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Karmacharya P, Crowson CS, Lennon RJ, Poudel D, Davis JM, Ogdie A, Liew JW, Ward MM, Ishimori M, Weisman MH, Brown MA, Rahbar MH, Hwang MC, Reveille JD, Gensler LS. Multimorbidity phenotypes in ankylosing spondylitis and their association with disease activity and functional impairment: Data from the prospective study of outcomes in ankylosing spondylitis cohort. Semin Arthritis Rheum 2024; 64:152282. [PMID: 37995469 PMCID: PMC10872589 DOI: 10.1016/j.semarthrit.2023.152282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 09/01/2023] [Accepted: 10/17/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVES To examine the association of multimorbidity phenotypes at baseline with disease activity and functional status over time in ankylosing spondylitis (AS). METHODS Patient-reported AS morbidities (comorbidities, N = 28 and extra-musculoskeletal manifestations, EMMs, N = 3) within 3 years of enrollment with a prevalence ≥1 %, were included from the Prospective Study of Outcomes in Ankylosing Spondylitis (PSOAS) cohort. We defined multimorbidity as ≥2 morbidities (MM2+) and substantial multimorbidity as ≥5 morbidities (MM5+). Multimorbidity clusters or phenotypes were identified using K-median clustering. Disease activity (ASDAS-CRP) and functional status (BASFI) measures were collected every 6 months. Generalized estimating equation method was used to examine the associations of multimorbidity counts and multimorbidity clusters with measures of disease activity and functional status over time. RESULTS Among 1,270 AS patients (9,885 visits) with a median follow-up of 2.9 years (IQ range: 1.0-6.8 years), the prevalence of MM2+ and MM5+ was 49 % and 9 % respectively. We identified five multimorbidity clusters: depression (n = 321, 25 %), hypertension (n = 284, 22 %), uveitis (n = 274, 22 %), no morbidities (n = 238, 19 %), and miscellaneous (n = 153, 12 %). Patients in the depression cluster were more likely to be female and had significantly more morbidities and worse disease activity and functional status compared to those with no morbidities. CONCLUSION Approximately 49 % of AS patients in the PSOAS cohort had multimorbidity and five distinct multimorbidity phenotypes were identified. In addition to the number of morbidities, the type of morbidity appears to be important to longitudinal outcomes in AS. The depression cluster was associated with worse disease activity and function.
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Affiliation(s)
- Paras Karmacharya
- Vanderbilt University Medical Center, Division of Rheumatology & Immunology, Nashville, TN, United States of America; Mayo Clinic, Division of Rheumatology, Rochester, MN, United States of America.
| | - Cynthia S Crowson
- Mayo Clinic, Division of Rheumatology, Rochester, MN, United States of America; Mayo Clinic, Department of Quantitative Health Sciences, Rochester, MN, United States of America
| | - Ryan J Lennon
- Mayo Clinic, Department of Quantitative Health Sciences, Rochester, MN, United States of America
| | - Dilli Poudel
- Indiana Regional Medical Center, Indiana, PA, United States of America
| | - John M Davis
- Mayo Clinic, Division of Rheumatology, Rochester, MN, United States of America
| | - Alexis Ogdie
- Perelman School of Medicine, University of Pennsylvania, Departments of Medicine/Rheumatology and Biostatistics, Epidemiology and Informatics, Philadelphia, United States of America
| | - Jean W Liew
- Boston University Chobanian & Avedisian School of Medicine, Section of Rheumatology, Boston, MA, USA
| | - Michael M Ward
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Intramural Research Program, Bethesda, USA
| | - Mariko Ishimori
- Cedars-Sinai Medical Center, Division of Rheumatology, Los Angeles, USA
| | - Michael H Weisman
- Cedars-Sinai Medical Center, Division of Rheumatology, Los Angeles, USA
| | - Matthew A Brown
- Department of Medical and Molecular Genetics, Faculty of Health, King's College London, England; Genomics England, London, England
| | - Mohammad H Rahbar
- Division of Clinical and Translational Sciences, McGovern Medical School, and Biostatistics/Epidemiology/Research Design (BERD) Core, Center for Clinical and Translational Sciences, (CCTS) at the University of Texas Health Science Center at Houston, USA
| | - Mark C Hwang
- McGovern Medical School at the University of Texas Health Science Center, Division of Rheumatology and Clinical Immunogenetics, Houston, USA
| | - John D Reveille
- McGovern Medical School at the University of Texas Health Science Center, Division of Rheumatology and Clinical Immunogenetics, Houston, USA
| | - Lianne S Gensler
- University of California San Francisco, Department of Medicine, Division of Rheumatology, San Francisco, USA
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Chung DXY, Loo YE, Kwan YH, Phang JK, Woon TH, Goh WR, Angkodjojo S, Fong W. Association of anxiety, depression and resilience with overall health and functioning in axial spondyloarthritis (axSpA): a cross-sectional study. BMJ Open 2023; 13:e071944. [PMID: 37156581 PMCID: PMC10174021 DOI: 10.1136/bmjopen-2023-071944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
OBJECTIVES To evaluate the association between anxiety, depression and resilience with overall health and functioning in axial spondyloarthritis (axSpA). DESIGN Cross-sectional evaluation of baseline data from a prospective cohort study, with recruitment from January 2018 to March 2021. SETTING Outpatient clinic in a tertiary hospital in Singapore. PARTICIPANTS Patients aged 21 years and above who were diagnosed with axSpA. OUTCOME MEASURES The Hospital Anxiety and Depression Scale (HADS) was used for assessing anxiety and depression, 10-item Connor Davidson Resilience Scale (CD-RISC-10) for resilience, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) for disease activity, Bath Ankylosing Spondylitis Functional Index (BASFI) for functional limitation and Assessment of SpondyloArthritis International Society Health Index (ASAS HI) for overall health and functioning. Univariable and multivariable linear regression analyses were performed to assess the association between anxiety, depression and resilience with health and functioning. RESULTS We included 296 patients in this study. The median (IQR) score for HADS-Anxiety was 5.0 (2.0-8.0), with 13.5% and 13.9% having borderline abnormal and abnormal anxiety, respectively. The median (IQR) score for HADS-Depression was 3.0 (1.0-7.0), with 12.8% and 8.4% having borderline abnormal and abnormal depression, respectively. The median (IQR) CD-RISC-10 score was 29.0 (23.0-32.0) while the median (IQR) ASAS HI score was 4.0 (2.0-7.0). Apart from BASDAI, BASFI and disease duration, anxiety and depression were associated with overall health and functioning (β: 0.12, 95% CI 0.03, 0.20; β: 0.20, 95% CI 0.09, 0.31) in the multivariable linear regression. Level of resilience was not associated with health and functioning. CONCLUSION Anxiety and depression, but not resilience, were associated with poorer health and functioning. Clinicians could consider routinely screening for anxiety and depression in their patients, especially in patients with more severe symptoms.
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Affiliation(s)
| | - Ying Ern Loo
- Department of Medicine, National University of Singapore, Singapore
| | - Yu Heng Kwan
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore
| | - Jie Kie Phang
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore
| | - Ting Hui Woon
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
| | - Wei Rui Goh
- Department of General Medicine (Rheumatology), Sengkang General Hospital, Singapore
| | - Stanley Angkodjojo
- Department of General Medicine (Rheumatology), Sengkang General Hospital, Singapore
| | - Warren Fong
- Department of Medicine, National University of Singapore, Singapore
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
- Duke-NUS Medical School, Singapore
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Roberts MJ, Leonard AN, Bishop NC, Moorthy A. Lifestyle modification and inflammation in people with axial spondyloarthropathy-A scoping review. Musculoskeletal Care 2022; 20:516-528. [PMID: 35179819 DOI: 10.1002/msc.1625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 02/12/2022] [Indexed: 11/08/2022]
Abstract
INTRODUCTION People with axial spondyloarthritis (AS) have an inflammatory profile, increasing the risk of hypertension, type 2 diabetes, obesity, and dyslipidaemia. Consequently, AS is linked with co-morbidities such as cardiovascular disease (CVD). Physical inactivity, diet, smoking, alcohol consumption, and obesity influence inflammation, but knowledge of the interaction between these with inflammation, disease activity, and CVD risk in AS is dominated by cross-sectional research. METHODS A review of the literature was conducted between July 2020 and December 2021. The focus of the scoping review is to summarise longitudinal and randomised control trials in humans to investigate how tracking or modifying lifestyle influences inflammation and disease burden in patients with AS. KEY MESSAGES: (1) Lifestyle modifications, especially increased physical activity (PA), exercise, and smoking cessation, are critical in managing AS. (2) Smoking is negatively associated with patient reported outcome measures with AS, plus pharmaceutical treatment adherence, but links with structural radiographic progression are inconclusive. (3) Paucity of data warrant structured studies measuring inflammatory cytokine responses to lifestyle modification in AS. CONCLUSION Increased PA, exercise, and smoking cessation should be supported at every given opportunity to improve health outcomes in patients with AS. The link between smoking and radiographic progression needs further investigation. Studies investigating the longitudinal effect of body weight, alcohol, and psychosocial factors on disease activity and physical function in patients with AS are needed. Given the link between inflammation and AS, future studies should also incorporate markers of chronic inflammation beyond the standard C-reactive protein and erythrocyte sedimentation rate measurements.
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Affiliation(s)
- Matthew J Roberts
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.,National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and the University of Leicester, Leicester, UK
| | - Amber N Leonard
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.,National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and the University of Leicester, Leicester, UK
| | - Nicolette C Bishop
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.,National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and the University of Leicester, Leicester, UK
| | - Arumugam Moorthy
- Department of Rheumatology, University Hospitals of NHS Trust, College of Life Sciences, University of Leicester, Leicester, UK
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Resilience in women with primary Sjögren's syndrome. Rheumatol Int 2021; 41:1987-1994. [PMID: 34091740 DOI: 10.1007/s00296-021-04899-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 05/17/2021] [Indexed: 10/21/2022]
Abstract
To assess the relationship between resilience and several diseases and individual features in primary Sjӧgren's Syndrome (SS) patients. Resilience was assessed using the Resilience Scale (RS-14). Disease activity, damage, and reported symptoms were assessed by means of ESSDAI (EULAR Sjögren's syndrome disease activity index), SSDDI (Sjӧgren's Syndrome Disease Damage Index) and ESSPRI (EULAR Sjӧgren's Syndrome Patient Reported Index). EuroQol, HADS (Hospital Anxiety and Depression Scale), SF-12 (Short-form 12 health survey), FAS (Fatigue Assessment Scale), FACIT-F (Functional Assessment of Chronic Illness Therapy - Fatigue), and IPAQ (International Physical Activity Questionnaire) questionnaires were submitted to evaluate physical and mental well-being of the recruited patients. Data about the autoimmune profile, systemic manifestations, and current therapy were collected. Educational qualifications and work activities were also considered. Descriptive, correlational, and linear regression analysis were performed. 74 consecutive women with primary SS and 74 sex and age-matched healthy subjects as a control group were recruited. SS patients displayed a moderate value of resilience (median 78.5) with no significant difference compared to controls (p = 0.38). An inverse relationship was found between resilience and mood disorders such as anxiety (p = 0.038) and depression (p < 0.001). Greater resilience was associated with a better perception of the quality of life (p = 0.02) and general health (p < 0.001), as well as with less fatigue (p = 0.008) and a more physically active lifestyle (p = 0.001). No significant relationship was found neither between resilience and age, socio-demographic and disease characteristics, nor with ESSDAI (p = 0.26), ESSPRI (p = 0.83) and SSDDI (p = 0.67). This is the first study assessing resilience in a large group of unselected primary SS patients. Most resilient primary SS patients are less depressed and show a better perception of their health. Greater resilience tends to correlate with less anxiety, physical and mental fatigue, and a more active lifestyle, while no association with disease activity and duration, damage, and socio-demographic features was detected. Considering the well-known role of resilience in helping to better cope with chronic illnesses, its assessment in SS patients should not be overlooked and the possible strategies for its improvement should be better explored and further implemented.
