Depression Common in Axial Spondyloarthritis

Aug 07, 2018

When disease activity is high and/or function impaired, consider depression a likely comorbidity that may be a result of inflammation.

Reference1. 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;20:140. doi: 10.1186/s13075-018-1644-6.

Zhao and colleagues at the University of Liverpool in the UK have found that depression is common in patients with axial spondyloarthritis (axSpA) and is associated with more severe disease activity.¹

Thumb through the slides for the details of the study and the take-home points for clinicians.

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AS, ankylosing spondylitis; axSpA, axial spondyloarthritis.

The proportion of male patients is higher in AS than in nr-axSpA cohorts, functional impairment is greater in AS cohorts, and AS is more commonly associated with elevated inflammatory markers.

axSpA, axial spondyloarthritis.

The authors conducted a systematic review of cross-sectional or longitudinal studies that examined depression and axSpA. Depression was quantified using the Hospital Anxiety and Depression Scale (HADS) as well as the Zung Self-Rating Depression Scale (SDS). Differences in markers of disease activity and functional impairment were compared between groups with and without depression. Ultimately, 15 full-text articles and one abstract were included in the analysis.

axSpA, axial spondyloarthritis; BASDAI, Bath Ankylosing Spondylitis Disease Activity Index; CI, confidence interval; HADS, Hospital Anxiety and Depression Scale; SDS, Self-Rating Depression Scale.

Pooled prevalence of mild depression was 38% (95% CI, 30% to 45%; I² = 85%). Pooled prevalence of at least moderate depression was 15% (95% CI, 6% to 25%; I² = 89%) using HADS, and 52% (95% CI, 29% to 75%, I² = 96%) using SDS.

axSpA, axial spondyloarthritis.

Be vigilant for signs and symptoms of depression in patients with axSpA. As a part of a holistic approach to the patient, mental health should be considered closely linked to disease activity and both should be addressed at office visits.

When disease activity is high and/or function impaired, consider depression a likely comorbidity that may be a result of inflammation. Inflammation in axSpA may cause antidepressant failure.

Treatment aimed at low disease activity or remission may improve comorbid depression as well.