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TOPLINE:

Patients with axial spondyloarthritis (axSpA) and moderate to severe depressive symptoms were less likely to achieve low disease activity (LDA) and inactive disease following the initiation of systemic therapy than those with axSpA but with mild or no depressive symptoms, according to an analysis of data from the register.

METHODOLOGY:

• Researchers conducted an analysis using data from the longitudinal, observational register (RABBIT-SpA) to evaluate the effect of depressive symptoms on treatment outcomes, specifically the achievement of inactive disease and LDA, in patients with axSpA.
• They included 1755 patients with axSpA (mean age, 44.1 years; 44% women) who initiated a new systemic therapy (disease-modifying antirheumatic drugs or non-steroidal anti-inflammatory drugs) between May 2017 and March 2024.
• The assessment of depressive symptoms was conducted using the five-item World Health Organization (WHO-5) Well-Being Index, with scores below 29 indicating moderate to severe symptoms.
• The treatment outcomes — LDA and inactive disease — were evaluated on the basis of the Axial Spondyloarthritis Disease Activity Score with C-reactive protein (ASDAS-CRP) after 3 and 6 months.

TAKEAWAY:

• Overall, 29% of patients exhibited moderate to severe depressive symptoms and had higher ASDAS-CRP scores and more comorbidities than those exhibiting mild or no depressive symptoms.
• Patients with moderate to severe depressive symptoms achieved LDA (41% vs 62% at 3 months; 44% vs 65% at 6 months) and inactive disease (20% vs 32% at 3 months; 19% vs 35% at 6 months) less frequently than those with mild or no depressive symptoms.
• Higher WHO-5 Well-Being Index scores were associated with increased odds of achieving LDA and inactive disease at both 3 and 6 months.

IN PRACTICE:

"[The study finding] highlights the need to integrate more objective measures of disease activity in axSpA and carefully consider the role of comorbidities like depression in interpreting PROs [patient-reported outcomes] and guiding clinical decisions," the authors wrote.

SOURCE:

This study was led by Andreas Reich, German Rheumatology Research Center (DRFZ Berlin), Berlin, Germany. It was published online on May 08, 2025, in RMD Open.

LIMITATIONS:

This study lacked a formal diagnosis of depression and robust objective parameters for evaluating disease activity in axSpA; the heavy reliance on patient-reported outcomes was also an important limitation.

DISCLOSURES:

RABBIT-SpA was supported by a joint, unconditional grant from AbbVie, Amgen, Biocon, Biogen, Celltrion, Hexal, Janssen-Cilag, Lilly, MSD, Novartis, Pfizer, and UCB. Two authors reported having financial ties with several pharmaceutical organisations, and others reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.