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Schaffert D, Bibi I, Blauth M, Lull C, von Ahnen JA, Gross G, Schulze-Hagen T, Knitza J, Kuhn S, Benecke J, Schmieder A, Leipe J, Olsavszky V. Using Automated Machine Learning to Predict Necessary Upcoming Therapy Changes in Patients With Psoriasis Vulgaris and Psoriatic Arthritis and Uncover New Influences on Disease Progression: Retrospective Study. JMIR Form Res 2024; 8:e55855. [PMID: 38738977 PMCID: PMC11240079 DOI: 10.2196/55855] [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: 12/30/2023] [Revised: 02/27/2024] [Accepted: 04/11/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND Psoriasis vulgaris (PsV) and psoriatic arthritis (PsA) are complex, multifactorial diseases significantly impacting health and quality of life. Predicting treatment response and disease progression is crucial for optimizing therapeutic interventions, yet challenging. Automated machine learning (AutoML) technology shows promise for rapidly creating accurate predictive models based on patient features and treatment data. OBJECTIVE This study aims to develop highly accurate machine learning (ML) models using AutoML to address key clinical questions for PsV and PsA patients, including predicting therapy changes, identifying reasons for therapy changes, and factors influencing skin lesion progression or an abnormal Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score. METHODS Clinical study data from 309 PsV and PsA patients were extensively prepared and analyzed using AutoML to build and select the most accurate predictive models for each variable of interest. RESULTS Therapy change at 24 weeks follow-up was modeled using the extreme gradient boosted trees classifier with early stopping (area under the receiver operating characteristic curve [AUC] of 0.9078 and logarithmic loss [LogLoss] of 0.3955 for the holdout partition). Key influencing factors included the initial systemic therapeutic agent, the Classification Criteria for Psoriatic Arthritis score at baseline, and changes in quality of life. An average blender incorporating three models (gradient boosted trees classifier, ExtraTrees classifier, and Eureqa generalized additive model classifier) with an AUC of 0.8750 and LogLoss of 0.4603 was used to predict therapy changes for 2 hypothetical patients, highlighting the significance of these factors. Treatments such as methotrexate or specific biologicals showed a lower propensity for change. An average blender of a random forest classifier, an extreme gradient boosted trees classifier, and a Eureqa classifier (AUC of 0.9241 and LogLoss of 0.4498) was used to estimate PASI (Psoriasis Area and Severity Index) change after 24 weeks. Primary predictors included the initial PASI score, change in pruritus levels, and change in therapy. A lower initial PASI score and consistently low pruritus were associated with better outcomes. BASDAI classification at onset was analyzed using an average blender of a Eureqa generalized additive model classifier, an extreme gradient boosted trees classifier with early stopping, and a dropout additive regression trees classifier with an AUC of 0.8274 and LogLoss of 0.5037. Influential factors included initial pain, disease activity, and Hospital Anxiety and Depression Scale scores for depression and anxiety. Increased pain, disease activity, and psychological distress generally led to higher BASDAI scores. CONCLUSIONS The practical implications of these models for clinical decision-making in PsV and PsA can guide early investigation and treatment, contributing to improved patient outcomes.
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Affiliation(s)
- Daniel Schaffert
- Department of Dermatology, Venereology and Allergology, University Medical Center and Medical Faculty Mannheim, University of Heidelberg, and Center of Excellence in Dermatology, Mannheim, Germany
| | - Igor Bibi
- Department of Dermatology, Venereology and Allergology, University Medical Center and Medical Faculty Mannheim, University of Heidelberg, and Center of Excellence in Dermatology, Mannheim, Germany
| | - Mara Blauth
- Department of Dermatology, Venereology and Allergology, University Medical Center and Medical Faculty Mannheim, University of Heidelberg, and Center of Excellence in Dermatology, Mannheim, Germany
| | - Christian Lull
- Department of Dermatology, Venereology and Allergology, University Medical Center and Medical Faculty Mannheim, University of Heidelberg, and Center of Excellence in Dermatology, Mannheim, Germany
| | - Jan Alwin von Ahnen
- Department of Dermatology, Venereology and Allergology, University Medical Center and Medical Faculty Mannheim, University of Heidelberg, and Center of Excellence in Dermatology, Mannheim, Germany
| | - Georg Gross
- Department of Medicine V, Division of Rheumatology, University Medical Center and Medical Faculty Mannheim, Mannheim, Germany
| | - Theresa Schulze-Hagen
- Department of Dermatology, Venereology and Allergology, University Medical Center and Medical Faculty Mannheim, University of Heidelberg, and Center of Excellence in Dermatology, Mannheim, Germany
| | - Johannes Knitza
- Institute of Digital Medicine, Philipps-University Marburg and University Hospital of Giessen and Marburg, Marburg, Germany
| | - Sebastian Kuhn
- Institute of Digital Medicine, Philipps-University Marburg and University Hospital of Giessen and Marburg, Marburg, Germany
| | - Johannes Benecke
- Department of Dermatology, Venereology and Allergology, University Medical Center and Medical Faculty Mannheim, University of Heidelberg, and Center of Excellence in Dermatology, Mannheim, Germany
| | - Astrid Schmieder
- Department of Dermatology, Venereology, and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Jan Leipe
- Department of Medicine V, Division of Rheumatology, University Medical Center and Medical Faculty Mannheim, Mannheim, Germany
| | - Victor Olsavszky
- Department of Dermatology, Venereology and Allergology, University Medical Center and Medical Faculty Mannheim, University of Heidelberg, and Center of Excellence in Dermatology, Mannheim, Germany
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Carbo M, Paap D, van Overbeeke L, Wink F, Bootsma H, Arends S, Spoorenberg A. Higher levels of physical activity are associated with less evasive coping, better physical function and quality of life in patients with axial spondyloarthritis. PLoS One 2024; 19:e0301965. [PMID: 38758932 PMCID: PMC11101074 DOI: 10.1371/journal.pone.0301965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 03/26/2024] [Indexed: 05/19/2024] Open
Abstract
OBJECTIVE To evaluate daily physical activity (PA) in relation to psychosocial factors, such as anxiety, depression and different types of coping strategies, as well as patient- and disease-related factors in patients with axial spondyloarthritis (axSpA). METHODS Consecutive outpatients from the Groningen Leeuwarden AxSpA (GLAS) cohort completed the modified Short Questionnaire to assess health-enhancing PA (mSQUASH), Hospital Anxiety and Depression Scale (HADS) and Coping with Rheumatic Stressors (CORS) questionnaires, as well as standardized patient- and disease-related assessments. Univariable and multivariable linear regression analyses and comparison of lowest and highest PA tertiles were performed to explore associations between the HADS, CORS, patient- and disease-related factors and PA. RESULTS In total, 84 axSpA patients were included; 60% male, mean age 49 (SD ±14) years, median symptom duration 20 (25th-75th percentiles: 12-31) years, mean ASDAS 2.1 (±1.0). Higher PA levels were significantly associated with better scores on patient-reported disease activity (BASDAI), physical function (BASFI) and quality of life (ASQoL). Furthermore, higher levels of PA were associated with less impact of axSpA on wellbeing and lower HADS depression scores. In the multivariable linear regression model, less use of the coping strategy 'decreasing activities' (β: -376.4; p 0.003) and lower BMI (β:-235.5; p: 0.030) were independently associated with higher level of PA. Comparison of patients from the lowest and highest PA tertiles showed results similar to those found in the regression analyses. CONCLUSION In this cohort of axSpA patients, higher levels of daily PA were associated with better patient-reported outcomes and lower depression scores. Additionally, the passive coping strategy "decreasing activities" and lifestyle factor BMI were independently associated with PA. Besides anti-inflammatory treatment, coping strategies and lifestyle should be taken into account in the management of individual axSpA patients. Incorporating these aspects into patient education could increase patient awareness and self-efficacy. In the future, longitudinal studies are needed to better understand the complex relationship between patient-, disease- and psychosocial factors associated with daily PA.
