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Depression/anxiety symptoms in axial spondyloarthritis and psoriatic arthritis patients in Serbia: a pilot study

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Abstract

To assess prevalence and change of depression/anxiety symptoms in spondyloarthritis patients and feasibility of depression/anxiety questionnaires. 43 Patients with axial spondyloarthritis (axSpA) and 27 patients with psoriatic arthritis (PsA) were consecutively recruited. There were 34 patients on biologics and 36 patients on nonbiologics. Patients were not previously treated for depression. The demographic variables, pain, patient global assessment, laboratory, clinical findings, diseases activity scores, Beck Depression Inventory (BDI) and Depression Anxiety and Stress Scale—short version (DASS-21) were collected. The study visits were at the beginning, after 1 month, after 3 and after 6 months. In axSpA and PsA patients on biologics, BDI and DASS-21 were significantly lower compared to nonbiologics group during time. The axSpA patients on biologics had significantly lower BDI and depression severity by BDI at each time point and lower DASS-21 after 1, 3 and 6 months. BDI in PsA patients who received biological therapy was significantly lower after 3 and 6 months. In biologics groups, BDI significantly decreased after 3 months in axSpA patients and after 1 month in PsA patients. In axSpA patients, there was a medium correlation between BDI and axial pain, patient global assessment and disease activity scores. The biological therapy significantly affected the depression/anxiety symptoms in axSpA and PsA during time. BDI moderately correlated with pain and disease activity in axSpA. BDI and DASS-21 are easy to use in daily practice.

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References

  1. Garg N, van den Bosch F, Deodhar A (2014) The concept of spondyloarthritis: where are we now? Best Pract Res Clin Rheumatol 28:663–672

    Article  PubMed  Google Scholar 

  2. Rudwaleit M, van der Heijde D, Landewe R et al (2009) The development of assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis 68:777–783

    Article  CAS  PubMed  Google Scholar 

  3. Rudwaleit M, van der Heijde D, Landewé R, Akkoc N, Brandt J, Chou CT et al (2011) The Assessment of SpondyloArthritis International Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general. Ann Rheum Dis 70:25–31

    Article  CAS  PubMed  Google Scholar 

  4. van der Heijde D, Ramiro S, Landewe R et al (2017) 2016 update of the ASAS-EULAR management recommendations for axial spondyloarthritis. Ann Rheum Dis 76:978–991

    Article  PubMed  Google Scholar 

  5. Smolen JS, Schöls M, Braun J, Dougados M, Fitzgerald O, Gladman DD et al (2018) Treating axial spondyloarthritis and peripheral spondyloarthritis, especially psoriatic arthritis, to target: 2017 update of recommendations by an international task force. Ann Rheum Dis 77:3–17

    Article  PubMed  Google Scholar 

  6. Kotsis K, Voulgari PV, Drosos AA, Carvalho AF, Hyphantis T (2014) Health-related quality of life in patients with ankylosing spondylitis: a comprehensive review. Expert Rev Pharmacoecon Outcomes Res 14:857–872

    Article  PubMed  Google Scholar 

  7. Tezel N, Yilmaz Tasdelen O, Bodur J et al (2015) Is the health-related quality of life and functional status of patients with psoriatic arthritis worse than that of patients with psorias is alone? Int J Rheum Dis 18:63–69

    Article  CAS  PubMed  Google Scholar 

  8. Baillet A, Gossec L, Carmona L, Wit M, van Eijk-Hustings Y, Bertheussen H et al (2016) Points to consider for reporting, screening for and preventing selected comorbidities in chronic inflammatory rheumatic diseases in daily practice: a EULAR initiative. Ann Rheum Dis 75:965–973

    Article  PubMed  Google Scholar 

  9. Marrie RA, Hitchon CA, Walld R, Patten SB, Bolton JM, Sareen J et al (2018) Increased burden of psychiatric disorders in rheumatoid arthritis. Arthritis Care Res (Hoboken) 70:970–978

    Article  Google Scholar 

  10. Uher R, Payne JL, Pavlova B, Perlis RH (2014) Major depressive disorder in DSM-5: implications for clinical practice and research of changes from DSM-IV. Depress Anxiety 31:459–471

    Article  PubMed  Google Scholar 

  11. Valkanova V, Ebmeier KP, Allan CL (2013) CRP, IL-6 and depression: a systematic review and meta-analysis of longitudinal studies. J Affect Disord 150:736–744

    Article  CAS  PubMed  Google Scholar 

  12. Crocq MA (2017) The history of generalized anxiety disorder as a diagnostic category. Dial Clin Neurosci 19:107–116

    Google Scholar 

  13. Rathbun AM, Harrold LR, Reed GW (2014) A description of patient- and rheumatologist-reported depression symptoms in an American rheumatoid arthritis registry population. Clin Exp Rheumatol 32:523–532

