Prevalence of Depression in Patients with Spondyloarthritis and Its Impact on Disease Activity: A Cross-Sectional Study
Depression in Patients with Spondyloarthritis and Its Impact on Disease Activity
DOI:
https://doi.org/10.54393/pjhs.v7i5.3923Keywords:
Spondyloarthritis, Depression, Disease Activity, PHQ-9Abstract
Spondyloarthritis refers to a chronic inflammatory rheumatic disorder that is characterized by pain, disability, and poor quality of life, potentially predisposing the affected patients to psychological comorbidity, including depression. Depression can hurt disease activity, treatment response, and clinical outcomes, but the burden has not been well acknowledged in clinical practice among patients with spondyloarthritis. Objective: To find the prevalence of depression in patients with spondyloarthritis (SpA) and to identify the association of depression with disease activity. Methods: A cross-sectional study was carried out in the Department of Rheumatology, Lady Reading Hospital, Peshawar, Pakistan. Adult patients who had verifiable cases of SpA were recruited in the study in six-month consecutive intervals between 1st February and 31st July 2025. Depression status was used to stratify the participants, and pertinent statistical tests were used to evaluate associations of normally and non-normally distributed variables. Independent t-test, Mann-Whitney U, and chi-square tests were used. Any p-value less than 0.050 was taken as statistically significant. Results: The prevalence of depressive symptoms in 323 spondyloarthritis patients was 51.1% with mild and moderate depression. Disease activity (BASDAI), inflammatory markers (ESR, CRP), and disease duration of depressed patients were considerably higher than those of non-depressed patients (p<0.050). Conclusions: Depression is very common among patients living with spondyloarthritis and is characterized by higher disease activity, systemic inflammation, and longer duration of disease, thereby supporting the importance of screening mental health during clinical care.
References
Ivanova M, Zimba O, Dimitrov I, Angelov AK, Georgiev T. Axial Spondyloarthritis: An Overview of the Disease. Rheumatology International. 2024 Sep; 44(9): 1607-19. doi: 10.1007/s00296-024-05601-9.
Hušáková M, Levitová A, Domluvilová D, Dad’ová K, Pavelka K. Depression and Anxiety in Individuals with Axial Spondyloarthritis and Nonspecific Low Back Pain Who Are Interested in Non-Pharmacological Therapy Options: Cross-Sectional Study. Medicine. 2022 Sep; 101(39): e30866. doi: 10.1097/MD.0000000000030866.
Chimenti MS, Fonti GL, Conigliaro P, Triggianese P, Bianciardi E, Coviello M et al. The Burden of Depressive Disorders in Musculoskeletal Diseases: Is There an Association Between Mood and Inflammation? Annals of General Psychiatry. 2021 Jan; 20(1): 1. doi: 10.1186/s12991-020-00322-2.
Chung DX, Loo YE, Kwan YH, Phang JK, Woon TH, Goh WR et al. Association of Anxiety, Depression and Resilience with Overall Health and Functioning in Axial Spondyloarthritis (Axspa): A Cross-Sectional Study. British Medical Journal Open. 2023 May; 13(5): e071944. doi: 10.1136/bmjopen-2023-071944.
Vestergaard SB, Esbensen BA, Klausen JM, Glintborg B, Lau L, Yilmaz Jantzen C et al. Prevalence of Anxiety and Depression and the Association with Self-Management Behaviour in> 12 000 Patients with Inflammatory Rheumatic Disease: A Cross-Sectional Nationwide Study. Rheumatic and Musculoskeletal Diseases Open. 2024 Jan; 10(1): e003412. doi: 10.1136/rmdopen-2023-003412.
Kuszmiersz P, Guła Z, Haugeberg G, Korkosz M. AB0896 the Hidden Burden: High Prevalence of Low Mood Despite Low Rates of Diagnosed Depression Among Patients with Spondyloarthritis. Annals of the Rheumatic Diseases. 2024 Jun; 83: 1753. doi: 10.1136/annrheumdis-2024-eular.5391.
Reich A, Weiß A, Lindner L, Zinke S, Stille C, Detert J et al. Effect of Depressive Symptoms on Treatment Response in Patients with axSpA: Data from the RABBIT-SpA register. Rheumatic and Musculoskeletal Diseases Open. 2025 May; 11(2). doi: 10.1136/rmdopen-2025-005422.
Zhao SS, Webers C, Nikiphorou E, Van der Heijde D, Braun J, Kiltz U et al. Disease Activity and Mental Health Symptoms in Axial Spondyloarthritis: Concordant or Discordant? Rheumatology. 2026 Jan; 65(1): keaf506. doi: 10.1093/rheumatology/keaf506.