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Öksüz E, Cinar FI, Cinar M, Tekgoz E, Yilmaz S. Assessment of the effects of loneliness, perceived social support, and depression on medication adherence in patients with ankylosing spondylitis. Perspect Psychiatr Care 2021; 57:517-523. [PMID: 32614084 DOI: 10.1111/ppc.12570] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/02/2020] [Accepted: 06/13/2020] [Indexed: 01/03/2023] Open
Abstract
PURPOSE This study aims to investigate the effects of loneliness, perceived social support, and depression on medication adherence of patients with ankylosing spondylitis (AS). DESIGN AND METHODS This cross-sectional study was conducted with 119 AS patients. Data were collected using the Morisky-Green-Levine Medication Adherence Scale, the UCLA Loneliness Scale (ULS), the Multidimensional Scale of Perceived Social Support (MSPSS), and the Beck Depression Inventory (BDI). FINDINGS Nonadherent patients were younger (P = .033), scored higher on the ULS (P = .015), and BDI (P = .024) scales, and lower on the MSPSS scale (P = .039) and on family support (P = .002). PRACTICAL IMPLICATIONS The biopsychosocial aspects of patients with AS should be managed holistically to improve their medication adherence.
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Affiliation(s)
- Emine Öksüz
- Department of Psychiatric and Mental Health Nursing, Gulhane Faculty of Nursing, University of Health Sciences Turkey, Ankara, Turkey
| | - Fatma Ilknur Cinar
- Department of Internal Medicine Nursing, Gulhane Faculty of Nursing, University of Health Sciences Turkey, Ankara, Turkey
| | - Muhammet Cinar
- Department of Internal Medicine, Division of Rheumatology, Gulhane Faculty of Medicine, University of Health Sciences Turkey, Ankara, Turkey
| | - Emre Tekgoz
- Department of Internal Medicine, Division of Rheumatology, Gulhane Faculty of Medicine, University of Health Sciences Turkey, Ankara, Turkey
| | - Sedat Yilmaz
- Department of Internal Medicine, Division of Rheumatology, Gulhane Faculty of Medicine, University of Health Sciences Turkey, Ankara, Turkey
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Gender differences in factors associated with low quality of life and depression in Korean patients with ankylosing spondylitis. Qual Life Res 2021; 30:2299-2310. [PMID: 33689133 DOI: 10.1007/s11136-021-02800-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To identify predictors of low health-related quality of life (HRQoL) and depression in ankylosing spondylitis (AS) patients with a focus on gender differences. METHODS We conducted a cross-sectional cohort study. Both AS-related clinical data and contextual factors were obtained. HRQoL and depressive mood were assessed by EuroQol-5 dimension (EQ-5D) and the Center for Epidemiological Studies Depression Scale (CES-D), respectively. Gender-stratified multivariable logistic regression analyses were performed. RESULTS Among 211 patients, 161 were males. Males had similar disease activity and higher radiographic damage compared with females. There was no significant difference in EQ-5D index score between genders. CES-D score was higher in females. Higher ASDAS-C-reactive protein (CRP) was associated with low HRQoL in both males (Odds ratio [OR] 4.25, 95% confidence interval [CI] 2.42-7.46) and females (OR 2.94, 95% CI 1.02-8.48). Being employed was associated with decreased possibility of having low HRQoL in males (OR 0.39, 95% CI 0.16-0.95). Regarding depression, higher ASDAS-CRP (OR 1.87, 95% CI 1.03-3.40), current smoking (OR 2.98, 95% CI 1.09-8.15), and being employed (OR 0.17, 95% CI 0.06-0.46) were associated with depression in males. For females, living with a partner was related to depression (OR 0.08, 95% CI 0.01-0.93). CONCLUSION AS patients with high disease activity are likely to be suffering from low HRQoL. Both disease-related factors and contextual factors were associated with depression, and predictors showed some differences between genders. Awareness of gender differences in comprehensive assessment can lead us to better personalized management in AS patients.
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7
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Yu K, Lo L, Lin M, Cheung Y, Wong S. A preliminary study of an online pain management programme for patients with ankylosing spondylitis. COUNSELLING & PSYCHOTHERAPY RESEARCH 2021. [DOI: 10.1002/capr.12314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Kai‐Ching Yu
- Department of Counselling and Psychology Hong Kong Shue Yan University North Point Hong Kong
| | - Lap‐Yan Lo
- Department of Counselling and Psychology Hong Kong Shue Yan University North Point Hong Kong
| | - Muriel Lin
- Department of Counselling and Psychology Hong Kong Shue Yan University North Point Hong Kong
| | - Yim Cheung
- Department of Counselling and Psychology Hong Kong Shue Yan University North Point Hong Kong
| | - Siu‐Sing Wong
- Department of Counselling and Psychology Hong Kong Shue Yan University North Point Hong Kong
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Cano-García L, Mena-Vázquez N, Manrique Arija S, Hernández-Sánchez MD, Segura-Ruiz R, Domínguez-Quesada C, Fernández-Nebro A. Psychological factors associated with sleep disorders in patients with axial spondyloarthritis or psoriatic arthritis: A multicenter cross-sectional observational study. J Clin Nurs 2020; 30:266-275. [PMID: 33113279 DOI: 10.1111/jocn.15546] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/26/2020] [Accepted: 10/18/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Studies in axial spondyloarthritis (AxSp) have shown that intensity of pain, anxiety, depression and inflammatory activity are associated with poor sleep quality. AIM To describe mood and sleep disorders and positive psychological factors in patients with AxSp and psoriatic arthritis (PsA) and to evaluate the psychological factors that are potentially involved in sleep disorders. DESIGN Multicenter cross-sectional observational study based on a series of patients with AxSp and PsA. PARTICIPANTS Participants were selected consecutively from patients aged ≥18 years with AxSp or PsA followed at the rheumatology department of 4 Spanish hospitals. INCLUSION CRITERIA age ≥18 years, AxSp (ASAS criteria) or PsA (CASPAR criteria), ability to understand the study and prepared to complete the questionnaires. METHODS Main outcomes: Oviedo Sleep Quality questionnaire result. SECONDARY OUTCOMES psychological status evaluated using the Hospital Anxiety and Depression Scale (HADS) questionnaire, health-related quality of life evaluated using SF-36, perception of pain evaluated using the short questionnaire for assessment of pain (BDU) and fatigue evaluated using the Fatigue Scale (FACIT) questionnaire. We performed a descriptive multivariate linear regression analysis to study factors that were independently associated with sleep disorders. The STROBE guidelines were adopted. RESULTS We included 301 patients (152 [50.5%] with AxSp and 149 [49.5%] with PsA). The multivariate linear regression analysis for the whole sample showed that insomnia was inversely associated with emotional recovery and biologic disease-modifying antirheumatic drugs and directly associated with depression in both groups. The analysis by disease (AxSp and PsA) showed that insomnia was independently associated with depression and emotional recovery. CONCLUSIONS Insomnia may be associated with other mood disorders, quality of life and inflammatory activity in the patients studied here. RELEVANCE TO CLINICAL PRACTICE A nurse intervention can be carried out to prevent sleep disorders knowing the consequences and triggers of the problem.
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Affiliation(s)
- Laura Cano-García
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain.,UGC de Reumatología, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Natalia Mena-Vázquez
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain.,UGC de Reumatología, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Sara Manrique Arija
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain.,UGC de Reumatología, Hospital Regional Universitario de Málaga, Málaga, Spain
| | | | | | | | - Antonio Fernández-Nebro
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain.,UGC de Reumatología, Hospital Regional Universitario de Málaga, Málaga, Spain.,Departamento de Medicina, Universidad de Málaga, Málaga, Spain
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Ogdie A, Duarte-García A, Hwang M, Navarro-Compán V, van der Heijde D, Mease P. Measuring Outcomes in Axial Spondyloarthritis. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:47-71. [PMID: 33091248 DOI: 10.1002/acr.24266] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/12/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Alexis Ogdie
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | - Mark Hwang
- University of Texas Health Science Center at Houston
| | | | | | - Philip Mease
- Swedish Medical Center, Providence St. Joseph Health, and University of Washington School of Medicine, Seattle
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10
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Reveille JD, Lee M, Gensler LS, Ward MM, Hwang MC, Learch TJ, Tahanan A, Diekman L, Rahbar MH, Ishimori ML, Weisman MH. The changing profile of ankylosing spondylitis in the biologic era. Clin Rheumatol 2020; 39:2641-2651. [PMID: 32648102 DOI: 10.1007/s10067-020-05260-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 06/19/2020] [Accepted: 06/23/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To compare disease characteristics, comorbidities, and medication utilization of 1141 patients with ankylosing spondylitis (AS) with short (< 20 years) and long (≥ 20 years) disease duration enrolled in the Prospective Study of Outcomes in AS (PSOAS) study over three different periods of time and followed longitudinally. METHODS Study visits were carried out every 6 months examining disease activity (Bath AS Disease Activity Index (BASDAI), C-reactive protein, erythrocyte sedimentation rate), functional impairment, depression, and medication utilization as well as radiographic severity. Groups were compared with regression models using generalized estimating equation, linear, and Poisson regressions after adjusting for sites and for patients withdrawing from the study at less than 2 years follow-up. RESULTS Overall, AS patients with long disease duration were more likely to be married, white, receiving disability, and to be with higher functional impairment and radiographic severity, more uveitis, diabetes, hypertension, cardiovascular disease, and osteoporosis, and with less nonsteroidal anti-inflammatory drug (NSAID) and more opioid use than those with short disease duration. Current smoking decreased between 2002 and 2019 regardless of disease duration. Lower baseline NSAID and methotrexate/sulfasalazine use and higher TNF inhibitor usage were seen only in those with shorter disease duration, though NSAID use and functional impairment decreased over time in both groups. Disease activity, depression scores, and NSAID use decreased and anti-TNF use increased in those followed > 8 years. CONCLUSIONS Patients with AS enrolling in this multicenter longitudinal cohort have different disease profiles and medication utilization over time, perhaps reflecting innovations in treatment and increasing disease awareness. Key Points • The use of NSAIDs, nonbiologic DMARDs, and prednisone has decreased over the past 16 years in patients with AS. • The use of anti-TNF agents has dramatically increased. • In treated patients, disease activity, depression scores, and functional impairment have decreased over time.