    PubMed  Google Scholar 

  14. Kilic G, Kilic E, Ozgocmen S (2014) Relationship between psychiatric status, self-reported outcome measures, and clinical parameters in axial spondyloarthritis. Medicine (Baltimore) 93:e337

    Article  Google Scholar 

  15. Shen CC, Hu LY, Yang AC, Kuo BI, Chiang YY, Tsai SJ (2016) Risk of psychiatric disorders following ankylosing spondylitis: a nationwide population-based retrospective cohort study. J Rheumatol 43:625–631

    Article  PubMed  Google Scholar 

  16. Garrett S, Jenkinson T, Kennedy LG, Whitelock H, Gaisford P, Calin A (1994) A new approach to defining disease status in ankylosing spondylitis: the bath ankylosing spondylitis disease activity index. J Rheumatol 21:2286–2291

    CAS  PubMed  Google Scholar 

  17. Calin A, Garrett S, Whitelock H, Kennedy LG, O’Hea J, Mallorie P, Jenkinson T (1994) A new approach to defining functional ability in ankylosing spondylitis: the development of the bath ankylosing spondylitis functional index. J Rheumatol 21:2281–2285

    CAS  PubMed  Google Scholar 

  18. Jenkinson TR, Mallorie PA, Whitelock HC, Kennedy LG, Garrett S, Calin A (1994) Defining spinal mobility in ankylosing spondylitis (AS). The bath AS metrology index. J Rheumatol 21:1694–1698

    CAS  PubMed  Google Scholar 

  19. Lukas C, Landewé R, Sieper J, Dougados M, Davis J, Braun J, van der Linden S, van der Heijde D (2009) Development of an ASAS-endorsed disease activity score (ASDAS) in patients with ankylosing spondylitis. Ann Rheum Dis 68:18–24

    Article  CAS  PubMed  Google Scholar 

  20. Schoels MM, Aletaha D, Alasti F, Smolen JS (2016) Disease activity in psoriatic arthritis (PsA): defining remission and treatment success using the DAPSA-score. Ann Rheum Dis 75:811–822

    Article  PubMed  Google Scholar 

  21. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J (1961) An inventory for measuring depression. Arch Gen Psychiatry 4:561–571

    Article  CAS  PubMed  Google Scholar 

  22. Beck AT, Steer RA, Carbin MG (1988) Psychometric properties of the Beck Depression Inventory: twenty-five years of evaluation. Clin Psychol Rev 8:77–100

    Article  Google Scholar 

  23. Lovibond SH, Lovibond PF (1995) Manual for the depression anxiety stress scales, 2nd edn. Psychology Foundation of Australia, Sydney

    Google Scholar 

  24. Lovibond P (2018) Overview of the DASS and its uses. Psychology foundation of Australia. Retrieved from http://www2.psy.unsw.edu.au/dass/over.htm. Accessed 31 Mar 2019

  25. Antony MM, Bieling PJ, Cox BJ, Enns MW, Swinson RP (1998) Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress Scales in clinical groups and a community sample. Psychol Assess 10:176–181

    Article  Google Scholar 

  26. Kok T, de Haan HA, van der Meer M, Najavits LM, De Jong CA (2015) Screening of current post-traumatic stress disorder in patients with substance use disorder using the depression, Anxiety and Stress Scale (DASS-21): a reliable and convenient measure. Eur Addict Res 21:71–77

    Article  PubMed  Google Scholar 

  27. Beaufort IN, De Weert-Van Oene GH, Buwalda VAJ, de Leeuw JRJ, Goudriaan AE (2017) The depression, anxiety and Stress Scale (DASS-21) as a screener for depression in substance use disorder inpatients: a pilot study. Eur Addict Res 23:260–288

    Article  PubMed  Google Scholar 

  28. Gross J, Ligges U (2015) Nortest: tests for Normality. R package version 1.0-4. https://CRAN.R-project.org/package=nortest. Accessed 31 Mar 2019

  29. Gastwirth JL, Gel YR, Wallace Hui WL, Lyubchich V, Miao W, Noguchi K (2017). lawstat: tools for biostatistics, public policy, and law. R package version 3.2. https://CRAN.R-project.org/package=lawstat. Accessed 31 Mar 2019

  30. Hothorn T, Hornik K (2019) exactRankTests: exact distributions for rank and permutation tests. R package version 0.8-30. https://CRAN.R-project.org/package=exactRankTests. Accessed 8 Jun 2019

  31. Hollander M, Wolfe DA, Chicken E (2014) Nonparametric statistical methods, 3rd edn. Wiley, Hoboken

    Google Scholar 

  32. Sheskin DJ (2011) Handbook of parametric and nonparametric statistical procedures, 5th edn. Chapman and Hall/CRC, Boca Raton

    Google Scholar 

  33. Diedenhofen B, Musch J (2015) cocor: a comprehensive solution for the statistical comparison of correlations. PLoS One 10:e0121945