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Affiliation(s)
- Marlies Carbo
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Davy Paap
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Physical Therapy, Saxion, University of Applied Sciences, Enschede, The Netherlands
| | - Laura van Overbeeke
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Freke Wink
- Department of Rheumatology, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Hendrika Bootsma
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Suzanne Arends
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Anneke Spoorenberg
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Safiah MH, Kalalib Al Ashabi K, Haj-Abow T, Alchallah MO, Khalayli N, Kudsi M. Exploring associations with depressive and anxiety symptoms among Syrian patients with ankylosing spondylitis undergoing biological treatment: A cross-sectional study. Medicine (Baltimore) 2024; 103:e37708. [PMID: 38579064 PMCID: PMC10994469 DOI: 10.1097/md.0000000000037708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/04/2024] [Indexed: 04/07/2024] Open
Abstract
People with ankylosing spondylitis (AS) are vulnerable group to experience mood disorders. It is crucial to identify factors that contribute to depression and anxiety in order to improve outcomes. This study seeks to determine the rates of depression and anxiety in Syrian AS patients, as well as identify potential predictors for these conditions. This cross-sectional study was conducted using convenience sampling at the Biological Treatment Unit of the Rheumatology Department of the Damascus Hospital. Data were collected from face-to-face interviews with patients using validated structural questionnaire. A multivariate linear regression model was used to investigate potential predictive factors of depressive and anxiety symptoms. Of the 103 patients, 49.5% showed clinically significant depressive symptoms, and 36.9 % showed clinically significant anxiety symptoms. Multivariate linear regression indicated that depressive and anxiety symptoms were predicted by job layoff, hip pain, positive history of mental distress, poor quality of life, severe fatigue, and high frequency of sleep disturbance with relatively high explanatory powers. depressive and anxiety symptoms were predicted by disease activity scores but with low explanatory power. This study demonstrated high levels of that depressive and anxiety symptoms among Syrian patients with AS undergoing biological treatment. Poor quality of life, severe fatigue, and high-frequency sleep disturbances are major predictive factors for depressive and anxiety symptoms. Screening for depression and anxiety holds significant importance in the comprehensive management of ankylosing spondylitis even in the context of concurrent biological treatment administration.
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Affiliation(s)
| | | | - Tasnim Haj-Abow
- Department of Rheumatology, Damascus Hospital, Damascus, Syria
| | | | - Naram Khalayli
- Faculty of Medicine, Damascus University, Damascus, Syria
| | - Maysoun Kudsi
- Faculty of Medicine, Damascus University, Damascus, Syria
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Helon K, Wisłowska M, Kanecki K, Goryński P, Nitsch-Osuch A, Bonek K. Time Trend Analysis of Comorbidities in Ankylosing Spondylitis: A Population-Based Study from 53,142 Hospitalizations in Poland. J Clin Med 2024; 13:602. [PMID: 38276108 PMCID: PMC10816889 DOI: 10.3390/jcm13020602] [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: 11/20/2023] [Revised: 01/13/2024] [Accepted: 01/15/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND (1) Influence of comorbidities on life expectancy and treatment outcomes is one of the main concerns of modern rheumatology, due to their rising prevalence and increasing impact on mortality and disability. The main objective of our study was to analyze the time trends and shifts in the comorbidity profile and mortality over 10 years in the Polish population with ankylosing spondylitis (AS). (2) Data from 2011-2020 years were acquired from the General Hospital Morbidity Study in the National Institute of Public Health-National Institute of Hygiene (NIH-PIB) as ICD-10 codes. Based on ICD10 codes, we calculated the percentage shares for comorbidities, with the relative risk ratios and odds ratios. We analyzed the hospitalization rates and mortality from the overlapping conditions. Also, we analyzed age and sex related differences in the clinical manifestations of AS patients. (3) Results: From 53,142 hospitalizations of patients with AS, we found that the male population presented higher rates of cardiovascular (2.7% vs. 1.3% p < 0.001) and pulmonary conditions (1.2% vs. 0.8% p < 0.025). Inflammatory bowel diseases were more common in the female population than in males (2.3% vs. 1.7%, p < 0.001). In the years 2011-2020, we observed a decline in the number of hospitalized patients due to cardiovascular (p < 0.001) and respiratory system conditions (p < 0.001), yet the relative risk and odd ratios remained high. In the years 2011-2020, 4056 patients received biological treatment (7%). The number of initiated biological therapies correlated negatively with the number of reported hospitalizations due to ischemic heart diseases (IHD) (p < 0.031, r = -0.8). Furthermore, in the logistic regression model, we found strong collinearity between cardiovascular and pulmonary comorbidities (VIF = 14; tolerance = 0.1); also, the number of reported IHD's correlated positively with the number of pulmonary infections (p < 0.031, r = 0.7) (4). CONCLUSIONS Cardiopulmonary comorbidities are a main factor associated with increased mortality in patients with AS, especially in hospitalized patients. The mortality rates among patients with AS admitted to hospital due to other conditions other than movement disorders exceed the populational risk. The number of biologically treated patients correlated negatively with hospital admissions due to IHD.