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Affiliation(s)
- John D Reveille
- Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston, 6431 Fannin St., Houston, TX, 77030, USA.
| | - MinJae Lee
- Division of Biostatistics, Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Lianne S Gensler
- Department of Medicine, Division of Rheumatology, University of California San Francisco, San Francisco, CA, USA
| | - Michael M Ward
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Mark C Hwang
- Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston, 6431 Fannin St., Houston, TX, 77030, USA
| | - Thomas J Learch
- Department of Radiology, Cedars-Sinai Medical Center Los Angeles, Los Angeles, CA, USA
| | - Amirali Tahanan
- Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston, Houston, TX, USA
| | - Laura Diekman
- Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston, 6431 Fannin St., Houston, TX, 77030, USA
| | - Mohammad H Rahbar
- Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston, Houston, TX, USA
| | - Mariko L Ishimori
- Division of Rheumatology, Cedars Sinai Medical Center Los Angeles, Los Angeles, CA, USA
| | - Michael H Weisman
- Division of Rheumatology, Cedars Sinai Medical Center Los Angeles, Los Angeles, CA, USA
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11
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Hwang MC, Lee MJ, Gensler LS, Ward MM, Brown MA, Eisen S, Learch TJ, Tahanan A, Rahbar MH, Ishimori ML, Weisman MH, Reveille JD. Longitudinal associations between depressive symptoms and clinical factors in ankylosing spondylitis patients: analysis from an observational cohort. Rheumatol Int 2020; 40:1053-1061. [PMID: 32166439 DOI: 10.1007/s00296-020-04544-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 02/28/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Although cross-sectional studies have shown that ankylosing spondylitis-specific factors correlate with depressive symptom severity, the association of these factors over time is unresolved. We examined the demographic and clinical factors associated with longitudinal depressive symptom severity in AS patients. METHODS We analyzed sociodemographic, clinical, behavioral and medication data from 991 patients from the Prospective Study of Outcomes in Ankylosing spondylitis cohort, and measured depression severity with the Center for Epidemiological Studies Depression (CES-D) Scale administered at approximately 6-month visit intervals. Multivariable longitudinal negative binomial regression models were conducted using generalized estimating equation modeling to assess the demographic, clinical, and medication-related factors associated with depression severity by CES-D scores over time. RESULTS The median baseline CES-D score (possible range 0-60) was 10.0 (interquartile range = 5, 17). In longitudinal multivariable analyses, higher CES-D scores were associated with longitudinal smoking, greater functional impairment, greater disease activity, self-reported depression, and poor global health scores. Marital status (e.g., being married) was associated with lower CES-D. Adjusted mean CES-D scores in our model decreased over time, with a significant interaction between time and gender observed. CONCLUSION This study identified longitudinal clinical factors such as greater disease activity, greater functional impairment, and poor global health to be associated with longitudinal depression severity. These factors are potentially modifiable and may help manage depressive symptoms in AS.
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Affiliation(s)
- Mark C Hwang
- Division of Rheumatology, Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin MSB 5.270, Houston, TX, 77030, USA.
| | - Min Jae Lee
- Division of Clinical and Translational Sciences, Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Lianne S Gensler
- Division of Rheumatology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Michael M Ward
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health Bethesda, Bethesda, MD, USA
| | - Matthew A Brown
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Seth Eisen
- Department of Medicine, Division of Rheumatology, Washington University at St. Louis, St. Louis, MO, USA
| | - Thomas J Learch
- Division of Rheumatology, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Amirali Tahanan
- Division of Clinical and Translational Sciences, Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Mohammad H Rahbar
- Division of Clinical and Translational Sciences, Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Mariko L Ishimori
- Division of Rheumatology, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Michael H Weisman
- Division of Rheumatology, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - John D Reveille
- Division of Rheumatology, Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin MSB 5.270, Houston, TX, 77030, USA
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12
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Fang ML, Wu CS, Weng LC, Huang HL. Factors associated with depressive symptoms in patients with ankylosing spondylitis in Northern Taiwan. PLoS One 2019; 14:e0224298. [PMID: 31648243 PMCID: PMC6812870 DOI: 10.1371/journal.pone.0224298] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 10/09/2019] [Indexed: 12/17/2022] Open
Abstract
Patients with ankylosing spondylitis (AS) experience impaired physical function and reduced quality of life, which puts this group at high risk for depression. Identifying factors associated with depressive symptoms could improve outcomes for this at-risk group. However, few studies have examined the relationship between demographic and clinical variables and depressive symptoms in patients with AS. This cross-sectional correlation study recruited patients with AS by convenience sampling from the division of immunology and rheumatology of a medical center in Northern Taiwan. Participants (N = 120) included 91 males and 29 females, age ≥ 20 years. Data were collected from chart reviews, and structural questionnaires, which included demographic information regarding employment status, history of falls, impact of AS on work; clinical information relative to AS was obtained from structural questionnaires: the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and functional index (BASFI), Numerical Rating Scale (NRS), Body Image Scale (BIS), and Beck Depression Inventory-II (BDI-II). Multiple regression analysis identified predictors of depression. The mean BDI-II score was 9.50 ± 8.30; 25% had scores indicating mild to severe depressive symptoms. Mean score on the BIS was 68.17 ± 16.14; 14.2% had fallen within the previous year; and 57.5% reported AS affected their work. Variables associated with depressive symptoms were work affected by AS (β = 0.14, p = .049), occurrence of a fall within the previous year (β = 0.14, p = .032), higher scores on the BASDAI (β = 0.21, p = .032), and lower body image (β = −0.38, p < .001). Clinical professionals should regularly assess patients with AS for depressive symptoms. Health care planning should provide instruction in fall prevention and control of disease activity, and strategies to improve body image, which could improve patients’ self-management capabilities and body image as well as mitigate depressive symptoms.
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Affiliation(s)
- Mei-Ling Fang
- Department of Nursing, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chien-Sheng Wu
- Division of Allergy, Immunology and Rheumatology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Li-Chueh Weng
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsiu-Li Huang
- Department of Long-term Care, College of Health Technology, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
- * E-mail:
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13
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Webers C, Vanhoof L, Leue C, Boonen A, Köhler S. Depression in ankylosing spondylitis and the role of disease-related and contextual factors: a cross-sectional study. Arthritis Res Ther 2019; 21:215. [PMID: 31639012 PMCID: PMC6805406 DOI: 10.1186/s13075-019-1995-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 09/05/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with ankylosing spondylitis (AS) have a higher prevalence of depression compared to the general population. Comorbid depression in AS likely has a multifactorial origin. While several disease-related and contextual factors have been associated with depressive symptoms in AS, a comprehensive model of their interrelations is currently lacking. Such a model could help understand the mechanisms leading to, or maintaining, depression in AS. The objectives of the current study were to determine which factors are associated with depressive symptoms in AS and to understand their underlying relationships. METHODS Data from a cross-sectional survey-based multicentre study were used. Potential determinants included both contextual and disease-related factors. Depressive symptoms were assessed by the Hospital Anxiety and Depression Subscale (HADS-D). Direct and indirect associations between risk factors and the latent depressive symptom outcome were explored using structural equation modelling. A final model was selected based on model fit criteria and clinical plausibility. RESULTS Among 245 patients, median HADS-D score was 3 (interquartile range 1-6), and 44 patients (18%) had a HADS-D score ≥ 8, indicating possible depression. In the final model, contextual factors significantly associated with depressive symptoms were male gender, being employed, lower income, lower mastery and worse satisfaction with social role participation. Bath AS Disease Activity Index (BASDAI) was the only disease-related factor that was associated with depressive symptoms, acted only indirectly via mastery, and its standardized total effect on depressive symptoms was smaller than that of several contextual factors. Mastery had a central role in the path diagram and mediated the effects of BASDAI, income and satisfaction with social role participation on depressive symptoms. The final model explained 64% of the variance in the depression outcome. CONCLUSIONS Both contextual and disease-related factors are associated with depressive symptoms in AS. Mastery, the extent to which one feels in control over life and disease, has a key role in this process. Results support a relevance of self-efficacy in disease management and patient education. In order to improve patients' mental health, research is warranted whether mastery and its relation with depression can be modified.
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Affiliation(s)
- Casper Webers
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, PO Box 5800, 6202 AZ, Maastricht, the Netherlands. .,Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands.
| | - Laura Vanhoof
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, PO Box 5800, 6202 AZ, Maastricht, the Netherlands
| | - Carsten Leue
- Department of Psychiatry and Psychology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, PO Box 5800, 6202 AZ, Maastricht, the Netherlands.,Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Sebastian Köhler
- School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, the Netherlands
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14
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Zhang L, Wu Y, Liu S, Zhu W. Prevalence of Depression in Ankylosing Spondylitis: A Systematic Review and Meta-Analysis. Psychiatry Investig 2019; 16:565-574. [PMID: 31446684 PMCID: PMC6710421 DOI: 10.30773/pi.2019.06.05] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 06/05/2019] [Indexed: 01/08/2023] Open
Abstract
The aim of this study was to provide a summary estimate of depression prevalence among people with ankylosing spondylitis (AS) in comparison to those without AS. A systematic literature search was conducted using PubMed, Embase, PsycINFO, Web of Science, the Cochrane database library, China National Knowledge Infrastructure, and Wanfang Database from their inception to December 2016. The results showed that thirty-one eligible studies involving 8,106 patients were analyzed. Fifteen methods of defining depression were reported. The overall pooled prevalence of depression was 35% (95% CI, 28-43%), with high between-study heterogeneity (I2=98.8%, p<0.001). The relative risk of depression among people with AS was 1.76 (95% CI: 1.21-2.55, eight studies, n=3,006) compared with people without AS. The depression score [standardized mean difference (SMD)=0.43, 95% CI: 0.19-0.67, seven studies, n=549] was higher in AS patients than in controls. The main influence on depression prevalence was the sample size and country of origin. In conclusion, one-third of people with AS experience symptoms of depression. Depression was more prevalent in AS patients than in controls. Further research is needed to identify effective strategies for preventing and treating depression among AS patients.
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Affiliation(s)
- Lijuan Zhang
- Department of Gastrointestinal Surgery, Shanghai Minimally Invasive Surgery Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yaping Wu
- Department of Rheumatology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shiguang Liu
- Department of Gastrointestinal Surgery, Shanghai Minimally Invasive Surgery Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weiyi Zhu
- Department of Nursing, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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15
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Garrido-Cumbrera M, Delgado-Domínguez C, Gálvez-Ruiz D, Mur CB, Navarro-Compán V. The Effect of Axial Spondyloarthritis on Mental Health: Results from the Atlas. J Rheumatol 2019; 46:1284-1289. [DOI: 10.3899/jrheum.180868] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2019] [Indexed: 01/07/2023]
Abstract
Objective.To assess the risk of mental disorders in patients with axial spondyloarthritis (axSpA) and to examine the factors associated with this.Methods.In 2016, a sample of 680 patients with axSpA were interviewed as part of the development process for the Atlas of Axial Spondyloarthritis in Spain. The risk of mental disorders in these patients was assessed using the 12-item General Health Questionnaire scale. Additionally, the variables associated with the risk of mental disorders were investigated, including sociodemographic characteristics (age, sex, relationship, patient association membership, job status, and educational level), disease status (Bath Ankylosing Spondylitis Disease Activity Index, spinal stiffness, and functional limitation), and previous diagnosis of mental disorders (depression and anxiety). Bivariate correlation analyses were performed, followed by multiple hierarchical and stepwise regression analysis.Results.A total of 45.6% patients were at risk of mental disorders. All variables except educational level and thoracic stiffness significantly correlated with risk of mental disorders. Nevertheless, disease activity, functional limitation, and age showed the highest coefficient (r = 0.543, p ≤ 0.001; r = 0.378, p ≤ 0.001; r = −0.174, p ≤ 0.001, respectively). In the stepwise regression analysis, 4 variables (disease activity, functional limitation, patient association membership, and cervical stiffness) explained the majority of the variance for the risk of mental disorders. Disease activity displayed the highest explanatory degree (R2 = 0.875, p < 0.001).Conclusion.In patients with axSpA, the prevalence of risk of mental disorders is high. Combined with a certain sociodemographic profile, high disease activity is a good indicator of the risk for mental disorders.
