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Wiąk-Walerowicz K, Wielosz E. Comparison of Ankylosing Spondylitis Disease Activity Score and Bath Ankylosing Spondylitis Disease Activity Index tools in assessment of axial spondyloarthritis activity. Reumatologia 2024; 62:64-69. [PMID: 38558891 PMCID: PMC10979369 DOI: 10.5114/reum/185429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 02/27/2024] [Indexed: 04/04/2024] Open
Abstract
Axial spondyloarthritis (axSpA) is an inflammatory joint disease, in which the dominant symptom is inflammatory back pain. It affects approximately 1% of the population, with a higher incidence in males. Spinal pain associated with spondyloarthritis is referred to as inflammatory back pain. In clinical practice, it is extremely important to be able to assess the activity of inflammatory back diseases and to select appropriate treatment and monitor the therapy. Currently, two main tools are used for assessment of the activity of axial spondyloarthritis: BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) and ASDAS (Ankylosing Spondylitis Disease Activity Score). The BASDAI is a tool used for years for assessment of disease activity, determining eligibility for treatment, and making decisions about continuation of therapy. Since BASDAI depends entirely on patient self-assessment, it is considered less objective than the ASDAS index. In turn, the latter includes not only answers to questions provided by the patient but also a parameter of inflammation such as erythrocyte sedimentation rate or C-reactive protein (CRP). Additionally, increasing numbers of studies report advantages of the ASDAS index over BASDAI. Moreover, as indicated by ASAS/EULAR (Assessment in Spondyloarthritis International Society/European Alliance of Associations for Rheumatology) 2022, ASDAS, especially ASDAS-CRP is the preferred tool for assessment of the activity of axSpA, whereas BASDAI is used only when the evaluation of the ASDAS is not possible. This paper presents the definition and symptoms of axSpA and reviews the latest research on ASDAS and BASDAI, with emphasis on the objectivity of the ASDAS assessment also presenting the doubts and limitations concerning this tool.
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Affiliation(s)
- Katarzyna Wiąk-Walerowicz
- Department of Rheumatology and Systemic Connective Tissue Diseases, Medical University of Lublin, Poland
| | - Ewa Wielosz
- Department of Rheumatology and Systemic Connective Tissue Diseases, Medical University of Lublin, Poland
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Kwon I, Choi N, Shin JH, Lee S, Nam B, Kim TH. Impact of anti-tumor necrosis factor treatment on lipid profiles in Korean patients with ankylosing spondylitis. JOURNAL OF RHEUMATIC DISEASES 2024; 31:41-48. [PMID: 38130959 PMCID: PMC10730802 DOI: 10.4078/jrd.2023.0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 09/07/2023] [Accepted: 09/15/2023] [Indexed: 12/23/2023]
Abstract
Objective To investigate the effects of anti-tumor necrosis factor (TNF) treatment on lipid profiles and identify risk factors for an increase in total cholesterol (TC) after the anti-TNF treatment in ankylosing spondylitis (AS) patients. Methods This retrospective cohort study analyzed AS patients who received the first-line anti-TNF treatment. Patients with at least nine months of follow-up were included; those who were under 18 years or on any lipid-lowering agent were excluded. A linear mixed model was used to assess the impact of anti-TNF inhibitors on disease activity and lipid profile (TC, low-density lipoprotein [LDL], high-density lipoprotein [HDL], and triglycerides [TG]). Univariable and multivariable linear regression were used to identify risk factors for an increase in TC after 3 months of anti-TNF treatment. Results A total of 315 AS patients were enrolled (78.1% male, median age 32.0 [26.0~41.0]). TC, HDL, and TG levels significantly increased particularly within the first 3 months of anti-TNF treatment, while LDL level did not show significant changes. Changes in inflammatory markers and lipid particles (TC, LDL, TG) were correlated over time, but HDL showed no significant correlation. Older age, higher baseline erythrocyte sedimentation rate, and lower baseline LDL level were related to an increase in TC after 3 months of the anti-TNF treatment. Conclusion In AS patients, anti-TNF treatment has been found to increase lipid particles, potentially due to its anti-inflammatory effects. Future research should explore the underlying mechanism and the clinical implications of dyslipidemia, particularly the occurrence of cardiovascular events, following anti-TNF treatment in AS patients.
