Background/Purpose: Spondyloarthropathies (SpA) are chronic inflammatory arthritides, characterized by both peripheral and axial skeletal involvement and some typical extra-articular marks; they tend to associate with several comorbidities and can increase the risk of an impaired working ability (WA) with a consequent impaired quality of life (QoL). The Hospital Anxiety and Depression Scale (HADS) is a reliable instrument to detect the risk of anxiety (A) and depression (D); scores higher than 8 are considered clinically relevant. This study aims at evaluating the risk of A and D in a monocentric cohort of SpA patients, analyzing possible correlations with disease activity, comorbidities, QoL and WA.

Methods: Adult patients diagnosed with Psoriatic Arthritis (PsA) and Ankylosing Spondylitis (AS) according to the Assessment of SpondyloArthritis international Society (ASAS) criteria, regularly followed at the SpA clinic of our unit, were consecutively enrolled from September 2021 to May 2022. Epidemiologic, clinic and clinimetric data were collected. Symptoms of A and D were evaluated by HADS administration. Each patient filled in the following Patient Reported Outcomes: FACIT-Fatigue (FACIT-F), SHORT-FORM 36 (SF-36) and Work Productivity and Activity Impairment (WPAI) questionnaire. Intergroups comparisons were assessed by using Chi-square, t-test and ANOVA. P values < 0.05 were considered significant.

Results: A total of 200 patients were enrolled, 115 men (57.5%), with a mean age of 56.4±17 years and a mean disease duration of 15.2±33.9 years; 135 (67.5%) had a diagnosis of PsA (M/F 79/56), while 59 (29.5%) had a diagnosis of AS (M/F 36/23). One-hundred and thirty-three patients (66.5%) were at risk for mood disorders according to the HADS score: 63 (30.6%) for A and 70 (35.2%) for D. Female sex and higher values of Ankylosing Spondylitis Disease Activity Score (ASDAS)-PCR (p< 0.009) were risk factors for the development of A, while patients more at risk for D onset had higher values of ASDAS-PCR, Disease Activity of PSoriatic Arthritis and SPondyloArthritisResearch Consortium of Canada index (p< 0.01) and had a diagnosis of fibromyalgia (FM) or osteoporosis (OP) (p≤0.04). Higher risks of developing A or D were also registered in those patients with lower values of FACIT-F (p< 0.001) and of all the domains of SF36 (p< 0.01). WPAI results showed that higher values of HADS were associated with higher values of presenteeism, work productivity loss and limitations in extra-work activities (p< 0.001).

Conclusion: These data highlight that two-thirds of patients in our cohort are at risk of developing mood disorders. A higher disease activity may associate with the onset of both A and D, female sex is associated with A while FM or OP increase the risk of D. Impaired physical and emotional domains of QoL and higher levels of work disability, tend to worsen the psychological burden of SpA patients. Therefore, a strategy of regular psychiatric screening should be planned to improve SpA patients quality of care. Moreover, aiming at reducing the risk of A or D development, rheumatologists should optimize control of disease activity and comorbidities assessment, trying to improve WA and QoL of patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/risk-of-mood-disorders-in-spa-patients-and-correlations-with-disease-activity-quality-of-life-and-working-ability-analysis-of-a-monocentric-cohort/