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16
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Packham J. Optimizing outcomes for ankylosing spondylitis and axial spondyloarthritis patients: a holistic approach to care. Rheumatology (Oxford) 2018; 57:vi29-vi34. [PMID: 30445484 PMCID: PMC6238224 DOI: 10.1093/rheumatology/key200] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 06/05/2018] [Indexed: 01/20/2023] Open
Abstract
Axial SpA (axSpA) can affect diverse elements of an individual's life. The areas affected can be much more wide-ranging than the historical medical model of SpA, causing increased disease activity (pain and stiffness) and disability (reduced range of movement and physical function). A more holistic view of the individual results in the realization that many other areas of life can be adversely affected by axSpA, from the ability to work effectively and function socially, to effects on quality of life and the onset of worsening fatigue or mood disturbance. A good understanding of these areas outside the medical model allows for an improved understanding of the overall life impact of axSpA. This highlights the importance of understanding how to measure these elements of life using patient-reported outcome measures that can truly reflect an individual's experience of axSpA. These measures can then provide a better insight into the risks and benefits of interventions and medications used to treat axSpA.
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Affiliation(s)
- Jonathan Packham
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
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17
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Swinnen TW, Westhovens R, Dankaerts W, de Vlam K. Widespread pain in axial spondyloarthritis: clinical importance and gender differences. Arthritis Res Ther 2018; 20:156. [PMID: 30053895 PMCID: PMC6062924 DOI: 10.1186/s13075-018-1626-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 05/14/2018] [Indexed: 11/10/2022] Open
Abstract
Background There is a remarkable lack of detailed knowledge on pain areas in axial spondyloarthritis (axSpA), and their clinical relevance is largely unknown. Pain area may reflect local disease processes, but amplification of nervous system signalling may alter this relationship. Also, gender differences in pain area may exist in axSpA, possibly confounding disease activity outcomes. Therefore, we firstly detailed pain locations in axSpA and evaluated gender differences. Secondly, we explored the relationship of regional pain definitions with clinical outcomes. Finally, we explored the role of pain area in the assessment of disease activity. Methods Body charts informed on the presence of axial, peripheral articular and non-articular pain in 170 patients (108 men, 62 women) with axSpA. Multivariate Odds Ratios (ORs) were used to compare genders. General linear models were used to explore clinical differences in disease activity (Bath Ankylosing Spondylitis Disease Activity Index [BASDAI]), activity limitations (Bath Ankylosing Spondylitis Functional Index [BASFI]), fear of movement (Tampa Scale for Kinesiophobia 11-item version [TSK-11]), anxiety (Hospital Anxiety and Depression Scale subscale anxiety [HADS-A]) and depression (HADS subscale depression [HADS-D]) between four subgroups classified by widespread non-articular pain (WNAP+/−) and physician global assessment of disease activity (PGDA+/−) (p < .05). Principal Component Analysis (PCA) was performed to explore gender differences in the structure of disease activity. Results Axial thoracic pain was least prevalent (lumbar, 74.4%; cervical, 47.6%; cervicothoracic, 47.6%; thoracic, 32.4%), but it was about three times more likely in women (OR, 2.92; p = .009). Axial cervicothoracic junction pain spread more diffusely in women (OR, 2.48; p = .018). Women exhibited a two- to threefold increased likelihood of widespread axial (OR, 3.33; p = .007) and peripheral articular (OR, 2.34; p = .023) pain. A subgroup of WNAP+/PGDA− combined with low PGDA (27% of all patients) was associated with worse BASFI, BASDAI, HADS-A and HADS-D in men and worse TSK-11 and HADS-A in women (p < .05). Disease activity outcomes showed a two-factor structure in women but not in men. Conclusions In patients with axSpA, the location and spread of pain was different between genders and was related to worse clinical status. On the basis of pain area and PGDA, clinical subgroups exhibiting a remarkably distinct health status were identified. Outcome instruments such as BASDAI should acknowledge gender differences to ensure structural validity. Electronic supplementary material The online version of this article (10.1186/s13075-018-1626-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Thijs Willem Swinnen
- Division of Rheumatology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium. .,Skeletal Biology and Engineering Research Center, Department of Development and Regeneration, KU Leuven, Herestraat 49 box 7003/13, 3000, Leuven, Belgium. .,Musculoskeletal Rehabilitation Research Unit, Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101 box 1501, 3001, Leuven, Belgium.
| | - René Westhovens
- Division of Rheumatology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.,Skeletal Biology and Engineering Research Center, Department of Development and Regeneration, KU Leuven, Herestraat 49 box 7003/13, 3000, Leuven, Belgium
| | - Wim Dankaerts
- Musculoskeletal Rehabilitation Research Unit, Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101 box 1501, 3001, Leuven, Belgium
| | - Kurt de Vlam
- Division of Rheumatology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.,Skeletal Biology and Engineering Research Center, Department of Development and Regeneration, KU Leuven, Herestraat 49 box 7003/13, 3000, Leuven, Belgium
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18
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Redeker I, Hoffmann F, Callhoff J, Haibel H, Sieper J, Zink A, Poddubnyy D. Determinants of psychological well-being in axial spondyloarthritis: an analysis based on linked claims and patient-reported survey data. Ann Rheum Dis 2018. [PMID: 29525776 PMCID: PMC6029638 DOI: 10.1136/annrheumdis-2017-212629] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The aim of this study was to assess the psychological well-being and to analyse factors associated with depressive symptoms in axial spondyloarthritis (axSpA). METHODS A stratified random sample of subjects with a diagnosis of axSpA (International Classification of Diseases, Tenth Revision, German Modification M45) was drawn from health insurance data in Germany. These persons received a postal questionnaire on disease-related, psychological and lifestyle factors as well as socioeconomic status. Additional information to verify the axSpA diagnosis was also collected. The psychological well-being was assessed by means of the 5-item WHO Well-Being Index (WHO-5), which is considered a screening tool for depression. The following established cut-offs on the WHO-5 were applied: >50: good well-being, no depressive symptoms; 29-50: mild depressive symptoms; ≤28: moderate-to-severe depressive symptoms. Information on comorbidities, drug prescriptions and non-pharmacological treatment was retrieved from claims data and linked to the questionnaire data. RESULTS A total of 1736 persons with a confirmed axSpA diagnosis were included. Using the cut-offs on the WHO-5, 533 persons (31%) were found to have moderate-to-severe depressive symptoms, 479 (28%) had mild depressive symptoms and 724 (42%) had a good well-being. Multivariable logistic regression revealed that higher disease activity, higher level of functional impairment, lower income, self-reported stress and lack of exercise, and younger age represent factors associated with moderate-to-severe depressive symptoms. CONCLUSIONS The prevalence of depressive symptoms in axSpA subjects is high and associated with disease-related parameters, socioeconomic status and lifestyle factors. These findings highlight the need for the careful evaluation of depressive symptoms as a part of the management strategy for axSpA.
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Affiliation(s)
- Imke Redeker
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
| | - Falk Hoffmann
- Department of Health Services Research, Carl von Ossietzky University, Oldenburg, Germany
| | - Johanna Callhoff
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
| | - Hildrun Haibel
- Department of Gastroenterology, Infectiology and Rheumatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Joachim Sieper
- Department of Gastroenterology, Infectiology and Rheumatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Angela Zink
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany.,Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Denis Poddubnyy
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany.,Department of Gastroenterology, Infectiology and Rheumatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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19
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Dau JD, Lee M, Ward MM, Gensler LS, Brown MA, Learch TJ, Diekman LA, Tahanan A, Rahbar MH, Weisman MH, Reveille JD. Opioid Analgesic Use in Patients with Ankylosing Spondylitis: An Analysis of the Prospective Study of Outcomes in an Ankylosing Spondylitis Cohort. J Rheumatol 2017; 45:188-194. [PMID: 29196383 DOI: 10.3899/jrheum.170630] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Opioid analgesics may be prescribed to ankylosing spondylitis (AS) patients with pain that is unresponsive to antirheumatic treatment. Our study assessed factors associated with opioid usage in AS. METHODS A prospective cohort of 706 patients with AS meeting modified New York criteria followed at least 2 years underwent comprehensive clinical evaluation of disease activity and functional impairment. These were assessed by the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI). Radiographic severity was assessed by the Bath Ankylosing Spondylitis Radiology Index and modified Stokes Ankylosing Spondylitis Scoring System. Medications taken concurrently with opioids, as well as C-reactive protein (CRP) levels and erythrocyte sedimentation rate (ESR), were determined at each study visit, performed every 6 months. Analyses were carried out at baseline, and longitudinal multivariable models were developed to identify factors independently associated with chronic and intermittent opioid usage over time. RESULTS Factors significantly associated with opioid usage, especially chronic opioid use, included longer disease duration, smoking, lack of exercise, higher disease activity (BASDAI) and functional impairment (BASFI), depression, radiographic severity, and cardiovascular disease. Patients taking opioids were more likely to be using anxiolytic, hypnotic, antidepressant, and muscle relaxant medications. Multivariable analysis underscored the association with smoking, older age, antitumor necrosis factor agent use, and psychoactive drugs, as well as with subjective but not objective determinants of disease activity. CONCLUSION Opioid usage was more likely to be associated with subjective measures (depression, BASDAI, BASFI) than objective measures (CRP, ESR), suggesting that pain in AS may derive from sources other than spinal inflammation alone.