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Affiliation(s)
- Katarzyna Helon
- Department of Rheumatology, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland; (M.W.); (K.B.)
| | - Małgorzata Wisłowska
- Department of Rheumatology, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland; (M.W.); (K.B.)
| | - Krzysztof Kanecki
- National Institute of Public Health—National Institute of Hygiene, 00791 Warsaw, Poland; (K.K.); (P.G.); (A.N.-O.)
| | - Paweł Goryński
- National Institute of Public Health—National Institute of Hygiene, 00791 Warsaw, Poland; (K.K.); (P.G.); (A.N.-O.)
| | - Aneta Nitsch-Osuch
- National Institute of Public Health—National Institute of Hygiene, 00791 Warsaw, Poland; (K.K.); (P.G.); (A.N.-O.)
| | - Krzysztof Bonek
- Department of Rheumatology, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland; (M.W.); (K.B.)
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Salari N, Sadeghi N, Hosseinian-Far A, Hasheminezhad R, Khazaie H, Shohaimi S, Mohammadi M. Prevalence of sleep disturbance in patients with ankylosing spondylitis: a systematic review and meta-analysis. Adv Rheumatol 2023; 63:33. [PMID: 37468951 DOI: 10.1186/s42358-023-00315-1] [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: 04/15/2023] [Accepted: 07/14/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Ankylosing Spondylitis (AS) patients face several challenges due to the nature of the disease and its physical and psychological complications. Sleep disorders are among the most important concerns. Sleep disorders can aggravate the signs and symptoms of the disease and ultimately reduce the quality of patients' lives. This study uses a systematic review and meta-analysis to pool the reported prevalence of sleep disorders among AS patients. METHODS To find related studies, the WoS, PubMed, ScienceDirect, Scopus, Embase, and Google Scholar databases were systematically searched without a lower time limit. Heterogeneity among the identified studies was checked using the I2 index, and the Begg and Mazumdar correlation test examined the existence of published bias. Comprehensive Meta-Analysis (v.2) software was adopted to analyze the data. RESULTS In the review of 18 studies with a sample size of 5,840, the overall pooled prevalence of sleep disorders among AS patients based on the random effects method was found to be 53% (95% CI: 44.9-61). The highest and lowest prevalence was in Egypt at 90% and Australia at 19.2%, respectively. Our meta-regression results show that with the increase in 'sample size' and 'year of publication', the overall prevalence of sleep disorders in patients with AS decreases (p < 0.05). CONCLUSION The results of the present study indicate a high and significant prevalence of sleep disorders among AS patients. Thus, health policymakers and healthcare providers must focus on timely diagnosis and effective educational and therapeutic interventions for the prevention and proper treatment of sleep disorders in this population of patients.
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Affiliation(s)
- Nader Salari
- Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Narges Sadeghi
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Amin Hosseinian-Far
- Department of Business Systems & Operations, University of Northampton, Northampton, UK
| | - Razie Hasheminezhad
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Habibolah Khazaie
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shamarina Shohaimi
- Department of Biology, Faculty of Science, University Putra Malaysia, Serdang, Selangor, Malaysia
| | - Masoud Mohammadi
- Cellular and Molecular Research Center, Gerash University of Medical Sciences, Gerash, Iran.
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Dong T, Lu S, Li X, Yang J, Liu Y. Genetic association between ankylosing spondylitis and major depressive disorders: Shared pathways, protein networks and the key gene. Medicine (Baltimore) 2023; 102:e33985. [PMID: 37327287 PMCID: PMC10270550 DOI: 10.1097/md.0000000000033985] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 05/22/2023] [Indexed: 06/18/2023] Open
Abstract
The prevalence of ankylosing spondylitis (AS) and major depressive disorders (MDD) becomes increasingly pronounced, exerting a significant impact on the life quality of contemporary people. Although there is mounting evidence of a link between AS and major depression disorders, the specific interactions between the two have not been thoroughly investigated. To this end, this study aimed to check whether the gene expression profiles of patients with AS and major depression disorders overlapped, and whether there were any functional links between the identified genes via protein-protein interactions. Herein, the relationship between the 4 datasets (GSE73754, GSE98793, GSE25101, and GSE54564) chosen from the Gene Expression Omnibus for evaluation and validation was investigated using gene characterization and functional enrichment. Then, following Gene Ontology and the Kyoto Encyclopedia of Genes and Genomes that explore the biological processes of common genes and demonstrate the interrelationships between common genes, hub genes were obtained using the STRING database and the application cytoHubba plugin of Cytoscape software. The correlation between the gene and 22 types of immuno-infiltrating cells was explored, and the key gene as well as the diagnostic efficiency of the key gene was obtained through verification. A total of 204 shared genes were discovered, the majority of which were functionally enriched in Ribosome, Coronavirus disease COVID19, Starch and sucrose metabolism, and Galactose metabolism. Then, efforts were made to go through STRING. Immuno-infiltration studies revealed that Neutrophils, T cells CD8, T cells CD4 naive, T cells CD4 memory resting, T cells CD4 memory activated, and T cells regulatory were associated with the pathogenesis of AS and MDD. Additionally, the receiver operating characteristic curve revealed that the key gene MRPL13 played diagnostic roles in AS and MDD after intersecting 10 hub genes with 37 differential expression genes from the 2 validation datasets. The obtained results suggest an overlapping genetic structure between AS and major depression disorders. MRPL13 may provide key insights into the relationship between AS and MDD.
