AxSpA: depression is common, linked to more severe disease activity

  • Zhao S & al.
  • Arthritis Res Ther
  • 11 Jul 2018

  • curated by Miriam Davis, PhD
  • Clinical Essentials
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Takeaway

  • The prevalence of depression in patients with axial spondyloarthritis (axSpA) runs at 15%.
  • Depression is associated with more severe disease activity and greater functional impairment.

Why this matters

  • Treatment of depression has the potential to diminish axSpA disease activity and ameliorate functional impairment.

Study design

  • Meta-analysis of 15 studies and 1 abstract (n=4753 patients with axSpA) that met eligibility criteria after search of Medline, PubMed, Web of Science, PsycINFO, CINAHL Plus, Cochrane Library, and conference abstracts.
  • Funding: None disclosed.

Key results

  • AxSpA had a pooled prevalence of 15% with at least moderate depression, using Hospital Anxiety and Depression Scale.
  • Similar prevalence was seen in ankylosing spondylitis (AS) and nonradiographic axSpA.
  • Comorbid depression was associated with worse disease activity than control group:
    • higher Bath AS Disease Activity Index (by 1.4 units; 95% CI, 1.0-1.9);
    • higher AS Disease Activity Score (by 0.05 units; 95% CI, 0.3-0.7); and
    • higher erythrocyte sedimentation rate (by 3.5 mm/hour; 95% CI, 0.6-6.4).
  • Comorbid depression was associated with greater functional impairment than control group:
    • higher Bath AS Functional Index (by 1.2 units; 95% CI, 0.6-1.8);
    • higher Bath AS Metrology Index (by 0.6 units; 95% CI, 0.3-0.8).

Limitations

  • Almost all studies used screening criteria to identify depression, possibly resulting in overestimation of prevalence.

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