Bixio R, Bonetto C, Fracassi E, Ristic B, Mastropaolo F, Pacenza G et al. Depression as a Possible Determinant of Fatigue in Patients with Axial Spondyloarthritis. Clinical and Experimental Rheumatology. 2024 Jan. doi: 10.55563/clinexprheumatol/d4cq48.
Wang X, Wu L, Liu J, Ma C, Liu J, Zhang Q. The Neuroimmune Mechanism of Pain-Induced Depression in Psoriatic Arthritis and Future Directions. Biomedicine and Pharmacotherapy. 2025 Jan; 182: 117802. doi: 10.1016/j.biopha.2024.117802.
Yang K, Gong Y, Geng Z, Xu X, Yan S, Zhang H et al. Correlates of Depression, Anxiety, and Stress among Patients with Ankylosing Spondylitis. Advances in Rheumatology. 2025 Mar; 65(1): 14. doi: 10.1186/s42358-025-00439-6.
Niazi Y, Moazzam M, Asif MF, Farooq SM. Prevalence and Epidemiology of Depression Symptoms among Pakistani Students: A Systematic Review and Meta-Analysis (2000-2025). Cambridge Prisms: Global Mental Health. 2025 Dec: 1-41. doi: 10.1017/gmh.2025.10125.pr8.
Parkinson JT, Foley ÉM, Jadon DR, Khandaker GM. Depression in Patients with Spondyloarthritis: Prevalence, Incidence, Risk Factors, Mechanisms, and Management. Therapeutic Advances in Musculoskeletal Disease. 2020 Oct; 12: 1759720X20970028. doi: 10.1177/1759720X20970028.
Georgiadis S, Ørnbjerg LM, Michelsen B, Kvien TK, Shoae Kazemi M, Závada J et al. Defining Bath Ankylosing Spondylitis Disease Activity Index Cut‐off Values for Disease Activity States in a Multinational European Cohort of Patients with Axial Spondyloarthritis. American College of Rheumatology: Open Rheumatology. 2025 Dec; 7(12): e70125. doi: 10.1002/acr2.70125.
Fonseca-Pedrero E, Díez-Gómez A, Pérez-Albéniz A, Al-Halabí S, Lucas-Molina B, Debbané M. Youth Screening Depression: Validation of the Patient Health Questionnaire-9 (PHQ-9) in a Representative Sample of Adolescents. Psychiatry Research. 2023 Oct; 328: 115486. doi: 10.1016/j.psychres.2023.115486.
Arzuaga-Hernández Á, Calixto OJ, Gómez O, Ávila JD, Sucerquia-Quintero JA, Bello-Gualtero JM et al. Impact of Gastrointestinal and Psychological Symptoms on Disease Activity and Functional Impairment in Patients with Spondyloarthritis: A Cross-Sectional Study. BioMed Central Rheumatology. 2025 Mar; 9(1): 28. doi: 10.1186/s41927-025-00478-y.
Reddy KN, Sabu N, Pandey N, Raut A, Joag K, Patil P. Anxiety and Depression Among Patients with Axial Spondyloarthritis. European Journal of Rheumatology. 2021 Nov; 9(1): 8. doi: 10.5152/eurjrheum.2021.21022.
Islam MN, Abed SA, Tarafder S, Ahmedullah AK, Rasker JJ, Methun MI. Are TNF-α and IL-1β Independently Associated with Depression in Axial Spondyloarthritis Patients? A Case-Control Study. Rheumatism. 2024 Jan; 4(1): 19-32. doi: 10.3390/rheumato4010003.
Garrido-Cumbrera M, Navarro-Compán V, Poddubnyy D, Sommerfleck F, Makri S, Correa-Fernández J et al. Factors Associated with Poor Mental Health in Patients with Axial Spondyloarthritis: Results from the International Map of Axial Spondyloarthritis (IMAS). Rheumatic and Musculoskeletal Diseases Open. 2024 Jun; 10(2). doi: 10.1136/rmdopen-2024-004218.
Cortés-Rodríguez A, Alves-Gomes L, Losa-Iglesias M, Gómez-Salgado J, Becerro-de-Bengoa-Vallejo R, Saavedra-García MÁ et al. Effects of Depression on Patients Suffering from Ankylosing Spondylitis: A Comparative Study. São Paulo Medical Journal. 2025 Apr; 143: e2024177. doi: 10.1590/1516-3180.2024.0177.r1.16102024.
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