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Affiliation(s)
- Tiantian Dong
- Center for External Treatment of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine Affiliated Hospital, Jinan, People’s Republic of China
- College of Acupuncture and Massage, Shandong University of Traditional Chinese Medicine, Jinan, People’s Republic of China
| | - Shiyou Lu
- Center for External Treatment of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine Affiliated Hospital, Jinan, People’s Republic of China
- College of Acupuncture and Massage, Shandong University of Traditional Chinese Medicine, Jinan, People’s Republic of China
| | - Xuhao Li
- College of Acupuncture and Massage, Shandong University of Traditional Chinese Medicine, Jinan, People’s Republic of China
| | - Jiguo Yang
- College of Acupuncture and Massage, Shandong University of Traditional Chinese Medicine, Jinan, People’s Republic of China
| | - Yuanxiang Liu
- College of First Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, People’s Republic of China
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Dong T, Lu S, Li X, Yang J, Liu Y. Genetic association between ankylosing spondylitis and major depressive disorders: Shared pathways, protein networks and the key gene. Medicine (Baltimore) 2023; 102:e33985. [PMID: 37327287 DOI: 10.1097/md.0000000000033985if:] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/25/2024] Open
Abstract
The prevalence of ankylosing spondylitis (AS) and major depressive disorders (MDD) becomes increasingly pronounced, exerting a significant impact on the life quality of contemporary people. Although there is mounting evidence of a link between AS and major depression disorders, the specific interactions between the two have not been thoroughly investigated. To this end, this study aimed to check whether the gene expression profiles of patients with AS and major depression disorders overlapped, and whether there were any functional links between the identified genes via protein-protein interactions. Herein, the relationship between the 4 datasets (GSE73754, GSE98793, GSE25101, and GSE54564) chosen from the Gene Expression Omnibus for evaluation and validation was investigated using gene characterization and functional enrichment. Then, following Gene Ontology and the Kyoto Encyclopedia of Genes and Genomes that explore the biological processes of common genes and demonstrate the interrelationships between common genes, hub genes were obtained using the STRING database and the application cytoHubba plugin of Cytoscape software. The correlation between the gene and 22 types of immuno-infiltrating cells was explored, and the key gene as well as the diagnostic efficiency of the key gene was obtained through verification. A total of 204 shared genes were discovered, the majority of which were functionally enriched in Ribosome, Coronavirus disease COVID19, Starch and sucrose metabolism, and Galactose metabolism. Then, efforts were made to go through STRING. Immuno-infiltration studies revealed that Neutrophils, T cells CD8, T cells CD4 naive, T cells CD4 memory resting, T cells CD4 memory activated, and T cells regulatory were associated with the pathogenesis of AS and MDD. Additionally, the receiver operating characteristic curve revealed that the key gene MRPL13 played diagnostic roles in AS and MDD after intersecting 10 hub genes with 37 differential expression genes from the 2 validation datasets. The obtained results suggest an overlapping genetic structure between AS and major depression disorders. MRPL13 may provide key insights into the relationship between AS and MDD.
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Affiliation(s)
- Tiantian Dong
- Center for External Treatment of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine Affiliated Hospital, Jinan, People's Republic of China
- College of Acupuncture and Massage, Shandong University of Traditional Chinese Medicine, Jinan, People's Republic of China
| | - Shiyou Lu
- Center for External Treatment of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine Affiliated Hospital, Jinan, People's Republic of China
- College of Acupuncture and Massage, Shandong University of Traditional Chinese Medicine, Jinan, People's Republic of China
| | - Xuhao Li
- College of Acupuncture and Massage, Shandong University of Traditional Chinese Medicine, Jinan, People's Republic of China
| | - Jiguo Yang
- College of Acupuncture and Massage, Shandong University of Traditional Chinese Medicine, Jinan, People's Republic of China
| | - Yuanxiang Liu
- College of First Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, People's Republic of China
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Pu Y, He Y, Zhao X, Zhang Q, Wen J, Hashimoto K, Liu Y. Depression-like behaviors in mouse model of Sjögren's syndrome: A role of gut-microbiota-brain axis. Pharmacol Biochem Behav 2022; 219:173448. [PMID: 35981685 DOI: 10.1016/j.pbb.2022.173448] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 10/15/2022]
Abstract
Depression is a common psychiatric symptom in patients with Sjögren's syndrome (SS). Prevalence of depression in SS patients is significantly higher than that in the general population. Increasing evidence suggests a crucial role of gut-microbiota-brain axis in depression. In this study, we investigated whether non-obese diabetic (NOD) mice, a widely used animal model of SS, exhibit depression-like phenotypes and abnormal composition of gut microbiota. Eleven-week-old NOD mice spontaneously exhibited SS-related symptoms without pancreatic destruction. NOD mice displayed depression-like behaviors, decreased expression of synaptic proteins in the prefrontal cortex (PFC), and abnormal composition of gut microbiota. Interestingly, SS-related proinflammatory factors in the submandibular gland (SMG) and autoantibodies (anti-SSA and anti-SSB) in the plasma were correlated with the expression of synaptic proteins in the PFC or depression-like behaviors. In addition, there were correlations between the relative abundance of microbiota and SS-related symptoms (or depression-related phenotypes). These data suggest that SS-related symptoms and abnormal composition of gut microbiota may play a role in depression-like phenotypes in NOD mice through gut-microbiota-brain axis.
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Affiliation(s)
- Yaoyu Pu
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yangyang He
- Department of Nephrology, Sichuan Academy of Medical Science and Sichuan Provincial People's Hospital, University of Electronic Science and Technology, Chengdu, China
| | - Xueting Zhao
- Department of Rheumatology and Immunology, Xiangyang Central Hospital, Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Qiuping Zhang
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ji Wen
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Kenji Hashimoto
- Division of Clinical Neuroscience, Chiba University Center for Forensic Mental Health, Chiba, Japan.
| | - Yi Liu
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Association of fear assessment in inflammatory rheumatic diseases (FAIR) questionnaire with ankylosing spondylitis quality of life and disease activity in patients with ankylosing spondylitis. JOURNAL OF SURGERY AND MEDICINE 2022. [DOI: 10.28982/josam.1119839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background/Aim: Fear against disease course, treatment, and limitations in family, work, and social life are commonly seen but mostly overlooked by physicians of patients with chronic inflammatory rheumatic diseases. Ankylosing spondylitis (AS) is a chronic inflammatory disease in young adults characterized by limitations in spinal mobility. The Fear Assessment (FAIR) Questionnaire was designed especially for patients with rheumatoid arthritis and spondyloarthritis to assess the level of fear from the patient’s perspective. Here we evaluate the FAIR score in AS patients and its association with disease activity, AS quality of life (ASQoL), depression, anxiety, and fatigue levels.