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Noguchi K, Gel YR, Brunner E, Konietschke F (2012) nparLD: an R software package for the nonparametric analysis of longitudinal data in factorial experiments. J Stat Softw 50:1–23

    Article  Google Scholar 

  35. Wilcox RR (2012) Introduction to robust estimation and hypothesis testing, 3rd edn. Academic Press, Boston

    Google Scholar 

  36. Arnold DM, Burns KE, Adhikari NK, Kho ME, Meade MO, Cook DJ (2009) The design and interpretation of pilot trials in clinical research in critical care. Crit Care Med 37:S69–S74

    Article  PubMed  Google Scholar 

  37. Evans DL, Charney DS, Lewis L et al (2005) Mood disorders in the medically ill: scientific review and recommendations. Biol Psychiatry 58:175–189

    Article  PubMed  Google Scholar 

  38. Ward MM, Kuzis S (2001) Risk factors for work disability in patients with ankylosing spondylitis. J Rheumatol 28:315–321

    CAS  PubMed  Google Scholar 

  39. Barlow JH, Wright CC, Williams B, Keat A (2001) Work disability among people with ankylosing spondylitis. Arthritis Rheum 45:424–429

    Article  CAS  PubMed  Google Scholar 

  40. Durmus D, Sarisoy G, Alayli G, Kesmen H, Çetin E, Bilgici A et al (2015) Psychiatric symptoms in ankylosing spondylitis: their relationship with disease activity, functional capacity, pain and fatigue. Compr Psychiatry 62:170–177

    Article  PubMed  Google Scholar 

  41. Xu X, Shen B, Zhang A, Liu J, Da Z, Liu H, Gu Z (2016) Anxiety and depression correlate with disease and quality-of-life parameters in Chinese patients with ankylosing spondylitis. Patient Prefer Adherence 20:879–885

    Google Scholar 

  42. Zou Q, Jiang Y, Mu F, Shi Y, Fang Y (2016) Correlation of axial spondyloarthritis with anxiety and depression. Med Sci Monit 22:3202–3208

    Article  PubMed  PubMed Central  Google Scholar 

  43. Baysal O, Durmuş B, Ersoy Y, Altay Z, Senel K, Nas K et al (2011) Relationship between psychological status and disease activity and quality of life in ankylosing spondylitis. Rheumatol Int 31:795–800

    Article  PubMed  Google Scholar 

  44. Raison CL, Rutherford RE, Woolwine BJ, Shuo C, Schettler P, Drake DF et al (2013) A randomized controlled trial of the tumor necrosis Raison CL, Rutherford factor antagonist infliximab for treatment-resistant depression: the role of baseline inflammatory biomarkers. JAMA Psychiatry 70:31–41

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Arısoy O, Bes C, Cifci C, Sercan M, Soy M (2013) The effect of TNF-alpha blockers on psychometric measures in ankylosing spondylitis patients: a preliminary observation. Rheumatol Int 33:1855–1864

    Article  CAS  PubMed  Google Scholar 

  46. Meesters J, Bergman S, Haglund E, Jacobsson L, Petersson IF, Bremander A (2018) Prognostic factors for change in self-reported anxiety and depression in spondyloarthritis patients: data from the population-based SpAScania cohort from southern Sweden. Scand J Rheumatol 47:185–193

    Article  PubMed  Google Scholar 

  47. Walsh JA, Song X, Kim G, Park Y (2018) Evaluation of the comorbidity burden in patients with ankylosing spondylitis using a large US administrative claims data set. Clin Rheumatol 37:1869–1878

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

Authors

Contributions

SM participated in clinical assessment, designed, coordinated and continuously reviewed the study, participated in data management and statistical analysis and prepared the manuscript for publication. KV participated in data management, performed the statistical analysis and prepared the manuscript for publication. MZ participated in clinical assessment and drafting the manuscript. G. R. participated in clinical assessment analysis and interpretation of data, as well as in drafting the manuscript. ND participated in interpretation of data and drafting the manuscript.

Corresponding author

Correspondence to Kristina Veljkovic.

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Conflict of interest

Authors S. Milutinovic, K.Veljkovic, M. Zlatanovic, G. Radunovic and N.Damjanov declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study protocol was reviewed and approved by the Ethics Committee of the Institute of Rheumatology, Belgrade, Serbia (Protocol Number: 29/1-35/2016).

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Informed consent was obtained from all individual participants included in the study.

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Milutinovic, S., Veljkovic, K., Zlatanovic, M. et al. Depression/anxiety symptoms in axial spondyloarthritis and psoriatic arthritis patients in Serbia: a pilot study. Rheumatol Int 39, 1595–1605 (2019). https://doi.org/10.1007/s00296-019-04376-8

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  • DOI: https://doi.org/10.1007/s00296-019-04376-8

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