Background/Purpose:  There has been growing interest in anxiety sensitivity, defined as the fear of behaviors or sensations associated with the experience of anxiety, in chronic pain research. However, few studies have investigated anxiety sensitivity in the context of inflammatory arthritis. The current study aimed to understand the relationship between anxiety sensitivity and indicators of severity in inflammatory arthritis.

Methods: Data included 148 subjects (mean age = 57.7, 72% female) drawn from a prospective longitudinal Early Arthritis Cohort (symptom less than 12 months at baseline) from 2012 to 2015. Anxiety sensitivity (AS) was assessed using the validated Anxiety Sensitivity Index (ASI). Three factors were investigated: physical AS (fear of autonomic arousal and physical symptoms), cognitive AS (fear of the cognitive aspects of anxiety), and social concerns AS (fear of social consequences of anxiety). Patients completed the ASI on their annual visits. Arthritis activity indicators included patient reported visual analogue scales for pain, fatigue, and functional status (modified health assessment questionnaire; mHAQ), physician assessed global disease activity, swollen 28 joint count, tender 28 joint count, Lansbury weighted joint count, erythrocyte sedimentation rate (ESR), c-reactive protein (CRP), and composite indices (DAS28ESR-3variable, Clinical Disease Activity Index (CDAI)). Bivariate correlations first examined the cross-sectional relationship between AS factors and indicators of disease severity. Adjusted linear and logistic regressions controlling for number of visits examined the longitudinal relationship between change in AS factors on indicators of severity. Only results significant at the 0.01 level are reported to adjust for multiple comparisons.

Results: Total summed mean scores significantly differed for social AS (M = 6.96, SD = 8.43), cognitive AS (M = 2.80, SD = 4.07), and physical AS (M = 3.56, SD = 4.19). The three AS factors were significantly associated with worse pain levels (r range = 0.250-0.293), fatigue (r range = 0.312-0.403), mHAQ (r range = 0.284-0.340) and CDAI (r range = 0.200-0.272). The strongest correlations were consistently indicated for the social AS. Only social (r  = 0.211) and physical AS (r = 0.250) were significantly associated with physician assessed global functioning and social AS was the only factor associated with the Lansbury Index (r  = 0.197). There was no significant relationship between changes in AS on disease severity; however, only higher physical AS scores at baseline significantly predicted persistence indicated by DAS28ESR > 2.6 (adjusted odds ratio = 1.150, 95%CI = 1.036-1.269, p< 0.01).

Conclusion: Anxiety sensitivity is associated with several indicators of severity among those with inflammatory arthritis; unique findings emerged across factors and the social AS factor has a particularly strong association with arthritis severity indicators.

« Back to 2016 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/anxiety-sensitivity-on-indicators-of-disease-severity-among-patients-with-inflammatory-arthritis/