Methods: This cross-sectional study included 79 patients with AS, and disease activity was assessed by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), AS-Disease Activity Score-C reactive protein, and functional status was assessed by Bath Ankylosing Spondylitis Functional Index (BASFI). Patient global assessment of disease and pain were scored on 0–10 cm visual analog scores. All patients completed FAIR and ASQoL questionnaires. The depression and anxiety were evaluated by Hospital Anxiety and Depression Scale (HADS), and fatigue was assessed by Fatigue Severity Scale (FSS).
Results: The mean age of AS patients (62% male) was 41.7 (11.3) years. Most of the patients were on biological disease-modifying anti-rheumatic drugs (bDMARDs). The patients’ median BASDAI, ASDAS-CRP, and BASFI were 5.4 (range, 3.8–7.4), 3.83 (1.4), and 4.0 (range, 2.3–6.2), respectively. The overall FAIR, ASQoL, FSS, HADS-depression, and HADS-anxiety scores were 75 (range, 52–91), 9.6 (5.2), 5.4 (range, 4.1–7), 7.7 (4.4) and 9.6 (5.2), respectively. There were statistically significant correlations between disease activity indices and FAIR, ASQoL, FSS, and HADS scores. The FAIR scores significantly correlated with ASQoL, FSS, and HADS scores. The patients with active disease (BASDAI ≥ 4) had significantly higher levels of FAIR, ASQoL, FSS, and HADS. The best cut-off value for the FAIR score of AS patients with moderate to severe disease activity was 50 (AUC: 0.734, 95% CI [0.599–0.870], P = 0.002), with a sensitivity of 89.8%, specificity of 55%, positive likelihood ratio of 1.99, and Youden index of 0.45.
Conclusion: This study shows that AS patients face a high level of fear which is associated with higher disease activity, higher risk of mood disorders, and lower quality of life. Physicians should not only focus on the physical improvement of the patient but also handle the fear of patients against their diseases and their treatment. This holistic approach will improve the dialogue between the physician and the patient, which will result in increased compliance with treatment and will raise the quality of care.
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10
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Kiltz U, Wiatr T, Redeker I, Baraliakos X, Fedorov K, Braun J. Effects of patient and disease characteristics on global functioning in patients with axial spondyloarthritis in routine care. Semin Arthritis Rheum 2022; 55:152006. [DOI: 10.1016/j.semarthrit.2022.152006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 04/01/2022] [Accepted: 04/11/2022] [Indexed: 10/18/2022]
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11
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Kiltz U, Boonen A, van der Heijde D, Bautista-Molano W, Vargas RB, Chiowchanwisawakit P, El-Zorkany B, Gaydukova I, Geher P, Gossec L, Gilio M, Grazio S, Gu J, Khan MA, Kim TJ, Maksymowych WP, Marzo-Ortega H, Navarro-Compán V, Ozgocmen S, Patrikos D, Pimentel-Santos FM, Reveille J, Schirmer M, Stebbings S, Van den Bosch F, Weber U, Braun J. Development of an environmental contextual factor item set relevant to global functioning and health in patients with axial Spondyloarthritis. Rheumatology (Oxford) 2021; 61:2054-2062. [PMID: 34534275 DOI: 10.1093/rheumatology/keab653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/28/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To describe the development of an Environmental contextual factors (EF) Item Set (EFIS) accompanying the disease specific Assessment of SpondyloArthritis international Society Health Index (ASAS HI). METHOD First, a candidate item pool was developed by linking items from existing questionnaires to 13 EF previously selected for the ICF/ASAS Core Set. Second, using data from two international surveys, which contained the EF item pool as well as the items from the ASAS HI, the number of EF-items was reduced based on the correlation between the item and the ASAS HI sum score combined with expert opinion. Third, the final English EFIS was translated into 15 languages and cross-culturally validated. RESULTS The initial item pool contained 53 EF addressing 4 ICF EF-chapters: products and technology (e1), support and relationship (e3), attitudes (e4) and health services (e5). Based on 1754 responses of axial spondyloarthritis patients in an international survey, 44 of 53 initial items were removed based on low correlations to the ASAS HI or redundancy combined with expert opinion. 9 items of the initial item pool (range correlation 0.21-0.49) form the final EFIS. The EFIS was translated into 15 languages and field tested in 24 countries. CONCLUSIONS An EFIS is available complementing the ASAS HI and helps to interpret the ASAS HI results by gaining an understanding of the interaction between a health condition and contextual factors. The EFIS emphasizes the importance of support and relationships, as well as attitudes of the patient and health services in relation to self-reported health.
