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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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Kwan A, Bingham K, Touma Z. Measures of Anxiety in Rheumatic Diseases. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:630-644. [PMID: 33091269 DOI: 10.1002/acr.24351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/05/2020] [Indexed: 12/30/2022]
Affiliation(s)
- Andrew Kwan
- University of Toronto, Toronto, Ontario, Canada
| | - Kathleen Bingham
- University of Toronto and University Health Network, Toronto, Ontario, Canada
| | - Zahi Touma
- University Health Network, Toronto, Ontario, Canada
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Kasiem FR, Luime JJ, Vis M, Kok MR, Wervers K, Gerards AH, Appels C, van der Graaff WL, Starmans-Kool M, Goekoop-Ruiterman Y, van Groenendael J, Korswagen LA, Veris-van Dieren JJ, Hazes J, Tchetverikov I. Lessons learned from clinical phenotypes in early psoriatic arthritis: the real-world Dutch south west Early Psoriatic ARthritis study. Scand J Rheumatol 2020; 50:124-131. [PMID: 33084451 DOI: 10.1080/03009742.2020.1803398] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Objective: This paper describes the baseline demographics, clinical characteristics, and patient-reported outcomes (PROs) according to clinical phenotype of patients with early psoriatic arthritis (PsA) for the purpose of creating a decision support system for daily clinical practice.Method: Patients with newly diagnosed PsA were included in the Dutch south west Early Psoriatic ARthritis (DEPAR) study. No classification criteria were applied, to ensure collection of real-world data on demographics, medication, clinical characteristics, and PROs. An IT infrastructure facilitated data collection.Results: We described 527 patients, categorized according to the clinical phenotype stated by the rheumatologist at the time of diagnosis, namely monoarthritis (15%), oligoarthritis (40%), polyarthritis (23%), enthesitis (10%), axial disease (2%), and dactylitis (10%). Overall psoriasis severity was mild and 83 patients (16%) had no psoriasis. Short-term sick leave (> 1 day per 4 weeks) was 17% and long-term sick leave (> 4 weeks) was 4%. The group with phenotype enthesitis reported the longest duration of complaints, had the highest fatigue scores, and contained the highest percentage of patients with a Hospital Anxiety and Depression Scale (HADS) anxiety score ≥ 8 and depression score ≥ 8.Conclusion: PsA patients presenting at outpatient clinics in the Netherlands had a mild degree of psoriasis, with impairment of quality of life and work productivity. Most patients presented with phenotype oligoarthritis. Those presenting with phenotype enthesitis more often reported scores suggestive of an anxiety or depression disorder and fatigue. It is important for attending rheumatologists to be aware of these differences when assessing patients with PsA.
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Affiliation(s)
- F R Kasiem
- Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - J J Luime
- Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - M Vis
- Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - M R Kok
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Rotterdam, The Netherlands
| | - K Wervers
- Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - A H Gerards
- Department of Rheumatology, Franciscus Gasthuis and Vlietland, Rotterdam, The Netherlands
| | - Cwy Appels
- Department of Rheumatology, Amphia Hospital, Breda, The Netherlands
| | | | - Mjf Starmans-Kool
- Department of Rheumatology, Zuyderland Hospital, Heerlen, The Netherlands
| | | | - Jhlm van Groenendael
- Department of Rheumatology, Reumazorg Zuid West Nederland, Roosendaal, The Netherlands
| | - L-A Korswagen
- Department of Rheumatology, Franciscus Gasthuis and Vlietland, Rotterdam, The Netherlands
| | - J J Veris-van Dieren
- Department of Rheumatology, Reumazorg Zuid West Nederland, Roosendaal, The Netherlands
| | - Jmw Hazes
- Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - I Tchetverikov
- Department of Rheumatology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
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Reilly E, McGrogan A, Sengupta R. Evaluating patient-reported fatigue and serum biomarkers in axial spondyloarthritis. Rheumatology (Oxford) 2020; 59:3111-3113. [PMID: 32259246 DOI: 10.1093/rheumatology/keaa115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/10/2020] [Accepted: 02/18/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Elizabeth Reilly
- Department of Rheumatology, Royal National Hospital for Rheumatic Diseases, Royal United Hospital NHS Trust.,Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - Anita McGrogan
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - Raj Sengupta
- Department of Rheumatology, Royal National Hospital for Rheumatic Diseases, Royal United Hospital NHS Trust
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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: 20] [Impact Index Per Article: 4.0] [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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Milutinovic S, Veljkovic K, Zlatanovic M, Radunovic G, Damjanov N. Depression/anxiety symptoms in axial spondyloarthritis and psoriatic arthritis patients in Serbia: a pilot study. Rheumatol Int 2019; 39:1595-1605. [PMID: 31309294 DOI: 10.1007/s00296-019-04376-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 07/09/2019] [Indexed: 12/24/2022]
Abstract
To assess prevalence and change of depression/anxiety symptoms in spondyloarthritis patients and feasibility of depression/anxiety questionnaires. 43 Patients with axial spondyloarthritis (axSpA) and 27 patients with psoriatic arthritis (PsA) were consecutively recruited. There were 34 patients on biologics and 36 patients on nonbiologics. Patients were not previously treated for depression. The demographic variables, pain, patient global assessment, laboratory, clinical findings, diseases activity scores, Beck Depression Inventory (BDI) and Depression Anxiety and Stress Scale-short version (DASS-21) were collected. The study visits were at the beginning, after 1 month, after 3 and after 6 months. In axSpA and PsA patients on biologics, BDI and DASS-21 were significantly lower compared to nonbiologics group during time. The axSpA patients on biologics had significantly lower BDI and depression severity by BDI at each time point and lower DASS-21 after 1, 3 and 6 months. BDI in PsA patients who received biological therapy was significantly lower after 3 and 6 months. In biologics groups, BDI significantly decreased after 3 months in axSpA patients and after 1 month in PsA patients. In axSpA patients, there was a medium correlation between BDI and axial pain, patient global assessment and disease activity scores. The biological therapy significantly affected the depression/anxiety symptoms in axSpA and PsA during time. BDI moderately correlated with pain and disease activity in axSpA. BDI and DASS-21 are easy to use in daily practice.
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Affiliation(s)
- Sanja Milutinovic
- Institute of Rheumatology, University of Belgrade Medical School, Belgrade, Serbia
| | - Kristina Veljkovic
- Department of Probability and Statistics, Faculty of Mathematics, University of Belgrade, Belgrade, Serbia.
| | - Maja Zlatanovic
- Institute of Rheumatology, University of Belgrade Medical School, Belgrade, Serbia
| | - Goran Radunovic
- Institute of Rheumatology, University of Belgrade Medical School, Belgrade, Serbia
| | - Nemanja Damjanov
- Institute of Rheumatology, University of Belgrade Medical School, Belgrade, Serbia
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