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Affiliation(s)
- Jonathan D Dau
- From the Department of Internal Medicine, Division of Rheumatology, and the Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston, Houston, Texas; National Institute of Arthritis and Musculoskeletal and Skin Diseases, US National Institutes of Health, Bethesda, Maryland; Department of Medicine, Division of Rheumatology, University of California San Francisco (UCSF), San Francisco, California, USA; University of Queensland Diamantina Institute, Translational Research Institute, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Princess Alexandra Hospital, Queensland, Australia; Division of Rheumatology, Cedars Sinai Medical Center, Los Angeles, California, USA.,J.D. Dau, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; M.J. Lee, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.M. Ward, MD, MPH, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health; L.S. Gensler, MD, Department of Medicine, Division of Rheumatology, UCSF; M.A. Brown, FRACP, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital; T.J. Learch, MD, Division of Rheumatology, Cedars Sinai Medical Center; L.A. Diekman, MS, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; A. Tahanan, BS, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Rahbar, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Weisman, MD, Division of Rheumatology, Cedars Sinai Medical Center; J.D. Reveille, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston
| | - MinJae Lee
- From the Department of Internal Medicine, Division of Rheumatology, and the Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston, Houston, Texas; National Institute of Arthritis and Musculoskeletal and Skin Diseases, US National Institutes of Health, Bethesda, Maryland; Department of Medicine, Division of Rheumatology, University of California San Francisco (UCSF), San Francisco, California, USA; University of Queensland Diamantina Institute, Translational Research Institute, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Princess Alexandra Hospital, Queensland, Australia; Division of Rheumatology, Cedars Sinai Medical Center, Los Angeles, California, USA.,J.D. Dau, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; M.J. Lee, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.M. Ward, MD, MPH, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health; L.S. Gensler, MD, Department of Medicine, Division of Rheumatology, UCSF; M.A. Brown, FRACP, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital; T.J. Learch, MD, Division of Rheumatology, Cedars Sinai Medical Center; L.A. Diekman, MS, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; A. Tahanan, BS, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Rahbar, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Weisman, MD, Division of Rheumatology, Cedars Sinai Medical Center; J.D. Reveille, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston
| | - Michael M Ward
- From the Department of Internal Medicine, Division of Rheumatology, and the Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston, Houston, Texas; National Institute of Arthritis and Musculoskeletal and Skin Diseases, US National Institutes of Health, Bethesda, Maryland; Department of Medicine, Division of Rheumatology, University of California San Francisco (UCSF), San Francisco, California, USA; University of Queensland Diamantina Institute, Translational Research Institute, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Princess Alexandra Hospital, Queensland, Australia; Division of Rheumatology, Cedars Sinai Medical Center, Los Angeles, California, USA.,J.D. Dau, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; M.J. Lee, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.M. Ward, MD, MPH, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health; L.S. Gensler, MD, Department of Medicine, Division of Rheumatology, UCSF; M.A. Brown, FRACP, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital; T.J. Learch, MD, Division of Rheumatology, Cedars Sinai Medical Center; L.A. Diekman, MS, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; A. Tahanan, BS, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Rahbar, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Weisman, MD, Division of Rheumatology, Cedars Sinai Medical Center; J.D. Reveille, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston
| | - Lianne S Gensler
- From the Department of Internal Medicine, Division of Rheumatology, and the Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston, Houston, Texas; National Institute of Arthritis and Musculoskeletal and Skin Diseases, US National Institutes of Health, Bethesda, Maryland; Department of Medicine, Division of Rheumatology, University of California San Francisco (UCSF), San Francisco, California, USA; University of Queensland Diamantina Institute, Translational Research Institute, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Princess Alexandra Hospital, Queensland, Australia; Division of Rheumatology, Cedars Sinai Medical Center, Los Angeles, California, USA.,J.D. Dau, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; M.J. Lee, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.M. Ward, MD, MPH, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health; L.S. Gensler, MD, Department of Medicine, Division of Rheumatology, UCSF; M.A. Brown, FRACP, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital; T.J. Learch, MD, Division of Rheumatology, Cedars Sinai Medical Center; L.A. Diekman, MS, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; A. Tahanan, BS, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Rahbar, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Weisman, MD, Division of Rheumatology, Cedars Sinai Medical Center; J.D. Reveille, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston
| | - Matthew A Brown
- From the Department of Internal Medicine, Division of Rheumatology, and the Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston, Houston, Texas; National Institute of Arthritis and Musculoskeletal and Skin Diseases, US National Institutes of Health, Bethesda, Maryland; Department of Medicine, Division of Rheumatology, University of California San Francisco (UCSF), San Francisco, California, USA; University of Queensland Diamantina Institute, Translational Research Institute, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Princess Alexandra Hospital, Queensland, Australia; Division of Rheumatology, Cedars Sinai Medical Center, Los Angeles, California, USA.,J.D. Dau, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; M.J. Lee, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.M. Ward, MD, MPH, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health; L.S. Gensler, MD, Department of Medicine, Division of Rheumatology, UCSF; M.A. Brown, FRACP, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital; T.J. Learch, MD, Division of Rheumatology, Cedars Sinai Medical Center; L.A. Diekman, MS, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; A. Tahanan, BS, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Rahbar, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Weisman, MD, Division of Rheumatology, Cedars Sinai Medical Center; J.D. Reveille, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston
| | - Thomas J Learch
- From the Department of Internal Medicine, Division of Rheumatology, and the Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston, Houston, Texas; National Institute of Arthritis and Musculoskeletal and Skin Diseases, US National Institutes of Health, Bethesda, Maryland; Department of Medicine, Division of Rheumatology, University of California San Francisco (UCSF), San Francisco, California, USA; University of Queensland Diamantina Institute, Translational Research Institute, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Princess Alexandra Hospital, Queensland, Australia; Division of Rheumatology, Cedars Sinai Medical Center, Los Angeles, California, USA.,J.D. Dau, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; M.J. Lee, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.M. Ward, MD, MPH, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health; L.S. Gensler, MD, Department of Medicine, Division of Rheumatology, UCSF; M.A. Brown, FRACP, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital; T.J. Learch, MD, Division of Rheumatology, Cedars Sinai Medical Center; L.A. Diekman, MS, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; A. Tahanan, BS, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Rahbar, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Weisman, MD, Division of Rheumatology, Cedars Sinai Medical Center; J.D. Reveille, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston
| | - Laura A Diekman
- From the Department of Internal Medicine, Division of Rheumatology, and the Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston, Houston, Texas; National Institute of Arthritis and Musculoskeletal and Skin Diseases, US National Institutes of Health, Bethesda, Maryland; Department of Medicine, Division of Rheumatology, University of California San Francisco (UCSF), San Francisco, California, USA; University of Queensland Diamantina Institute, Translational Research Institute, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Princess Alexandra Hospital, Queensland, Australia; Division of Rheumatology, Cedars Sinai Medical Center, Los Angeles, California, USA.,J.D. Dau, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; M.J. Lee, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.M. Ward, MD, MPH, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health; L.S. Gensler, MD, Department of Medicine, Division of Rheumatology, UCSF; M.A. Brown, FRACP, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital; T.J. Learch, MD, Division of Rheumatology, Cedars Sinai Medical Center; L.A. Diekman, MS, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; A. Tahanan, BS, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Rahbar, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Weisman, MD, Division of Rheumatology, Cedars Sinai Medical Center; J.D. Reveille, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston
| | - Amirali Tahanan
- From the Department of Internal Medicine, Division of Rheumatology, and the Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston, Houston, Texas; National Institute of Arthritis and Musculoskeletal and Skin Diseases, US National Institutes of Health, Bethesda, Maryland; Department of Medicine, Division of Rheumatology, University of California San Francisco (UCSF), San Francisco, California, USA; University of Queensland Diamantina Institute, Translational Research Institute, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Princess Alexandra Hospital, Queensland, Australia; Division of Rheumatology, Cedars Sinai Medical Center, Los Angeles, California, USA.,J.D. Dau, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; M.J. Lee, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.M. Ward, MD, MPH, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health; L.S. Gensler, MD, Department of Medicine, Division of Rheumatology, UCSF; M.A. Brown, FRACP, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital; T.J. Learch, MD, Division of Rheumatology, Cedars Sinai Medical Center; L.A. Diekman, MS, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; A. Tahanan, BS, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Rahbar, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Weisman, MD, Division of Rheumatology, Cedars Sinai Medical Center; J.D. Reveille, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston
| | - Mohammad H Rahbar
- From the Department of Internal Medicine, Division of Rheumatology, and the Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston, Houston, Texas; National Institute of Arthritis and Musculoskeletal and Skin Diseases, US National Institutes of Health, Bethesda, Maryland; Department of Medicine, Division of Rheumatology, University of California San Francisco (UCSF), San Francisco, California, USA; University of Queensland Diamantina Institute, Translational Research Institute, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Princess Alexandra Hospital, Queensland, Australia; Division of Rheumatology, Cedars Sinai Medical Center, Los Angeles, California, USA.,J.D. Dau, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; M.J. Lee, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.M. Ward, MD, MPH, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health; L.S. Gensler, MD, Department of Medicine, Division of Rheumatology, UCSF; M.A. Brown, FRACP, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital; T.J. Learch, MD, Division of Rheumatology, Cedars Sinai Medical Center; L.A. Diekman, MS, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; A. Tahanan, BS, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Rahbar, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Weisman, MD, Division of Rheumatology, Cedars Sinai Medical Center; J.D. Reveille, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston
| | - Michael H Weisman
- From the Department of Internal Medicine, Division of Rheumatology, and the Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston, Houston, Texas; National Institute of Arthritis and Musculoskeletal and Skin Diseases, US National Institutes of Health, Bethesda, Maryland; Department of Medicine, Division of Rheumatology, University of California San Francisco (UCSF), San Francisco, California, USA; University of Queensland Diamantina Institute, Translational Research Institute, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Princess Alexandra Hospital, Queensland, Australia; Division of Rheumatology, Cedars Sinai Medical Center, Los Angeles, California, USA.,J.D. Dau, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; M.J. Lee, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.M. Ward, MD, MPH, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health; L.S. Gensler, MD, Department of Medicine, Division of Rheumatology, UCSF; M.A. Brown, FRACP, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital; T.J. Learch, MD, Division of Rheumatology, Cedars Sinai Medical Center; L.A. Diekman, MS, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; A. Tahanan, BS, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Rahbar, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Weisman, MD, Division of Rheumatology, Cedars Sinai Medical Center; J.D. Reveille, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston
| | - John D Reveille
- From the Department of Internal Medicine, Division of Rheumatology, and the Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston, Houston, Texas; National Institute of Arthritis and Musculoskeletal and Skin Diseases, US National Institutes of Health, Bethesda, Maryland; Department of Medicine, Division of Rheumatology, University of California San Francisco (UCSF), San Francisco, California, USA; University of Queensland Diamantina Institute, Translational Research Institute, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Princess Alexandra Hospital, Queensland, Australia; Division of Rheumatology, Cedars Sinai Medical Center, Los Angeles, California, USA. .,J.D. Dau, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; M.J. Lee, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.M. Ward, MD, MPH, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health; L.S. Gensler, MD, Department of Medicine, Division of Rheumatology, UCSF; M.A. Brown, FRACP, University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital; T.J. Learch, MD, Division of Rheumatology, Cedars Sinai Medical Center; L.A. Diekman, MS, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston; A. Tahanan, BS, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Rahbar, PhD, Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School at The University of Texas Health Science Center Houston; M.H. Weisman, MD, Division of Rheumatology, Cedars Sinai Medical Center; J.D. Reveille, MD, Department of Internal Medicine, Division of Rheumatology, McGovern Medical School at The University of Texas Health Science Center Houston.
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Swinnen TW, Vlaeyen JW, Dankaerts W, Westhovens R, de Vlam K. Activity Limitations in Patients with Axial Spondyloarthritis: A Role for Fear of Movement and (Re)injury Beliefs. J Rheumatol 2017; 45:357-366. [DOI: 10.3899/jrheum.170318] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2017] [Indexed: 10/18/2022]
Abstract
Objective.To determine whether fear of movement and (re)injury [FOM/(R)I] beliefs, measured with the Tampa Scale for Kinesiophobia 11-item version (TSK-11), influence activity limitations and mediate the relationship between pain severity and activity limitations in axial spondyloarthritis (axSpA).Methods.In 173 patients with axSpA, these data were collected: sex, body mass index, disease duration, medication, activity limitations (BASFI; Bath Ankylosing Spondylitis Functional Index), disease activity [Bath Ankylosing Spondylitis Disease Activity Index (BASDAI); BASDAIinf, items 5 and 6; BASDAIpain, items 2 and 3; C-reactive protein and physician’s global assessment], spinal mobility (BASMI; Bath Ankylosing Spondylitis Metrology Index), and FOM/(R)I (TSK-11). Scaling assumptions and reliability of TSK-11 were tested with item-to-total correlations, item variances, and Cronbach’s alpha coefficient. Hypothesis testing determined TSK-11’s construct validity. Multiple linear regression showed the contribution of TSK-11 to BASFI (enter and backward modeling). Mediation by TSK-11 was analyzed (bias-corrected bootstrapping and Sobel test).Results.Adequate scale (Cronbach’s alpha = 0.80) and item internal consistency (range item-scale correlations 0.41–0.58, except for item 5, r = 0.23), equal item-scale correlations, and item variances were found for TSK-11. Construct validity was confirmed, except for the hypothesized positive relationship between TSK-11 and BASMI. Regression models (enter method, adjusted R2 range 53–74%) consistently identified TSK-11 as a determinant of BASFI (β range 0.155 to 0.321, p < 0.05), although BASMI (β range 0.441 to 0.537) and disease activity (β range 0.243 to 0.571, p < 0.05) were the largest determinants. TSK-11 partially mediated the BASDAIpain/BASFI relationship (B = 0.107; Sobel test, p = 0.004; bias-corrected CI 0.046–0.197).Conclusion.TSK-11 is a promising and valid tool to assess fearful beliefs in relation to activity limitations in axSpA. Future research applying TSK-11 may reveal FOM/(R)I as a novel treatment target in axSpA.