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Affiliation(s)
- Uta Kiltz
- Rheumazentrum Ruhrgebiet, Herne Germany; and.,Ruhr-Universität Bochum, Germany
| | - Annelies Boonen
- Department of Internal MedicineDivision of Rheumatology, Maastricht University Medical Center, the Netherlands.,Care and Public Health Research Institute (CAPHRI), Maastricht University, the Netherlands
| | | | - Wilson Bautista-Molano
- University Hospital Fundación Santa Fe de Bogotá, and Universidad El Bosque, Bogotá, Colombia
| | | | | | | | | | - Pal Geher
- Semmelweis University, Budapest, Hungary
| | - Laure Gossec
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris France.,Pitié-Salpêtrière hospital, AP-HP Sorbonne Université, Rheumatology department, Paris, France
| | - Michele Gilio
- Department of Internal Medicine - "San Carlo" Hospital Potenza and Madonna delle Grazie Hospital of Matera, Potenza, Italy
| | - Simeon Grazio
- Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | | | - Muhammad Asim Khan
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Tae-Jong Kim
- Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | | | - Helena Marzo-Ortega
- NIHR Leeds Biomedical Research Centre, Chapel Allerton Hospital, Leeds, and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | | | - Salih Ozgocmen
- Department of RheumatologyIstinye University, Medicalpark Gaziosmanpasa Hospital, Istanbul, Turkey
| | | | | | - John Reveille
- Department of Internal MedicineUniversity of Texas Health Science Center at Houston, USA
| | - Michael Schirmer
- Innsbruck Medical University, Department of Internal Medicine, Clinic IIAustria
| | - Simon Stebbings
- University of Otago, Dunedin School of Medicine, Dunedin, New Zealand
| | - Filip Van den Bosch
- VIB Center for Inflammation Research, Ghent, Belgium.,Department of Rheumatology Ghent University Hospital, Ghent, Belgium
| | - Ulrich Weber
- Practice Buchsbaum, Rheumatology, Schaffhausen, Switzerland
| | - Juergen Braun
- Rheumazentrum Ruhrgebiet, Herne Germany; and.,Ruhr-Universität Bochum, Germany
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12
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Lu H, Wang Y, Wang X, Wu X, Zhou L, Lin L, Sheng R, Tian H, Li T, Xu H. Yisaipu ® Provide AS Patients With an Economical Therapeutic Option While Original Biologicals are More Advantageous in the COVID-19 Epidemic Situation. Front Pharmacol 2021; 12:692768. [PMID: 34552481 PMCID: PMC8450409 DOI: 10.3389/fphar.2021.692768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 08/20/2021] [Indexed: 01/13/2023] Open
Abstract
Objectives: Anti-tumor necrosis factor (TNF) agents have been regarded as the most effective treatment for ankylosing spondylitis (AS) so far. However, economic factors limited the prescription of original biologicals in China. Yisaipu® is a biosimilar for etanercept as pre fill syringes (PFS), which has entered China's national medical insurance catalog for more than 10 yr and was widely used because it greatly reduced the economic burden of AS patients. Yisaipu® is provided subcutaneous injection in hospital setting only. We collected clinical data of AS patients before, during and after COVID-19 epidemic, in an attempt to investigate the advantages and disadvantages of original biologicals and Yisaipu® during regular follow up and COVID-19 epidemic. Methods: AS patients who received original biologicals or Yisaipu® in our department for more than 1 yr were included in our study. General data, demographic characteristics, disease activity, quality of life and medical compliance were collected from regular visits. The patients were followed up through telephone interviews from April 20th to 27th, 2020 about the overall impact of the COVID-19 epidemic. Results: There was no significant difference in Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score-CRP (ASDAS-CRP) between the two groups. Health Assessment Questionnaire for Spondyloarthropathies (HAQ-s) showed that Yisaipu® group was superior to original biological group in terms of eating, gripping and driving. In addition, the medical cost of Yisaipu® was lower than that of original biologicals. The overall impact of the COVID-19 epidemic on patients of original biological group was comparatively smaller than that on Yisaipu® group. Conclusions: Yisaipu® provided AS patients with an economical selection during regular follow-up, while original biologicals had certain advantages in the COVID-19 epidemic setting, including a longer time interval between two drug administrations and the self-injection dose form of medication.
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Affiliation(s)
- Hongjuan Lu
- Department of Rheumatology and Immunology, Changzheng Hospital, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Yuanqiong Wang
- Department of Rheumatology and Immunology, Changzheng Hospital, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Xiuwen Wang
- Department of Rheumatology and Immunology, Changzheng Hospital, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Xin Wu
- Department of Rheumatology and Immunology, Changzheng Hospital, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Ling Zhou
- Department of Rheumatology and Immunology, Changzheng Hospital, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Li Lin
- Department of Rheumatology and Immunology, Changzheng Hospital, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Rong Sheng
- Department of Rheumatology and Immunology, Changzheng Hospital, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Haoran Tian
- Department of Rheumatology and Immunology, Changzheng Hospital, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Ting Li
- Department of Rheumatology and Immunology, Changzheng Hospital, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Huji Xu
- Department of Rheumatology and Immunology, Changzheng Hospital, Second Affiliated Hospital of Naval Medical University, Shanghai, China
- School of Clinical Medicine, Tsinghua University, Beijing, China
- Peking-Tsinghua Center for Life Sciences, Tsinghua University, Beijing, China
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13
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Prados-Ojeda JL, Luque-Luque R, Gordillo-Urbano RM, Guler I, López-Medina C, Collantes-Estévez E, Escudero-Contreras A. Assessment of Subclinical Psychotic Symptoms in Patients with Rheumatoid Arthritis and Spondyloarthritis. J Clin Med 2021; 10:jcm10163461. [PMID: 34441756 PMCID: PMC8396915 DOI: 10.3390/jcm10163461] [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: 05/26/2021] [Revised: 07/31/2021] [Accepted: 08/01/2021] [Indexed: 11/17/2022] Open
Abstract
Inflammatory and autoimmune processes have been associated with the onset of depressive and psychotic symptoms. Rheumatoid arthritis (RA) and spondyloarthritis (SpA) are rheumatic diseases with an inflammatory etiology. A high prevalence of depressive and anxiety-related comorbidity has been reported for both diseases, with no evidence of a greater prevalence of psychosis. The objective of the present study was to evaluate for the first time subclinical psychotic symptoms in patients with RA and SpA. This is a cross-sectional, single-center study including RA and SpA patients, as well as healthy controls. Abnormal psychotic experiences (positive, negative, and depressive symptoms) were evaluated using the Community Assessment of Psychic Experiences (CAPE-42). Functional capacity was evaluated using the Short-Form Health Survey SF-12. We compared the CAPE and SF-12 scores between the three groups. We recruited 385 individuals: 218 with RA, 100 with SpA, and 67 healthy controls. According to the CAPE scale, the frequency of subclinical psychotic symptoms was greater in patients than in healthy controls (RA, 1.90 vs. 1.63, p < 0.001; SpA, 1.88 vs. 1.63, p = 0.001). Distress was also greater in patients than in controls owing to the presence of symptoms. No differences were observed between the three groups for the mental dimension scores in the SF-12 Health Survey (43.75 in RA, 45.54 in SpA, and 43.19 in healthy controls). Our findings point to a greater prevalence of subclinical psychotic symptoms in patients with RA and patients with SpA than in the general population. The results suggest an association between inflammation and depression/subclinical psychotic symptoms.
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Affiliation(s)
- Juan L. Prados-Ojeda
- Mental Health Department, Reina Sofia University Hospital, 14004 Cordoba, Spain; (J.L.P.-O.); (R.L.-L.); (R.M.G.-U.)
