Background/Purpose: Background: Patients with axial spondyloarthritis (axSpA) who are more physically active experience less pain and better physical functioning. It is also known that psychological factors such as anxiety and depression are associated with physical functioning and reduction of Quality of Life (QoL). Furthermore, evasive coping strategies are commonly used in health-related coping. Our objective was to determine if coping strategies, anxiety and depression are associated with physical activity in patients with axSpA. To our knowledge this has not been studied before

Methods: Consecutive out-patients from the Groningen Leeuwarden AxSpA cohort (GLAS) participated in this study. Additionally to the standardized follow-up assessments, patients completed the axSpA-Short Questionnaire to assess health-enhancing physical activity (axSpA-SQUASH), the Coping with Rheumatic Stressors (CORS) and the Hospital Anxiety and Depression Scale (HADS). Uni- and multivariate linear regression analyses were used to explore associations of copings strategies, anxiety and depression, and patient- and disease related factors with daily physical activity. Patients were stratified into three tertiles of physical activity: low, intermediate and high. To identify group differences, Kruskal-Wallis test or the Chi-Square test were used with post-hoc testing.

Results: In total 85 patients were included; 59% were male, mean age was 49±14, median symptom duration 19.5 years (IQR 12.0-31.0), 71% were HLA-B27 positive and mean ASDAS was 2.1 (SD 1.0). Median axSpA-SQUASH total physical activity score was 9406.3 (IQR 5538.8;12081.3). Scores of HADS-Anxiety (scale 7-28) and HADS-Depression (scale 7-28) had median scores 5.0 (IQR 3.0;7.0) and of 3.0 (IQR 2.0;5.5). The mostly used coping strategies was comforting cognitions (for pain, range 9-36) median of 25.5(IQR 22.0;28.0).
Univariate analysis showed that lower daily physical activity was significantly associated with gender (female), higher disease activity (BASDAI), worse physical function (BASFI), worse quality of life (ASQoL), coping strategies “decreasing activities” and “pacing”, higher depression score (HADS). In the multivariate linear regression model the coping strategy “decreasing activities” (β: -376.4; 95%-CI: -621.9; -130.8, p-value: 0.003) and BMI (β: -235.5; 95%-CI: -450.9; -20.0, p-value: 0.03) were independently associated with physical activity. The multivariate model explained 22% of variance (R2: 0.2197, p-value: 0.001). In the group comparison similar results were seen. (Table 1)

Conclusion: In this cross-sectional study in axSpA patients with established disease, multiple patient and disease related factors were associated with daily physical activity. The evasive coping strategy “decreasing activities” and BMI were independently associated with the level of physical activity. These findings suggest that to improve daily physical activity in axSpA patients attention should be paid not only on targeting disease activity, but also to other patient and disease related aspects especially coping strategies used.

Table 1. Differences between the low, intermediate and high physical activity tertiles.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/are-coping-strategies-anxiety-and-depression-associated-with-daily-physical-activity-in-patient-with-axial-spa/