Alexithymia in ankylosing spondylitis

The influence of alexithymia on disease activity and quality of life in patients with axial spondyloarthritis: A cross-sectional study

OBJECTIVE

To evaluate the prevalence of alexithymia and its influence on disease activity, quality of life, and clinical outcomes in axial spondyloarthritis (axSpA) patients.

PATIENTS AND METHODS

This cross-sectional study included 110 (59 men and 51 women) consecutive axSpA patients who agreed to participate at our rheumatology outpatient clinic. Patient demographics, pain, disease activity measures, functionality, quality of life, alexithymia, psychological status, neuropathic pain, and fibromyalgia were evaluated. Patients were divided into 2 groups (without vs with alexithymia) and compared. The risk factors for alexithymia were evaluated.

RESULTS

The prevalence of alexithymia in axSpA patients was 31.8% according to a Toronto Alexithymia Scale-20 cutoff of ≥61. The mean age and body mass index of patients were 41.25 ± 9.64 years and 27.73 ± 4.51 kg/m² , respectively. Most patients with alexithymia were women. Patients with alexithymia had significantly high scores for depression, anxiety, fibromyalgia, disease activity, enthesitis, worse quality of life, and poor functionality (all P < 0.05). Female gender (odds ratio [OR] = 22.359), patient global assessment (OR = 7.873), Bath Ankylosing Spondylitis Functional Index (OR = 1.864), and fibromyalgia symptom severity (OR = 1.303) were found to be independent risk factors for alexithymia.

CONCLUSION

The present study results showed that about one-third of axSpA patients had alexithymia, and the patients with alexithymia had higher disease activity, worse quality of life, and worse functional status than those without alexithymia. Female gender, patient global assessment, functional status, and fibromyalgia symptom severity were found to be important contributing factors to alexithymia.

Neuro-Inflammaging and Psychopathological Distress

Inflammaging is a low degree of chronic and systemic tissue inflammation associated with aging, and is intimately linked to pro-inflammatory mediators. These substances are involved in the pathogenesis of chronic inflammatory diseases and related psychopathological symptoms. When inflammation and aging affect the brain, we use the term neuro-inflammaging. In this review, we focused on the neuro-inflammatory process typical of advanced ages and the related psychopathological symptoms, with particular attention to understanding the immune-pathogenetic mechanisms involved and the potential use of immunomodulatory drugs in the control of clinical psychological signs. Inflammation and CNS were demonstrated being intimately linked in the neuro-inflammatory loop. IL-1, IL-6, TNF-a, COX and PGE are only partially responsible. BBB permeability and the consequent oxidative stress resulting from tissue damage make the rest. Some authors elaborated the "theory of cytokine-induced depression". Inflammation has a crucial role in the onset symptoms of psychopathological diseases as it is capable of altering the metabolism of biogenic monoamines involved in their pathogenesis. In recent years, NSAIDs as an adjunct therapy in the treatment of relevant psychopathological disorders associated with chronic inflammatory conditions demonstrated their efficacy. Additionally, novel molecules have been studied, such as adalimumab, infliximab, and etanercept showing antidepressant and anxiolytic promising results. However, we are only at the beginning of a new era characterized by the use of biological drugs for the treatment of inflammatory and autoimmune diseases, and this paper aims to stimulate future studies in such a direction.