLQI; P =.003), skin visual analog scale (VAS; P =.003), and PSAID-12 (P =.002) scores, all of which were greater among participants with high anxiety levels.

Researchers noted that although disease activity control was essential in the reduction of anxiety among patients with PsA, these rates were still found to be high at 6 months. They concluded, “For this reason, physicians should be more aware of the prevalence of anxiety and the need for further efforts to manage anxiety in PsA population, especially when more intensive treatment modalities are required.”


Ayan G, Farisogulları B, Bilgin E, et al. Anxiety levels before biologic initiation and changes with treatment in patients with psoriatic arthritis: HUR-BIO biologic registry results. Clin Rheumatol. Published online January 27, 2022. doi:10.1007/s10067-021-06012-y