Depression Is Associated with Worse Outcomes in Axial Spondyloarthropathy Population

Gillian Fitzgerald^1,2, Phil Gallagher³, Oliver FitzGerald⁴, Killian O Rourke⁵, Claire Sheehy⁶, Catherine Sullivan⁷, Carmel Silke⁸, Frances Stafford⁹, Muhammad Haroon¹⁰, Ronan Mullan² and Finbar O' Shea¹¹, ¹Rheumatology, St James's Hospital, Dublin 8, Ireland, ²Department of Rheumatology, Tallaght Hospital, TCD, Dublin 24, Ireland, ³St. Vincent's University Hospital, Department of Rheumatology, Dublin, Ireland, ⁴St. Vincent's University Hospital, Department of Rheumatology. UCD Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland, ⁵Rheumatology, Midlands Regional Hospital, Tullamore, Co Offaly, Ireland, ⁶Rheumatology, University Hospital Waterford, Waterford, Ireland, ⁷Department of Rheumatology, Cork University Hospital, Cork, Ireland, ⁸Rheumatology, Sligo University Hospital, Sligo, Ireland, ⁹Rheumatology, Blackrock Clinic, Co Dublin, Ireland, ¹⁰Rheumatology, Kerry General Hospital, Co Kerry, Ireland, ¹¹Rheumatology, St. James’s Hospital, Dublin, Ireland, Dublin 8, Ireland

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: Axial spondyloarthritis and depression

Session Information

Date: Tuesday, November 15, 2016

Title: Spondylarthropathies and Psoriatic Arthritis – Clinical Aspects and Treatment - Poster III

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose: The association of depression with poor health outcomes in rheumatic diseases such as rheumatoid arthritis is well established. However, the impact of depression on disease outcomes in axial spondyloarthropathy (axSpA) is less well defined. The Ankylosing Spondylitis Registry of Ireland (ASRI) was established in 2013. The objectives of ASRI are to provide descriptive epidemiological data on the axSpA population in Ireland and to establish a registry for potential future studies of genetics, aetiology and therapeutics. The aim of this study is to determine the prevalence of depression in a well characterised axSpA cohort and explore relationships.

Methods: A standardised detailed clinical assessment is performed on each patient and entered in a database. Disease activity is assessed by Bath AS Disease Activity Index (BASDAI), spinal mobility by Bath AS Metrology Index (BASMI), function by the Bath AS Functional Index (BASFI) and Health Assessment Questionnaire (HAQ) and quality of life by AS Quality of Life (ASQoL). Structured interviews provide patient-reported data, including the presence of physician-diagnosed depression. Statistical analysis was performed using SPSS.

Results: As of June 2016, 564 patients have been entered into the database: 78.2% (n=441) males, mean age 47.1 (SD 12.4), mean disease duration 20.8 years (SD 12.2), mean delay to diagnosis of 8.6 years (SD 7.97), early disease (<10 years) 23.9%, 78% fulfil modified New York criteria. Mean BASDAI is 3.9 (SD2.4), BASFI 3.7 (SD2.6), BASMI 3.2 (SD 2.5), HAQ 0.55 (SD 0.52) and ASQoL 6.4 (SD 5.5). Prevalence of depression is 11.9%, with no significant difference between genders. The prevalence of depression is higher in patients with peptic ulcer disease (25.5% versus 10.6%, p=0.002), late disease (68% versus 13.5%, p=0.042) and current smokers (16.6% versus 10%, p=0.032). The mean delay to diagnosis was higher in patients with depression than without depression (10.9 ± 8.9 versus 8.3 ± 7.9 years, p=0.02). There is a trend towards a higher prevalence of depression in patients with diabetes (23.1% versus 11.3%, p=0.071). There is no association between depression and BASDAI, BASMI or BASFI. Patients with depression have higher mean ASQoL (9.7 ± 5.6 versus 5.9 ± 5.3, p<0.001) and HAQ scores (0.79 ± 0.57 versus 0.51 ± 0.51, p<0.001). In multiple regression analysis, peptic ulcer disease and ASQoL remained significantly associated with depression, with a trend towards association with current smoking.

Conclusion: Twelve percent of this axSpA population have depression. Presence of depression is associated with worse quality of life and function. However, there is no association between depression and advanced structural disease. AxSpA patients should be actively screened for depression.

Disclosure: G. Fitzgerald, None; P. Gallagher, None; O. FitzGerald, Abbott Immunology Pharmaceuticals, 2,Pfizer Inc, 2,Bristol-Myers Squibb, 2,Abbott Immunology Pharmaceuticals, 5,Pfizer Inc, 5,Bristol-Myers Squibb, 5,Celgene, 5,Janssen Pharmaceutica Product, L.P., 5,Novartis Pharmaceutical Corporation, 5,UCB Pharma, 5,Eli Lilly and Company, 5; K. O Rourke, None; C. Sheehy, None; C. Sullivan, None; C. Silke, None; F. Stafford, None; M. Haroon, None; R. Mullan, None; F. O' Shea, None.

To cite this abstract in AMA style:

Fitzgerald G, Gallagher P, FitzGerald O, O Rourke K, Sheehy C, Sullivan C, Silke C, Stafford F, Haroon M, Mullan R, O' Shea F. Depression Is Associated with Worse Outcomes in Axial Spondyloarthropathy Population [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/depression-is-associated-with-worse-outcomes-in-axial-spondyloarthropathy-population/. Accessed .

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