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The Discriminative Values of the Bath Ankylosing Spondylitis Disease Activity Index, Ankylosing Spondylitis Disease Activity Score, C-Reactive Protein, and Erythrocyte Sedimentation Rate in Spondyloarthritis-Related Axial Arthritis. J Clin Rheumatol 2017; 23:267-272. [DOI: 10.1097/rhu.0000000000000522] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Yildirim T, Solmaz D, Emul M, Akgol G, Yalvac D, Ersoy Y. Affective temperament profile in ankylosing spondylitis patients using TEMPS-A. J Phys Ther Sci 2017; 29:394-400. [PMID: 28356618 PMCID: PMC5360997 DOI: 10.1589/jpts.29.394] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 11/22/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study aimed to compare the most common dominant affective temperaments in Ankylosing Spondylitis patients and investigate the relationship between the dominant affective temperaments and pain levels, disease activity, quality of life, current depression, and anxiety level in Ankylosing Spondylitis patients. [Subjects and Methods] Fifty-one patients diagnosed with axial spondiloartropathy and forty-two age- and gender-matched control subjects were included in this study. Disease duration, erythrocyte sedimentation rate, serum C-reactive protein, pain by the Visual Analog Scale, disease activity by the Bath Ankylosing Spondylitis Disease Activity Index, functional status by the Bath Ankylosing Spondylitis Functional Index; psychological status by the Beck Depression Inventory, Beck Anxiety Inventory and overall health assessment by the Ankylosing Spondylitis Quality of Life Scale were assessed in patients. The Turkish version of the Temperament Evaluation of Memphis, Pisa, Paris and San Diego Auto Questionnaire was used to determine the dominant affective temperament. [Results] There was no statistical difference in the distribution of temperament subtypes between patients with Ankylosing Spondylitis and the controls. Depressive, anxious, and cyclothymic temperament scores were higher in patients with high values on the Bath Ankylosing Spondylitis Functional Index and Visual Analog Scale. There was a correlation between anxious subtypes of affective temperament scores and the value of Ankylosing Spondylitis Quality of Life Scale. Correlation analysis also found depressive, cyclothymic, irritable, and anxious temperament and psychiatric symptoms to be significantly related. [Conclusion] Affective temperament may contribute to symptoms of depression and anxiety in patients with Ankylosing Spondylitis and may increase disease activity and may reduce their quality of life.
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Affiliation(s)
- Tulay Yildirim
- Department of Physical Medicine and Rehabilitation, Inonu University, Turkey
| | - Dilek Solmaz
- Department of Internal Medicine, Division of Rheumatology, Izmir Katip Celebi University School of Medicine, Turkey
| | - Murat Emul
- Department of Psychiatry, Medical School of Cerrahpasa, Istanbul University, Turkey
| | - Gurkan Akgol
- Department of Physical Medicine and Rehabilitation, Fırat University, Turkey
| | - Dilek Yalvac
- Department of Psychiatry, Dr Abdurahman Yurtaslan Onkoloji Research and Training Hospital, Turkey
| | - Yuksel Ersoy
- Department of Physical Medicine and Rehabilitation, Inonu University, Turkey
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Swinnen TW, Milosevic M, Van Huffel S, Dankaerts W, Westhovens R, de Vlam K. Instrumented BASFI (iBASFI) Shows Promising Reliability and Validity in the Assessment of Activity Limitations in Axial Spondyloarthritis. J Rheumatol 2016; 43:1532-40. [PMID: 27307537 DOI: 10.3899/jrheum.150439] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The Bath Ankylosing Spondylitis Functional Index (BASFI) is the most popular method to assess activity capacity in axial spondyloarthritis (axSpA), to our knowledge. It is endorsed by the Assessment of Spondyloarthritis international Society. But it may have recall bias or aberrant self-judgments in individual patients. Therefore, we aimed to (1) develop the instrumented BASFI (iBASFI) by adding a body-worn accelerometer with automated algorithms to performance-based measurements (PBM), (2) study the iBASFI's core psychometric properties, and (3) reduce the number of iBASFI items. METHODS Twenty-eight patients with axSpA wore a 2-axial accelerometer while completing 12 PBM derived from the BASFI. A chronometer and both manual and "automated algorithm-based" acceleration segmentation identified movement time. Test-retest trials and methods (algorithm vs manual segmentation/chronometer/BASFI) were compared with ICC, standard error of measurement [percentage of movement time (SEM%)], and Spearman ρ correlation coefficients. Linear regression identified the optimal set of reliable iBASFI PBM. RESULTS Good to excellent test-retest reliability was found for 8/12 iBASFI items (ICC range 0.812-0.997, SEM range 0.4-30.4%), typically with repeated and fast movements. Automated algorithms excellently mimicked manual segmentation (ICC range 0.900-0.998) and the chronometer (ICC range 0.878-0.998) for 10/12 iBASFI items. Construct validity compared with the BASFI was confirmed for 7/12 iBASFI items (δ range 0.504-0.755). Together, sit-to-stand speed test (stBeta 0.483), cervical rotation (stBeta -0.392), and height (stBeta -0.375) explained 59% of the variance in the BASFI (p < 0.01). CONCLUSION The proof-of-concept iBASFI showed promising reliability and validity in measuring activity capacity. The number of the iBASFI's PBM may be minimized, but further validation in larger axSpA cohorts is needed before its clinical use.
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Affiliation(s)
- Thijs Willem Swinnen
- From the Division of Rheumatology, University Hospitals Leuven; Skeletal Biology and Engineering Research Center, Department of Development and Regeneration, KU Leuven; Musculoskeletal Rehabilitation Research Unit, Department of Rehabilitation Sciences, KU Leuven; Stadius Centre for Dynamical Systems, Signal Processing and Data Analytics, Department of Electrical Engineering, KU Leuven; iMinds, Medical Information Technology, KU Leuven, Leuven, Belgium.T.W. Swinnen, PT, MSc, Doctoral Research Fellow, Division of Rheumatology, University Hospitals Leuven, and Skeletal Biology and Engineering Research Center, Department of Development and Regeneration, KU Leuven, and Musculoskeletal Rehabilitation Research Unit, Department of Rehabilitation Sciences, KU Leuven; M. Milosevic, MSc Eng, Doctoral Research Fellow, Stadius Centre for Dynamical Systems, Signal Processing and Data Analytics, Department of Electrical Engineering, KU Leuven, and iMinds, Medical Information Technology, KU Leuven; S. Van Huffel, MSc Eng, PhD, Full Professor Biomedical Data Processing, Stadius Centre for Dynamical Systems, Signal Processing and Data Analytics, Department of Electrical Engineering, KU Leuven, and iMinds, Medical Information Technology, KU Leuven; W. Dankaerts, PT, PhD, Professor Rehabilitation Sciences, Musculoskeletal Rehabilitation Research Unit, Department of Rehabilitation Sciences, KU Leuven; R. Westhovens, MD, PhD, Full Professor Rheumatology, Division of Rheumatology, University Hospitals Leuven, and Skeletal Biology and Engineering Research Center, Department of Development and Regeneration, KU Leuven; K. de Vlam, MD, PhD, Principal Investigator Clinical Rheumatology, Division of Rheumatology, University Hospitals Leuven, and Skeletal Biology and Engineering Research Center, Department of Development and Regeneration, KU Leuven
| | - Milica Milosevic
- From the Division of Rheumatology, University Hospitals Leuven; Skeletal Biology and Engineering Research Center, Department of Development and Regeneration, KU Leuven; Musculoskeletal Rehabilitation Research Unit, Department of Rehabilitation Sciences, KU Leuven; Stadius Centre for Dynamical Systems, Signal Processing and Data Analytics, Department of Electrical Engineering, KU Leuven; iMinds, Medical Information Technology, KU Leuven, Leuven, Belgium.T.W. Swinnen, PT, MSc, Doctoral Research Fellow, Division of Rheumatology, University Hospitals Leuven, and Skeletal Biology and Engineering Research Center, Department of Development and Regeneration, KU Leuven, and Musculoskeletal Rehabilitation Research Unit, Department of Rehabilitation Sciences, KU Leuven; M. Milosevic, MSc Eng, Doctoral Research Fellow, Stadius Centre for Dynamical Systems, Signal Processing and Data Analytics, Department of Electrical Engineering, KU Leuven, and iMinds, Medical Information Technology, KU Leuven; S. Van Huffel, MSc Eng, PhD, Full Professor Biomedical Data Processing, Stadius Centre for Dynamical Systems, Signal Processing and Data Analytics, Department of Electrical Engineering, KU Leuven, and iMinds, Medical Information Technology, KU Leuven; W. Dankaerts, PT, PhD, Professor Rehabilitation Sciences, Musculoskeletal Rehabilitation Research Unit, Department of Rehabilitation Sciences, KU Leuven; R. Westhovens, MD, PhD, Full Professor Rheumatology, Division of Rheumatology, University Hospitals Leuven, and Skeletal Biology and Engineering Research Center, Department of Development and Regeneration, KU Leuven; K. de Vlam, MD, PhD, Principal Investigator Clinical Rheumatology, Division of Rheumatology, University Hospitals Leuven, and Skeletal Biology and Engineering Research Center, Department of Development and Regeneration, KU Leuven
| | - Sabine Van Huffel
- From the Division of Rheumatology, University Hospitals Leuven; Skeletal Biology and Engineering Research Center, Department of Development and Regeneration, KU Leuven; Musculoskeletal Rehabilitation Research Unit, Department of Rehabilitation Sciences, KU Leuven; Stadius Centre for Dynamical Systems, Signal Processing and Data Analytics, Department of Electrical Engineering, KU Leuven; iMinds, Medical Information Technology, KU Leuven, Leuven, Belgium.T.W. Swinnen, PT, MSc, Doctoral Research Fellow, Division of Rheumatology, University Hospitals Leuven, and Skeletal Biology and Engineering Research Center, Department of Development and Regeneration, KU Leuven, and Musculoskeletal Rehabilitation Research Unit, Department of Rehabilitation Sciences, KU Leuven; M. Milosevic, MSc Eng, Doctoral Research Fellow, Stadius Centre for Dynamical Systems, Signal Processing and Data Analytics, Department of Electrical Engineering, KU Leuven, and iMinds, Medical Information Technology, KU Leuven; S. Van Huffel, MSc Eng, PhD, Full Professor Biomedical Data Processing, Stadius Centre for Dynamical Systems, Signal Processing and Data Analytics, Department of Electrical Engineering, KU Leuven, and iMinds, Medical Information Technology, KU Leuven; W. Dankaerts, PT, PhD, Professor Rehabilitation Sciences, Musculoskeletal Rehabilitation Research Unit, Department of Rehabilitation Sciences, KU Leuven; R. Westhovens, MD, PhD, Full Professor Rheumatology, Division of Rheumatology, University Hospitals Leuven, and Skeletal Biology and Engineering Research Center, Department of Development and Regeneration, KU Leuven; K. de Vlam, MD, PhD, Principal Investigator Clinical Rheumatology, Division of Rheumatology, University Hospitals Leuven, and Skeletal Biology and Engineering Research Center, Department of Development and Regeneration, KU Leuven
| | - Wim Dankaerts