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Affiliation(s)
- Inbeom Kwon
- Department of Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Nayeon Choi
- Biostatistical Consulting and Research Lab, Medical Research Collaborating Center, Hanyang University, Seoul, Korea
| | - Ji Hui Shin
- Departments of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Seunghun Lee
- Departments of Radiology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Bora Nam
- Departments of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
- Hanyang University Institute for Rheumatology Research, Seoul, Korea
| | - Tae-Hwan Kim
- Departments of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
- Hanyang University Institute for Rheumatology Research, Seoul, Korea
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Kim J, Kim MJ, Oh GY, Lee SK, Kim T, Shin K. The predictability of ASDAS on drug survival in patients with ankylosing spondylitis on biologic therapy: data from the KOBIO registry. Ther Adv Musculoskelet Dis 2023; 15:1759720X231201714. [PMID: 37822329 PMCID: PMC10563457 DOI: 10.1177/1759720x231201714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 08/25/2023] [Indexed: 10/13/2023] Open
Abstract
Background The Ankylosing Spondylitis (AS) Disease Activity Score (ASDAS) is largely used for assessing disease activity in patients with AS. Objectives We aimed to investigate the predictability of ASDAS on drug survival in patients with low Bath AS Disease Activity Index (BASDAI) during biologic therapy. Design Using data from multi-center, prospective, observational prospective cohort, Korean College of Rheumatology Biologics and Targeted Therapy (KOBIO) registry. Methods The study population consisted of patients enrolled in the KOBIO registry from December 2012 to December 2018. The baseline demographic data and variables such as extra-articular manifestations, HLA-B27 positivity, family history of spondyloarthritis, ASDAS C-reactive protein (CRP), BASDAI, and Bath AS Functional Index scores were collected from the database. The disease activity indices were followed yearly after initiating a tumor necrosis factor (TNF) inhibitor (TNFi). Disease activities were defined as high (ASDAS-CRP ⩾ 2.1, BASDAI ⩾ 4) and low (ASDAS-CRP < 2.1, BASDAI < 4). Results Data from 1773 patients were analyzed. Among 269 patients with low BASDAI at baseline, 151 (56.1%) patients had high ASDAS-CRP, yet in 142 patients with low ASDAS-CRP at baseline, only 24 (16.9%) patients had a high BASDAI. High ASDAS-CRP captured more patients who had initiated or switched to a TNFi than those with high BASDAI (92.5% versus 84.8%, respectively, p < 0.001). Moreover, among AS patients with low BASDAI after 1 year of therapy, drug persistence in the following year was significantly lower in patients with high ASDAS than in those with low ASDAS (68.7% versus 82.5%, p < 0.001). Conclusion ASDAS-CRP not only has its advantages over BASDAI in assessing disease activity but also low ASDAS-CRP at 1 year can be a marker of long-term drug survival of TNFi therapy.
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Affiliation(s)
- Jinhyun Kim
- Division of Rheumatology, Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Min Jung Kim
- Division of Rheumatology, Seoul Metropolitan Government – Seoul National University Boramae Hospital, Seoul, Korea
| | - Geun Young Oh
- Division of Rheumatology, Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Sun Kyung Lee
- Division of Rheumatology, Seoul Metropolitan Government – Seoul National University Boramae Hospital, Seoul, Korea
| | - Taeeun Kim
- Patient Access, Novartis Korea Ltd., Seoul, Korea
| | - Kichul Shin
- Department of Internal Medicine, Seoul Metropolitan Government – Seoul National University Boramae Hospital, Seoul, Korea 20 Boramae-ro-5-gil, Dongjak-gu, Seoul 07061, Korea
- Department of Internal Medicine, College of Medicine, Seoul National University, Seoul, Korea
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Lee SC, Yang CH, Tsai YC, Yu KH. The effect of uveitis and undiagnosed spondyloarthritis: a systematic review and meta-analysis. Sci Rep 2023; 13:14779. [PMID: 37679498 PMCID: PMC10484908 DOI: 10.1038/s41598-023-41971-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 09/04/2023] [Indexed: 09/09/2023] Open
Abstract
Delay diagnosis of spondyloarthritis (SpA) is associated with poor functional ability and quality of life. Uveitis is the most frequent extraarticular manifestation in SpA, and its prevalence increases with longer disease duration. This study examines the effect of uveitis on the disease activity and functional outcome of undiagnosed SpA. We reviewed published and unpublished studies. Data were pooled using the random-effects model; pooled means, and mean differences (MDs) were calculated. In the included 14 studies, disease activity, functional index, and inflammatory markers were measured in 2581 patients with SpA with uveitis and 13,972 without. The pooled mean delay in diagnosis of SpA with uveitis (6.08 years; 95% CI 4.77 to 7.38) was longer than those without (5.41 years; 95% CI 3.94 to 6.89). The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score was the highest for a delay of 2-5 years (5.60, 95% CI 5.47 to 5.73) and the Bath Ankylosing Spondylitis Functional Index (BASFI) score was the lowest for a delay of < 2 years (2.92, 95% CI 2.48 to 3.37) and gradually increased to delay of > 10 years (4.17, 95% CI 2.93 to 5.41). Patients with SpA with uveitis had higher trend of Ankylosing Spondylitis Disease Activity Score (ASDAS)-CRP and BASDAI. The delay to diagnosis was longer in SpA with uveitis, and disease activity was often higher than those without uveitis. Early diagnosis of SpA with timely initiation of an appropriate management plan may reduce the adverse effects of the disease and improve functional ability.