- Morphological and Socio-Sanitary Sciences, University of Cordoba, 14004 Cordoba, Spain
- Maimonides Institute of Biomedical Research of Córdoba (IMIBIC), 14004 Cordoba, Spain; (I.G.); (E.C.-E.); (A.E.-C.)
| | - Rogelio Luque-Luque
- Mental Health Department, Reina Sofia University Hospital, 14004 Cordoba, Spain; (J.L.P.-O.); (R.L.-L.); (R.M.G.-U.)
- Morphological and Socio-Sanitary Sciences, University of Cordoba, 14004 Cordoba, Spain
- Maimonides Institute of Biomedical Research of Córdoba (IMIBIC), 14004 Cordoba, Spain; (I.G.); (E.C.-E.); (A.E.-C.)
| | - Rafael M. Gordillo-Urbano
- Mental Health Department, Reina Sofia University Hospital, 14004 Cordoba, Spain; (J.L.P.-O.); (R.L.-L.); (R.M.G.-U.)
| | - Ipek Guler
- Maimonides Institute of Biomedical Research of Córdoba (IMIBIC), 14004 Cordoba, Spain; (I.G.); (E.C.-E.); (A.E.-C.)
| | - Clementina López-Medina
- Maimonides Institute of Biomedical Research of Córdoba (IMIBIC), 14004 Cordoba, Spain; (I.G.); (E.C.-E.); (A.E.-C.)
- Medical and Surgical Sciences Department, University of Cordoba, 14004 Cordoba, Spain
- Rheumatology Department, Reina Sofia University Hospital, 14004 Cordoba, Spain
- Correspondence:
| | - Eduardo Collantes-Estévez
- Maimonides Institute of Biomedical Research of Córdoba (IMIBIC), 14004 Cordoba, Spain; (I.G.); (E.C.-E.); (A.E.-C.)
- Medical and Surgical Sciences Department, University of Cordoba, 14004 Cordoba, Spain
- Rheumatology Department, Reina Sofia University Hospital, 14004 Cordoba, Spain
| | - Alejandro Escudero-Contreras
- Maimonides Institute of Biomedical Research of Córdoba (IMIBIC), 14004 Cordoba, Spain; (I.G.); (E.C.-E.); (A.E.-C.)
- Medical and Surgical Sciences Department, University of Cordoba, 14004 Cordoba, Spain
- Rheumatology Department, Reina Sofia University Hospital, 14004 Cordoba, Spain
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14
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Hur JW, Ko KM, Park KS, Hong SJ, Kim HS, Lee MS. Real-world experiences of the diagnosis process in Korean patients with ankylosing spondylitis based on a self-report questionnaire. J Int Med Res 2021; 49:3000605211004201. [PMID: 33823632 PMCID: PMC8033485 DOI: 10.1177/03000605211004201] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Objectives The diagnosis of ankylosing spondylitis (AS) is often delayed, which affects
various clinical outcomes. This study examined the real-world situation of
patients with AS during diagnosis and treatment. Methods Data were obtained from 26 tertiary care hospitals in Korea using a
self-report questionnaire. The questionnaire assessed symptoms, pain,
extra-articular manifestations, the initial pattern of pain before
diagnosis, factors leading to delayed referral to rheumatology, time until
receiving an AS diagnosis, comorbid diseases, treatment status, and disease
education needs. Results Between September and October 2019, 1012 patients with AS completed the
survey. Of these, 75.8% were men and 51.8% were in their 30s or 40s. Median
disease duration was 76 months. The median time to diagnosis with AS was 12
months. When pain occurred, the medical departments most frequently visited
first were orthopedic (61.5%) and rheumatology (18.7%) departments. The
likelihood of the first visit being to the orthopedic department and the
frequency of biologics use increased with the disease duration. The rates of
uveitis, depressed mood, and comorbid diseases were higher in the group with
delayed diagnosis. Conclusions Physicians should be aware of subtypes of AS that take longer to diagnose and
comorbid diseases in the real-world clinical setting.
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Affiliation(s)
- Jin-Wuk Hur
- Division of Rheumatology, Department of Internal Medicine, Nowon
Eulji University Hospital, Seoul, Republic of Korea
| | - Kyung Min Ko
- Division of Rheumatology, Department of Internal Medicine,
International St. Mary's Hospital, Catholic Kwandong University, Incheon,
Republic of Korea
| | - Kyung-Su Park
- Division of Rheumatology, Department of Internal Medicine, St.
Vincent’s Hospital, The Catholic University of Korea College of Medicine, Suwon,
Republic of Korea
| | - Seung-Jae Hong
- Division of Rheumatology, Department of Internal Medicine, Kyung
Hee University Medical Center, Seoul, Republic of Korea
| | - Hyun-Sook Kim
- Division of Rheumatology, Department of Internal Medicine,
Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
- Hyun-Sook Kim, Division of Rheumatology,
Department of Internal Medicine, Division of Rheumatology, Soonchunhyang Univ.
Seoul Hospital, 59 Daesagwan-ro, Yongsan-gu. Seoul 04401, Republic of Korea.
| | - Myeung-Su Lee
- Division of Rheumatology, Department of Internal Medicine,
Wonkwang University Hospital, Iksan, Republic of Korea
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15
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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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16
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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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17
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Parkinson JT, Foley ÉM, Jadon DR, Khandaker GM. Depression in patients with spondyloarthritis: prevalence, incidence, risk factors, mechanisms and management. Ther Adv Musculoskelet Dis 2020; 12:1759720X20970028. [PMID: 33224281 PMCID: PMC7649919 DOI: 10.1177/1759720x20970028] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/12/2020] [Indexed: 12/27/2022] Open
Abstract
Depression is a major neuropsychiatric disorder common in patients with rheumatological conditions including spondyloarthritis (SpA). It is associated with higher disease activity, functional impairment, poor treatment response and quality of life in patients with musculoskeletal disorders. Using ankylosing spondylitis (AS) and psoriatic arthritis (PsA) as examples, we have reviewed the evidence regarding the burden, risk factors, potential mechanisms and clinical management of depression in spondyloarthritis. The prevalence of depression is higher in patients with AS and PsA compared with the general population, with evidence of moderate/severe depression in about 15% of patients with AS or PsA. Mild depression is even more common and estimated to be present in about 40% of patients with AS. In addition to conventional risk factors such as stressful life events and socioeconomic deprivation, increased risk of depression in SpA may be associated with disease-related factors, such as disease activity, poor quality of life, fatigue, and sleep disturbances. Emerging evidence implicates inflammation in the aetiology of depression, which could also be a shared mechanism for depression and chronic inflammatory conditions such as AS and PsA. It is imperative for clinicians to actively assess and treat depression in SpA, as this could improve treatment adherence, quality of life, and overall long-term clinical and occupational outcomes. The use of validated tools can aid recognition and management of depression in rheumatology clinics. Management of depression in SpA, especially when to refer to specialist mental health services, are discussed.