- From the Division of Rheumatology, University Hospitals Leuven; Skeletal Biology and Engineering Research Center, Department of Development and Regeneration, KU Leuven; Musculoskeletal Rehabilitation Research Unit, Department of Rehabilitation Sciences, KU Leuven; Stadius Centre for Dynamical Systems, Signal Processing and Data Analytics, Department of Electrical Engineering, KU Leuven; iMinds, Medical Information Technology, KU Leuven, Leuven, Belgium.T.W. Swinnen, PT, MSc, Doctoral Research Fellow, Division of Rheumatology, University Hospitals Leuven, and Skeletal Biology and Engineering Research Center, Department of Development and Regeneration, KU Leuven, and Musculoskeletal Rehabilitation Research Unit, Department of Rehabilitation Sciences, KU Leuven; M. Milosevic, MSc Eng, Doctoral Research Fellow, Stadius Centre for Dynamical Systems, Signal Processing and Data Analytics, Department of Electrical Engineering, KU Leuven, and iMinds, Medical Information Technology, KU Leuven; S. Van Huffel, MSc Eng, PhD, Full Professor Biomedical Data Processing, Stadius Centre for Dynamical Systems, Signal Processing and Data Analytics, Department of Electrical Engineering, KU Leuven, and iMinds, Medical Information Technology, KU Leuven; W. Dankaerts, PT, PhD, Professor Rehabilitation Sciences, Musculoskeletal Rehabilitation Research Unit, Department of Rehabilitation Sciences, KU Leuven; R. Westhovens, MD, PhD, Full Professor Rheumatology, Division of Rheumatology, University Hospitals Leuven, and Skeletal Biology and Engineering Research Center, Department of Development and Regeneration, KU Leuven; K. de Vlam, MD, PhD, Principal Investigator Clinical Rheumatology, Division of Rheumatology, University Hospitals Leuven, and Skeletal Biology and Engineering Research Center, Department of Development and Regeneration, KU Leuven
| | - Rene Westhovens
- From the Division of Rheumatology, University Hospitals Leuven; Skeletal Biology and Engineering Research Center, Department of Development and Regeneration, KU Leuven; Musculoskeletal Rehabilitation Research Unit, Department of Rehabilitation Sciences, KU Leuven; Stadius Centre for Dynamical Systems, Signal Processing and Data Analytics, Department of Electrical Engineering, KU Leuven; iMinds, Medical Information Technology, KU Leuven, Leuven, Belgium.T.W. Swinnen, PT, MSc, Doctoral Research Fellow, Division of Rheumatology, University Hospitals Leuven, and Skeletal Biology and Engineering Research Center, Department of Development and Regeneration, KU Leuven, and Musculoskeletal Rehabilitation Research Unit, Department of Rehabilitation Sciences, KU Leuven; M. Milosevic, MSc Eng, Doctoral Research Fellow, Stadius Centre for Dynamical Systems, Signal Processing and Data Analytics, Department of Electrical Engineering, KU Leuven, and iMinds, Medical Information Technology, KU Leuven; S. Van Huffel, MSc Eng, PhD, Full Professor Biomedical Data Processing, Stadius Centre for Dynamical Systems, Signal Processing and Data Analytics, Department of Electrical Engineering, KU Leuven, and iMinds, Medical Information Technology, KU Leuven; W. Dankaerts, PT, PhD, Professor Rehabilitation Sciences, Musculoskeletal Rehabilitation Research Unit, Department of Rehabilitation Sciences, KU Leuven; R. Westhovens, MD, PhD, Full Professor Rheumatology, Division of Rheumatology, University Hospitals Leuven, and Skeletal Biology and Engineering Research Center, Department of Development and Regeneration, KU Leuven; K. de Vlam, MD, PhD, Principal Investigator Clinical Rheumatology, Division of Rheumatology, University Hospitals Leuven, and Skeletal Biology and Engineering Research Center, Department of Development and Regeneration, KU Leuven
| | - Kurt de Vlam
- From the Division of Rheumatology, University Hospitals Leuven; Skeletal Biology and Engineering Research Center, Department of Development and Regeneration, KU Leuven; Musculoskeletal Rehabilitation Research Unit, Department of Rehabilitation Sciences, KU Leuven; Stadius Centre for Dynamical Systems, Signal Processing and Data Analytics, Department of Electrical Engineering, KU Leuven; iMinds, Medical Information Technology, KU Leuven, Leuven, Belgium.T.W. Swinnen, PT, MSc, Doctoral Research Fellow, Division of Rheumatology, University Hospitals Leuven, and Skeletal Biology and Engineering Research Center, Department of Development and Regeneration, KU Leuven, and Musculoskeletal Rehabilitation Research Unit, Department of Rehabilitation Sciences, KU Leuven; M. Milosevic, MSc Eng, Doctoral Research Fellow, Stadius Centre for Dynamical Systems, Signal Processing and Data Analytics, Department of Electrical Engineering, KU Leuven, and iMinds, Medical Information Technology, KU Leuven; S. Van Huffel, MSc Eng, PhD, Full Professor Biomedical Data Processing, Stadius Centre for Dynamical Systems, Signal Processing and Data Analytics, Department of Electrical Engineering, KU Leuven, and iMinds, Medical Information Technology, KU Leuven; W. Dankaerts, PT, PhD, Professor Rehabilitation Sciences, Musculoskeletal Rehabilitation Research Unit, Department of Rehabilitation Sciences, KU Leuven; R. Westhovens, MD, PhD, Full Professor Rheumatology, Division of Rheumatology, University Hospitals Leuven, and Skeletal Biology and Engineering Research Center, Department of Development and Regeneration, KU Leuven; K. de Vlam, MD, PhD, Principal Investigator Clinical Rheumatology, Division of Rheumatology, University Hospitals Leuven, and Skeletal Biology and Engineering Research Center, Department of Development and Regeneration, KU Leuven.
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Durmus D, Sarisoy G, Alayli G, Kesmen H, Çetin E, Bilgici A, Kuru O, Ünal M. Psychiatric symptoms in ankylosing spondylitis: their relationship with disease activity, functional capacity, pain and fatigue. Compr Psychiatry 2015; 62:170-7. [PMID: 26343482 DOI: 10.1016/j.comppsych.2015.07.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 06/12/2015] [Accepted: 07/24/2015] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVES The aim of this study is to evaluate psychiatric symptoms in patients with ankylosing spondylitis (AS) and to investigate the relationship of the disease activity, functional capacity, pain, and fatigue with psychiatric symptoms. METHODS Eighty AS patients and 80 healthy controls were included in the study. Spinal pain by visual analog scale (pain VAS-rest), disease activity by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), functional capacity by Bath Ankylosing Spondylitis Functional Index (BASFI), and fatigue by Multidimensional Assessment of Fatigue (MAF) were assessed in patients. Psychiatric symptoms were measured using the Symptom Checklist-90-R (SCL-90 R), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Pittsburgh Sleep Quality Index (PSQI) and Rosenberg Self-Esteem Scale (RSES). RESULTS SCL-90-R total and all subscale scores (except interpersonal sensitivity and psychoticism) and BDI scores were significantly higher in the AS group compared to control group. PSQI total and all subscale scores were significantly higher in the AS group. State anxiety scale score was significantly higher and RSES score was significantly lower in the AS group. Psychiatric symptoms (except Rosenberg Self-Esteem score) were significantly correlated with BASDAI, BASFI, pain VAS rest, and MAF scores. CONCLUSION Psychiatric symptoms are often seen in patients with AS. Disease activity, functional capacity, pain and fatigue were correlated with psychiatric symptoms but self-esteem was not. Therefore, psychiatric symptoms should be taken into consideration in the management of AS.
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Affiliation(s)
- Dilek Durmus
- Department of Physical Medicine and Rehabilitation, Medical Faculty, Ondokuz Mayis University, Samsun, Turkey
| | - Gökhan Sarisoy
- Department of Psychiatry, Medical Faculty, Ondokuz Mayis University, Samsun, Turkey.
| | - Gamze Alayli
- Department of Physical Medicine and Rehabilitation, Medical Faculty, Ondokuz Mayis University, Samsun, Turkey
| | - Hakan Kesmen
- Department of Physical Medicine and Rehabilitation, Medical Faculty, Ondokuz Mayis University, Samsun, Turkey
| | - Eda Çetin
- Department of Psychiatry, Medical Faculty, Ondokuz Mayis University, Samsun, Turkey
| | - Ayhan Bilgici
- Department of Physical Medicine and Rehabilitation, Medical Faculty, Ondokuz Mayis University, Samsun, Turkey
| | - Omer Kuru
- Department of Physical Medicine and Rehabilitation, Medical Faculty, Ondokuz Mayis University, Samsun, Turkey
| | - Mustafa Ünal
- Department of Family Medicine, Ondokuz Mayis University, Samsun, Turkey
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Cal SF, Sá LRD, Glustak ME, Santiago MB. Resilience in chronic diseases: A systematic review. COGENT PSYCHOLOGY 2015. [DOI: 10.1080/23311908.2015.1024928] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Sílvia Fernanda Cal
- Rheumatology Ambulatory, Bahian School of Medicine and Public Health-EBMSP (Escola Bahiana de Medicina e Saúde Pública), Av. Dom João VI, n°. 275, Brotas, Salvador, Bahia, Brazil
| | - Lis Ribeiro de Sá
- Course in Medicine, Centro Universitário Serra dos Órgãos – UNIFESO, Rua Alberto Torres 111 Alto, Teresópolis, Rio de Janeiro 25964-004, Brazil
| | - Maria Eugênia Glustak
- Course in Psychology, Federal University of Paraná (UFPR), Praça Santos Andrade n° 50-Centro, Curitiba, Paraná 81531-900, Brazil
| | - Mittermayer Barreto Santiago
- Rheumatology Service, Bahian School of Medicine and Public Health-EBMSP (Escola Bahiana de Medicina e Saúde Pública), Av. Dom João VI, n° 275, Brotas, Salvador, Bahia 40290-000, Brazil
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Kilic G, Kilic E, Ozgocmen S. Relationship between psychiatric status, self-reported outcome measures, and clinical parameters in axial spondyloarthritis. Medicine (Baltimore) 2014; 93:e337. [PMID: 25546683 PMCID: PMC4602610 DOI: 10.1097/md.0000000000000337] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This article aims to compare the risks of depression and anxiety in patients with ankylosing spondylitis (AS) and nonradiographic axial spondyloarthritis (nr-axSpA) and investigate the relationship among self-reported outcome measures, clinical parameters, and physical variables of patients with axSpA. Patients with axSpA were recruited from Erciyes Spondyloarthritis Cohort. The patients met Assessment of Spondyloarthritis International Society classification criteria for axial SpA and were assessed in a cross-sectional study design for visual analog scale (VAS) pain, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Ankylosing Spondylitis Quality of Life questionnaire (ASQoL), and Ankylosing Spondylitis Disease Activity Score-C-reactive protein (ASDAS-CRP). Psychological status was evaluated using the hospital anxiety and depression scale (HADS). Multivariate logistic regression analysis was applied to determine the associations between psychological variables and clinical parameters after adjusting for confounding variables. Of the 316 patients (142 nr-axSpA, 174 AS), 139 (44%) had high risk for depression (HADS-D score ≥ 7) and 71 (22.5%) for anxiety (HADS-A score ≥ 10). HADS-D and HADS-A scores were similar between patients with AS and nr-axSpA. Patients with high risk for depression and anxiety had higher scores in BASDAI, BASFI, and ASDAS-CRP, and also poorer scores in VAS pain and ASQoL. Multivariate logistic regression analysis showed that the ASDAS-CRP, ASQoL, BASDAI, as well as educational level were factors associated with the risk of depression whereas the ASQoL and educational level were factors associated with the risk of anxiety. Patients with nr-axSpA and AS have similar burden of psychological distress. The quality of life (ASQoL) and educational level were factors associated with the risk of both depression and anxiety whereas disease activity (BASDAI and ASDAS-CRP) was the independent risk factor associated with depression but not anxiety in axSpA. These findings suggest that psychological status should be examined while assessing patients with axSpA including AS and nr-axSpA.