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Affiliation(s)
- Shih-Ching Lee
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital, No. 5, Fu-Shin St., Kuei-Shan, 333, Tao-Yuan, Taiwan
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
| | - Chung-Han Yang
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital, No. 5, Fu-Shin St., Kuei-Shan, 333, Tao-Yuan, Taiwan
| | - Yun-Chen Tsai
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital, No. 5, Fu-Shin St., Kuei-Shan, 333, Tao-Yuan, Taiwan
- Graduate Institute of Clinical Medicine, National Taiwan University, Taipei, Taiwan
| | - Kuang-Hui Yu
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital, No. 5, Fu-Shin St., Kuei-Shan, 333, Tao-Yuan, Taiwan.
- Chang Gung University, Tao-Yuan, Taiwan.
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Untargeted Lipidomics Reveals Characteristic Biomarkers in Patients with Ankylosing Spondylitis Disease. Biomedicines 2022; 11:biomedicines11010047. [PMID: 36672555 PMCID: PMC9855684 DOI: 10.3390/biomedicines11010047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/10/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
Objective. Ankylosing spondylitis (AS) is a chronic inflammatory disease of the axial skeleton. Early and accurate diagnosis is necessary for the timely and effective treatment of this disease and its common complications. Lipid metabolites form various kinds of bioactive molecules that regulate the initiation and progression of inflammation. However, there are currently few studies that investigate the alteration of serum lipid in AS patients. Methods. Blood samples were collected from 115 AS patients and 108 healthy controls (HCs). Serum-untargeted lipidomics were performed using ultrahigh-performance liquid chromatography coupled with Q-Exactive spectrometry, and the data were determined by multivariate statistical methods to explore potential lipid biomarkers. Results. Lipid phenotypes associated with disease activity were detected in the serum of patients with AS. Of all 586 identified lipids, there are 297 differential lipid metabolites between the AS and HC groups, of which 15 lipid metabolites are significant. In the AS groups, the levels of triacylglycerol (TAG) (18:0/18:1/20:0) were increased, and the levels of phosphatidylcholine (PC) (16:0e/26:4) and PC (18:1/22:6) were decreased. The areas under the receiver operating characteristic curve (AUC) of TAG (18:0/18:1/20:0), PC (16:0e/26:4), and PC (18:1/22:6) were 0.919, 0.843, and 0.907, respectively. Conclusion. Our findings uncovered that lipid deregulation is a crucial hallmark of AS, thereby providing new insights into the early diagnosis of AS.
