Depression Associated With More Severe Disease Activity, Functional Impairment in axSpA

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Depression is common in patients with axSpA and is associated with more severe disease activity and functional impairment.

In patients with axial spondyloarthritis (axSpA), depression is common and is associated with more severe disease activity and greater functional impairment, according to the results of a systematic review and meta-analysis published in Arthritis Research & Therapy.  

Reports of the prevalence of depression in patients with axSpA are highly variable. Therefore, the investigators sought to describe the prevalence of depression in patients with axSpA; compare the prevalence of depression in axSpA, ankylosing spondylitis (AS), and nonradiographic axSpA cohorts; and compare disease activity and functional impairment in patients with and without depression.

A total of 15 original articles and 1 abstract were included for analysis. Overall, 14 studies described AS cohorts and 2 studies described non-radiographic axSpA cohorts. There were 3 screening criteria and 1 diagnostic criterion used to define depression. The prevalence of depression ranged from 11% to 64%, depending on the criteria and thresholds used.

When the Hospital Anxiety and Depression Scale (HADS) threshold of ≥11 was used, the pooled prevalence of moderate depression was 15%. The prevalence of depression was similar in the axSpA, AS and nonradiographic axSpA cohorts. Individuals with depression had significantly worse disease activity, including higher Bath Ankylosing Spondylitis Disease Activity Index by 1.4 units (95% CI, 1.0-1.9), higher Ankylosing Spondylitis Disease Activity Score by 0.5 units (95% CI, 0.3-0.7), and higher erythrocyte sedimentation rate by 3.5 mm/h (95% CI, 0.6-6.4).       

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Patients with depression also had greater functional impairment, with higher Bath Ankylosing Spondylitis Functional Index and Bath Ankylosing Spondylitis Metrology Index by 1.2 units (95% CI, 0.6-1.8) and 0.6 units (95% CI, 0.3-0.8), respectively. The mean age of each of the study cohorts was inversely correlated with the prevalence of depression.

The investigators concluded that the identification and management of depression should form part of the holistic care of patients with axSpA. Additional longitudinal studies are warranted in order to explore the effect of depression on treatment outcomes.

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Zhao S, Thong D, Miller N, et al. The prevalence of depression in axial spondyloarthritis and its association with disease activity: a systematic review and meta-analysis. Arthritis Res Ther. 2018;20(1):140.