Ab1040 characterization of anxiety and depression and their impact on disease activity, fatigue and quality of life in spondylarthritis patients treated with anti-tumor necrosis factor alpha agents

Background The psychological health of patients with spondylarthritis (SpA) influences their response to anti-tumor necrosis factor alpha (anti-TNF-α) therapy. However, little is known about the correlation between anxiety and depression symptoms and clinical outcomes over time. Objectives Hence, based on clinical practice setting, this study, aimed to explore the impact of anxiety and depression symptoms on clinical outcomes in patients with SpA treated with anti-TNF-α agents over time. Methods An observational retrospective longitudinal cohort study was conducted. Adult patients with diagnosis of SpA according to Assessment of Spondylarthritis International Society (ASAS) classification criteria, who started their first anti-TNFα agent between 2002 and 2022 were included. Sociodemographic, clinical and laboratory data were obtained from the national register Reuma.pt at the time of initiation of the first anti-TNF-α agent and after 12 months (M). Anxiety and depression symptoms were assessed by Hospital Anxiety and Depression Scale (HADS). A score ≥8 on the HADS-Anxiety and HADS-Depression indicates the presence of clinically significant anxiety and depression symptoms, respectively. Ankylosing Spondylitis (AS) Disease Activity Score with CRP (ASDAS-CRP) and Bath AS Disease Activity Index (BASDAI) were assessed to measure disease activity. Pain Visual-Analogue-Scale (VAS), Bath AS Functional Index (BASFI) and Bath AS Metrological Index (BASMI) were also collected to assess pain severity and disability. To evaluate enthesitis the Maastricht AS enthesitis score (MASES) was performed. Clinical response was evaluated by ASDAS response. Fatigue was evaluated using Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue: score ≤ 39 indicates the presence of clinically significant fatigue and health-related quality of life with EQ-5D. In order to correlate anxiety and depression with clinical outcomes, Pearson coefficient was used. Linear regression models adjusted for age, gender and disease duration were used to assess the impact of anxiety and depression symptoms on clinical outcomes. Results A total of 130 patients with SpA (mean age of 40.6±10.8 years old; 85.4% female; 74% with AS) with a median disease duration of 7 [4-14] years were included. Nearly half (50.6%) of patients had anxiety, 33.8% depression and 30% had both anxiety and depression symptoms. At the baseline, the median of anxiety and depression symptoms was 8 [4.5-12] and 6 [3-8], respectively. At the baseline, there were statistically significant correlations between anxiety and depression symptoms and pain-VAS at night (r p =0.47, p=0.03 and r p =0.6, p=0.004, respectively); between depression symptoms and BASMI (r p =-0.34, p=0.006) and between anxiety and depression symptoms and EQ-5D (r p =-0.56, p=0.04 and r p =-0.65, p=0.011, respectively). At 12M, there were statistically significant correlations between anxiety symptoms and BASDAI (r p =0.23, p=0.03), FACIT-Fatigue (r p =-0.68, p<0.001) and EQ-5D (r p =-0.51, p=0.001); and between depression (r p =-0.65, p<0.001) and EQ-5D (r p =-0.59, p<0.001). In the multivariable regression models, depression symptoms at baseline moment predicted VAS at night (β=0.6, p=0.06). At 12M anxiety symptoms predicted BASDAI (β=0.2, p=0.027), FACIT-Fatigue (β=-0.7, p<0.001) and EQ-5D (β=-0.5, p<0.002); depression symptoms also predicted EQ-5D (β=-0.6, p<0.001). Conclusion Anxiety and depression are common conditions in patients with SpA treated with anti-TNF-α agents. After 12M of treatment, anxiety and depression symptoms predicted worse quality of life and anxiety also predicted higher disease activity and fatigue. Our results encourage the assessment and monitoring of anxiety and depression symptoms over time in these patients in order to design more individualized multidisciplinary approaches. Further longitudinal research is needed to explore the impact of anti-TNF-α agents on anxiety and depression symptoms. REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests None Declared.