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Affiliation(s)
- Gamze Kilic
- From the Division of Rheumatology (GK, EK, SO), Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Erciyes University, Kayseri, Turkey
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Chan CYY, Tsang HHL, Lau CS, Chung HY. Prevalence of depressive and anxiety disorders and validation of the Hospital Anxiety and Depression Scale as a screening tool in axial spondyloarthritis patients. Int J Rheum Dis 2014; 20:317-325. [PMID: 25293872 DOI: 10.1111/1756-185x.12456] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine the prevalence of anxiety and depression in axial spondyloarthritis (SpA) patients by a psychiatrist using the Chinese-bilingual Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, fourth edition patient research version (CB-SCID-I/P), and to examine the effectiveness of the Hospital Anxiety and Depression Scale (HADS) as a screening tool. METHODS We recruited 160 Chinese axial-SpA patients to determine the prevalence of anxiety and depression using the CB-SCID-I/P. Recruited subjects were asked to complete the HADS. HADS, HADS-depression (HADS-D) subscale and HADS-anxiety (HADS-A) subscale were analyzed to determine their effectiveness in screening for depressive and anxiety disorders. RESULTS The prevalence of current major depressive disorder (MDD) and anxiety disorder were 10.6% and 15.6%, respectively. The full-scale HADS outperformed the HADS-D subscale in screening for current MDD (area under the curve [AUC] 0.889; 0.844) and all depressive disorders (AUC 0.885; 0.862) while the HADS-A subscale outperformed the full scale HADS in screening for anxiety disorders (AUC 0.894; 0.846). The optimal cut-off point of the full scale HADS for screening current MDD and all depressive disorders were 7/8 and 6/7, yielding a sensitivity of 82.4% and 83.9%, specificity of 78.7% and 74.8%, respectively. The optimal cut-off point of HADS-A subscale for screening anxiety disorders was 6/7, yielding a sensitivity of 88.0% and specificity of 74.4%. CONCLUSION The prevalence of MDD and anxiety disorder in SpA patients were 10.6% and 15.6%, respectively. We recommend using the full-scale HADS in screening for depressive disorders and HADS-A subscale for anxiety disorders.
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Affiliation(s)
- Cynthia Y Y Chan
- Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Helen H L Tsang
- Division of Rheumatology and Clinical Immunology, Queen Mary Hospital, Hong Kong, China
| | - C S Lau
- Division of Rheumatology and Clinical Immunology, Queen Mary Hospital, Hong Kong, China.,Division of Rheumatology and Clinical Immunology, University of Hong Kong, Hong Kong, China
| | - H Y Chung
- Division of Rheumatology and Clinical Immunology, Queen Mary Hospital, Hong Kong, China
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Kotsis K, Voulgari PV, Drosos AA, Carvalho AF, Hyphantis T. Health-related quality of life in patients with ankylosing spondylitis: a comprehensive review. Expert Rev Pharmacoecon Outcomes Res 2014; 14:857-72. [PMID: 25193010 DOI: 10.1586/14737167.2014.957679] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Ankylosing spondylitis (AS) is a complex systemic rheumatological disease which often causes severe disability and impaired quality of life (QoL). We searched the PubMed/MEDLINE electronic database for available literature on QoL and its predictors in patients with AS. Recent evidence indicates that AS patients have poorer QoL compared to the general population, but similar to that of patients with other rheumatological disorders. Disease activity is one of the most powerful predictors of QoL, however latest advances in pharmacological treatment (namely, anti-TNF-α) along with physical exercise can minimize the effects of AS on QoL. Psychological distress symptoms contribute to impaired QoL both directly and indirectly by influencing disease activity. The impact of other psychosocial variables, however, is less studied and more prospective investigations are necessary, which could eventually lead to the development of psychosocial interventions that are personalized to this patient population.
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Affiliation(s)
- Konstantinos Kotsis
- Department of Psychiatry, Division of Medicine, School of Health Sciences, University of Ioannina, Ioannina 45110, Greece
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Domínguez CJD, Ugalde PF, Vilchez DR, Carretero-Dios H, Estévez EC. Positive and negative affective states and disease activity in ankylosing spondylitis. Rheumatol Int 2014; 35:519-24. [PMID: 25123554 DOI: 10.1007/s00296-014-3107-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 07/25/2014] [Indexed: 11/26/2022]
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Gordeev VS, Maksymowych WP, Schachna L, Boonen A. Understanding presenteeism in patients with ankylosing spondylitis: contributing factors and association with sick leave. Arthritis Care Res (Hoboken) 2014; 66:916-24. [PMID: 24339444 DOI: 10.1002/acr.22253] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 11/26/2013] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To understand the impact of ankylosing spondylitis (AS) on presenteeism and to explore its relationship to sick leave. METHODS AS patients completed a questionnaire consisting of sociodemographics, disease characteristics, and work outcomes, including sick leave and presenteeism, assessed by the Work Limitations Questionnaire (WLQ). Associations between a broad range of explanatory variables with the WLQ and AS-related sick leave were assessed by zero-inflated negative binomial and zero-inflated Poisson regressions. RESULTS Of 311 employed patients (204 men [65.6%]), 18% had sick leave in the past month. Limitations in meeting time management demands (33.7%), physical demands (30.2%), mental-interpersonal demands (20.2%), and output (19.0%) were noted. With the mean ± SD WLQ index score of 6.7 ± 5.9, the average decrease in work productivity attributable to health was 6.3%; an extra 7.1% of work hours would be needed to compensate for lost productivity. Helplessness, female sex, and impaired health-related quality of life (Ankylosing Spondylitis Quality of Life instrument [ASQoL]) were major contributors to the level of presenteeism (P < 0.01). At-work limitations (WLQ) and lower quality of life (ASQoL) were significantly associated with probability of sick leave, while the length of sick leave was strongly associated with lower educational level and helplessness (P < 0.01), and in some models, also with disease duration and country of residence (P < 0.05). CONCLUSION AS hinders patients' work, mainly in time management and physical demand domains. The WLQ and ASQoL are able to identify patients who incur sick leave. Helplessness contributes independently to the level of presenteeism and the length of sick leave.
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Affiliation(s)
- Vladimir S Gordeev
- London School of Hygiene & Tropical Medicine, London, UK; Maastricht University and Maastricht University Medical Center, Maastricht, The Netherlands
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Zeboulon-Ktorza N, Boelle PY, Nahal RS, D'agostino MA, Vibert JF, Turbelin C, Madrakian H, Durand E, Launay O, Mahr A, Flahault A, Breban M, Hanslik T. Influence of environmental factors on disease activity in spondyloarthritis: a prospective cohort study. J Rheumatol 2013; 40:469-75. [PMID: 23418385 DOI: 10.3899/jrheum.121081] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Spondyloarthritis (SpA) is a complex inflammatory disorder. We investigated the influence of environmental factors on SpA disease activity. METHODS A prospective cohort of adults with SpA was followed for 3 years. Patients logged on to a secured Website every 3 months to complete a questionnaire. They reported whether they had been exposed to environmental factors such as stressful or traumatic life events, infections, or vaccinations. Outcome variables included the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Functional Index (BASFI), and pain and patient global assessment (PGA) on visual numerical scales (each rated 0-10). Analyses were performed using a generalized estimating equation for repeated measures, adjusted for the outcome variable collected by the previous questionnaire. RESULTS In total, 272 patients were included in the analysis, completing the questionnaire on 2240 occasions. The average time (mean ± SD) between 2 connections to the Website was 4.0 ± 2.0 months. Occurrence of life events was followed by an increase of 0.5 (95% CI 0.4-0.7) in the BASDAI, 0.5 (95% CI 0.3-0.6) in the BASFI, 0.7 (95% CI 0.5-0.9) in the PGA, and 0.8 (95% CI 0.6-1.0) for pain (p < 0.0001 for all variations). A moderately statistically significant link was found between vaccination and an elevation of the BASDAI of 0.3 (95% CI 0.0-0.5; p = 0.032). No influence of other factors was detected. CONCLUSION This prospective study in a dedicated SpA cohort shows for the first time a link between stressful events and disease activity. Although this link was statistically highly significant, its clinical meaning remains to be determined because the average magnitude of variation of the different variables studied was rather mild.
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Affiliation(s)
- Nadine Zeboulon-Ktorza
- Ambroise Paré Hospital, APHP, Versailles Saint-Quentin-en-Yvelines University, Versailles, France
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Joshi R, Reveille JD, Brown MA, Weisman MH, Ward MM, Gensler LS, Wordsworth BP, Evans DM, Assassi S. Is there a higher genetic load of susceptibility loci in familial ankylosing spondylitis? Arthritis Care Res (Hoboken) 2012; 64:780-4. [PMID: 22231927 DOI: 10.1002/acr.21601] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Several genetic risk variants for ankylosing spondylitis (AS) have been identified in genome-wide association studies. Our objective was to examine whether familial AS cases have a higher genetic load of these susceptibility variants. METHODS Overall, 502 AS patients were examined, consisting of 312 patients who had first-degree relatives (FDRs) with AS (familial) and 190 patients who had no FDRs with AS or spondylarthritis (sporadic). All patients and affected FDRs fulfilled the modified New York criteria for AS. The patients were recruited from 2 US cohorts (the North American Spondylitis Consortium and the Prospective Study of Outcomes in Ankylosing Spondylitis) and from the UK-Oxford cohort. The frequencies of AS susceptibility loci in IL-23R, IL1R2, ANTXR2, ERAP-1, 2 intergenic regions on chromosomes 2p15 and 21q22, and HLA-B27 status as determined by the tag single-nucleotide polymorphism (SNP) rs4349859 were compared between familial and sporadic cases of AS. Association between SNPs and multiplex status was assessed by logistic regression controlling for sibship size. RESULTS HLA-B27 was significantly more prevalent in familial than sporadic cases of AS (odds ratio 4.44 [95% confidence interval 2.06, 9.55], P = 0.0001). Furthermore, the AS risk allele at chromosome 21q22 intergenic region showed a trend toward higher frequency in the multiplex cases (P = 0.08). The frequency of the other AS risk variants did not differ significantly between familial and sporadic cases, either individually or combined. CONCLUSION HLA-B27 is more prevalent in familial than sporadic cases of AS, demonstrating higher familial aggregation of AS in patients with HLA-B27 positivity. The frequency of the recently described non-major histocompatibility complex susceptibility loci is not markedly different between the sporadic and familial cases of AS.
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Affiliation(s)
- Reeti Joshi
- Washington University, St. Louis, Missouri, USA
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Jang JH, Green CE, Assassi S, Reveille JD, Ward MM, Weisman MH, Nicassio PM. The contribution of disease activity on functional limitations over time through psychological mediators: a 12-month longitudinal study in patients with ankylosing spondylitis. Rheumatology (Oxford) 2011; 50:2087-92. [PMID: 21875876 DOI: 10.1093/rheumatology/ker274] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To explore whether helplessness, internality and depression would mediate the relationship between disease activity and functional limitations in patients with AS in a 12-month longitudinal study. METHODS A total of 294 participants with AS meeting modified New York criteria completed clinical and psychological assessments at 6-month intervals. Psychological measures evaluated helplessness, depression and internality. Path analysis evaluated the direct and indirect effects of baseline disease activity on 12-month functional limitations via the psychological measures of helplessness, internality and depression at 6 months. RESULTS Baseline disease activity demonstrated direct and indirect effects on 12-month functional limitations. Helplessness and depression, but not internality, served as mediators of the relationship between disease activity and functional limitations. CONCLUSION Higher baseline disease activity predicted greater functional limitations at 12 months through helplessness and depression. Our findings suggest that helplessness and depression may constitute future treatment targets in reducing functional limitations in patients with AS.
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Affiliation(s)
- Jennifer H Jang
- Department of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Becker B-131, Los Angeles, CA 90048, USA
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Current World Literature. Curr Opin Rheumatol 2011; 23:219-26. [DOI: 10.1097/bor.0b013e3283448536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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