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Affiliation(s)
- Joel T. Parkinson
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Herchel Smith Building for Brain and Mind Sciences, Cambridge Biomedical Campus, Robinson Way, Cambridge, Cambridgeshire CB2 0SZ, UK
| | - Éimear M. Foley
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Deepak R. Jadon
- Department of Rheumatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Department of Medicine, University of Cambridge, UK
| | - Golam M. Khandaker
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
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18
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Webers C, Stolwijk C, Schiepers O, Schoonbrood T, van Tubergen A, Landewé R, van der Heijde D, Boonen A. Infliximab treatment reduces depressive symptoms in patients with ankylosing spondylitis: an ancillary study to a randomized controlled trial (ASSERT). Arthritis Res Ther 2020; 22:225. [PMID: 32993799 PMCID: PMC7523309 DOI: 10.1186/s13075-020-02305-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 08/25/2020] [Indexed: 12/12/2022] Open
Abstract
Background Patients with ankylosing spondylitis (AS) are at increased risk of depression. This increased risk has been hypothesized to be solely secondary due to AS-related symptoms, or additionally due to a common inflammatory pathway. From a clinical perspective, it is important to know whether treatment with tumor necrosis factor alpha inhibitors reduces depressive symptoms, while from a pathophysiological point of view, it would be insightful to understand whether such an effect would be a direct result of reduced inflammation, the result of reduced AS-related symptoms, or both. The objective of this study was to evaluate the effect of infliximab on depressive symptoms in patients with AS in a randomized-controlled trial setting. Methods Data were retrieved from a subgroup of patients from the AS Study for the Evaluation of Recombinant Infliximab Therapy (ASSERT). Patients were randomly allocated to infliximab (n = 16) or placebo (n = 7) until week 24, after which all received infliximab until week 54. Associations between treatment group and depressive symptoms, measured with the Center for Epidemiological Studies Depression scale (CES-D, range 0–60 (best-worst)) at baseline and over time, were explored with generalized estimating equations (GEE). Results Mean CES-D score at baseline was 15.5 (SD 9.3) in the infliximab group and 17.3 (SD 5.7) in the placebo group. Twelve patients (52%) had a CES-D score > 16, suggestive for clinical depression. After 24 weeks, mean CES-D had decreased to 9.5 (SD 11.4) in the infliximab group, but was 18.0 (SD 6.9) in the placebo group. GEE revealed larger improvements in depressive symptoms (B = − 6.63, 95%CI − 13.35 to 0.09) and odds of possible depression (OR = 0.02, 95%CI 0.00 to 0.72) in the infliximab group, compared to the placebo group. Both associations largely disappeared when adjusted for self-reported disease activity and/or physical function. Additional adjustment for C-reactive protein (CRP) did not change results. Conclusions Depressive symptoms are common in patients with AS and active disease. Infliximab improves these depressive symptoms in AS when compared to placebo by improving disease symptoms. We did not find an indication for a direct link between CRP-mediated inflammation and depressive symptoms. Trial registration Trial registration (ASSERT): NCT00207701. Registered on September 21, 2005 (retrospectively registered).
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Affiliation(s)
- Casper Webers
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, PO Box 5800, Maastricht, 6202 AZ, The Netherlands. .,Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands.
| | - Carmen Stolwijk
- Department of Internal Medicine, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Olga Schiepers
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands
| | - Thea Schoonbrood
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, PO Box 5800, Maastricht, 6202 AZ, The Netherlands
| | - Astrid van Tubergen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, PO Box 5800, Maastricht, 6202 AZ, The Netherlands.,Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Robert Landewé
- Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology Centre, University of Amsterdam, Amsterdam, the Netherlands.,Department of Rheumatology, Zuyderland Medical Centre, Heerlen, the Netherlands
| | | | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, PO Box 5800, Maastricht, 6202 AZ, The Netherlands.,Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
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19
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Maguire S, O'Shea F. Social isolation due to the COVID-19 pandemic has led to worse outcomes in females with inflammatory arthritis. Ir J Med Sci 2020; 190:33-38. [PMID: 32656691 PMCID: PMC7354357 DOI: 10.1007/s11845-020-02307-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 07/05/2020] [Indexed: 11/30/2022]
Abstract
Background Prolonged social isolation as a result of the COVID-19 global pandemic has been a source of considerable psychological distress for many people. This can manifest in many ways and if left undetected can impact negatively on general health. It is essential to understand the impact of these conditions on inflammatory arthritis (IA) patients, especially axial spondyloarthropathy (axSpA). Aim To capture the level of psychological distress for patients with IA following prolonged social isolation. Methods A survey was sent out to patients with a confirmed diagnosis of IA. This captured changes in sleep, mood, disease activity, employment and general health since the beginning of the social isolation period. A PHQ-4 (Patient Health Questionnaire) was included to determine level of psychological distress. Results Females with IA reported significantly higher rates of decline in general health (40% vs 16%, p = 0.01), mood disturbance (43.4% vs 26%, p = 0.03) and increased disease activity (50% vs 16%, p = 0.01) compared to males. Evaluating the mean PHQ-4 scores, no significant difference was noted between genders (4.80 vs 3.44, p = 0.10). However, females demonstrated a non-significant trend toward increased rates of moderate to severe psychological distress (40% vs 30%, p = 0.13). Subanalysis of patients with axSpA found high rates of moderate to severe distress in both genders. Conclusions Females with IA reported significantly higher rates of decline in general health, mood disturbance and increased disease activity during the period of social isolation. This was reflected in a trend towards greater levels of psychological distress.
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Affiliation(s)
- Sinead Maguire
- Department of Rheumatology, St James' Hospital, Dublin, Ireland.
| | - Finbar O'Shea
- Department of Rheumatology, St James' Hospital, Dublin, Ireland
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20
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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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