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Bruckmann NM, Rischpler C, Tsiami S, Kirchner J, Abrar DB, Bartel T, Theysohn J, Umutlu L, Herrmann K, Fendler WP, Buchbender C, Antoch G, Sawicki LM, Tsobanelis A, Braun J, Baraliakos X. Effects of anti-TNF-therapy on inflammatory, structural and osteoblastic activity lesions in radiographic axial spondyloarthritis - a prospective proof-of-concept study using PET/MRI of SIJ and spine. Arthritis Rheumatol 2022; 74:1497-1505. [PMID: 35474641 DOI: 10.1002/art.42149] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 02/28/2022] [Accepted: 04/19/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Proof-of-concept trial on the effect of TNF-inhibitors on osteoblastic activity by Na[18 F]F-PET/MRI in relation to inflammatory and structural lesions in r-axSpA patients during 6 months of treatment. METHODS Clinically active r-axSpA patients (n=16) were prospectively included to undergo Na[18 F]F-PET/MRI of the SIJ and spine (n=10) at baseline and follow-up. Three readers (1 for PET/MRI, 2 for conventional MRI) evaluated all images, blinded to timepoint. Bone marrow edema (BME), structural lesions (fat lesions (FL), sclerosis, erosions and ankylosis) and Na[18 F]F uptake were recorded on the level of SIJ (SIJ-Q) and vertebral corners (VC). RESULTS Overall, 11 male and 5 female patients (mean age 38.6±12.0 years) were followed-up for a mean of 4.6 (range 3-6) months. A total of 128 SIJ-Q and 920 VCs were analysed at each timepoint. At baseline, Na[18 F]F uptake was found in 96.0% SIJ-Qs with BME, 94.2% with sclerosis and 88.3% with FL. At follow-up, 65.3% of SIJ-Q with BME (p<0.001), 33.8% with sclerosis (p=0.23) and 24.5% with FL (p=0.01) showed decrease of Na[18 F]F uptake. For VCs, Na[18 F]F uptake was found in 81.5% edges with sclerosis, 41.9% with FL and 33.7% with BME at baseline. At follow-up, 73.5% VC with BME (p=0.01), 53.3% with FL (p=0.03) and 55.6% with sclerosis (p=0.16) showed decrease in Na[18 F]F uptake. CONCLUSION Anti-TNF treatment led to significant decrease of osteoblastic activity within 3-6 months, especially but not solely at sites with inflammation. Larger datasets are needed for confirmation of the anti-osteoblastic effects of TNF-inhibitors for prevention of radiographic progression in axSpA.
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Affiliation(s)
- Nils Martin Bruckmann
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, D-40225 Dusseldorf, Germany
| | - Christoph Rischpler
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, D-45147, Essen, Germany
| | - Styliani Tsiami
- Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Germany
| | - Julian Kirchner
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, D-40225 Dusseldorf, Germany
| | - Daniel B Abrar
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, D-40225 Dusseldorf, Germany
| | - Timo Bartel
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, D-45147, Essen, Germany
| | - Jens Theysohn
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, D-45147, Essen, Germany
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, D-45147, Essen, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, D-45147, Essen, Germany
| | - Wolfgang P Fendler
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, D-45147, Essen, Germany
| | - Christian Buchbender
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, D-40225 Dusseldorf, Germany
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, D-40225 Dusseldorf, Germany
| | - Lino M Sawicki
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, D-40225 Dusseldorf, Germany
| | | | - Juergen Braun
- Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Germany
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GICA Ş, AKKUBAK Y, AKSOY ZK, KÜÇÜK A, CÜRE E. Effects of the COVID-19 pandemic on psychology and disease activity in patients with ankylosing spondylitis and rheumatoid arthritis. Turk J Med Sci 2021; 51:1631-1639. [PMID: 33773523 PMCID: PMC8569757 DOI: 10.3906/sag-2011-188] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 03/27/2021] [Indexed: 02/05/2023] Open
Abstract
Background/aim The COVID-19 outbreak is known to increase stress levels of most patients with chronic diseases. Patients with ankylosing spondylitis (AS) and rheumatoid arthritis (RA) are highly susceptible to environmental stress. In the current study, we aimed to determine how the COVID-19 pandemic psychologically affected patients with chronic progressive diseases such as AS and RA and the effects of these psychological factors on disease activity. Materials and methods Age and sex-matched patients with AS (n = 80), RA (n = 80), and healthy controls (n = 80) were included in the study. All participants were evaluated with the “Perceived COVID-19 Threat Form (PCTF)”, “Suicide-Ideation Scale (SIS)”, “Hospital Anxiety and Depression Scale (HADS)”, “The Ability to Cope with Trauma (PACT)”, and “Psychological General Well-Being Index (PGWB)” scales. BASDAI was used in patients with AS, and DAS28 was used in patients with RA to assess disease severity. Results Compared to healthy individuals, patients with RA and AS had lower PGWB scores and higher HADS depression and anxiety subscale scores. Almost all psychometric assessment test scores were worse in AS patients with high-disease activity compared to those in low-disease activity. PACT scores were higher in patients with moderate RA compared to patients with mild RA (p = 0.006). While a positive correlation was identified between BASDAI and most of the psychometric assessment test scores (r = 0 .36 for PCTF, r = 0.53 for depressive scores, r = 0.54 for anxiety scores, r = 0.57 for suicidal ideation), DAS28 scores were found to be associated only with PACT total and PACT perceived forward-focused subscale scores (r = –.26 and r = .33, respectively). Conclusion Psychologically, AS and RA patients were found to be worse off compared to healthy controls. The perceived COVID threat and psychological status were associated with disease activity in AS, but not RA patients. Patients with chronic illnesses may be more vulnerable to the psychological effects of the pandemic, which can worsen disease activity.
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Affiliation(s)
- Şakir GICA
- Department of Psychiatry, Meram Medical Faculty, Necmettin Erbakan University, KonyaTurkey
| | - Yasemin AKKUBAK
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Necmettin Erbakan University, KonyaTurkey
| | - Zakire Kübra AKSOY
- Department of Psychiatry, Meram Medical Faculty, Necmettin Erbakan University, KonyaTurkey
| | - Adem KÜÇÜK
- Department of Rheumatology, Meram Medical Faculty, Necmettin Erbakan University, KonyaTurkey
| | - Erkan CÜRE
- Department of Internal Medicine, Ota Jinemed Hospital, İstanbulTurkey
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Gıca Ş, Akkubak Y, Aksoy ZK, Küçük A, Cüre E. Effects of the COVID-19 pandemic on psychology and disease activity in patients with ankylosing spondylitis and rheumatoid arthritis. Turk J Med Sci 2021. [PMID: 33773523 DOI: 10.3906/sag-2011-188.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background/aim The COVID-19 outbreak is known to increase stress levels of most patients with chronic diseases. Patients with ankylosing spondylitis (AS) and rheumatoid arthritis (RA) are highly susceptible to environmental stress. In the current study, we aimed to determine how the COVID-19 pandemic psychologically affected patients with chronic progressive diseases such as AS and RA and the effects of these psychological factors on disease activity. Materials and methods Age and sex-matched patients with AS (n = 80), RA (n = 80), and healthy controls (n = 80) were included in the study. All participants were evaluated with the “Perceived COVID-19 Threat Form (PCTF)”, “Suicide-Ideation Scale (SIS)”, “Hospital Anxiety and Depression Scale (HADS)”, “The Ability to Cope with Trauma (PACT)”, and “Psychological General Well-Being Index (PGWB)” scales. BASDAI was used in patients with AS, and DAS28 was used in patients with RA to assess disease severity. Results Compared to healthy individuals, patients with RA and AS had lower PGWB scores and higher HADS depression and anxiety subscale scores. Almost all psychometric assessment test scores were worse in AS patients with high-disease activity compared to those in low-disease activity. PACT scores were higher in patients with moderate RA compared to patients with mild RA (p = 0.006). While a positive correlation was identified between BASDAI and most of the psychometric assessment test scores (r = 0 .36 for PCTF, r = 0.53 for depressive scores, r = 0.54 for anxiety scores, r = 0.57 for suicidal ideation), DAS28 scores were found to be associated only with PACT total and PACT perceived forward-focused subscale scores (r = –.26 and r = .33, respectively). Conclusion Psychologically, AS and RA patients were found to be worse off compared to healthy controls. The perceived COVID threat and psychological status were associated with disease activity in AS, but not RA patients. Patients with chronic illnesses may be more vulnerable to the psychological effects of the pandemic, which can worsen disease activity.
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Affiliation(s)
- Şakir Gıca
- Department of Psychiatry, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Yasemin Akkubak
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Necmettin Erbakan University, Konya, Turkey
| | - Zakire Kübra Aksoy
- Department of Psychiatry, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Adem Küçük
- Department of Rheumatology, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Erkan Cüre
- Department of Internal Medicine, Ota Jinemed Hospital, İstanbul, Turkey
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