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Meta-Analysis
. 2018 Jul 11;20(1):140.
doi: 10.1186/s13075-018-1644-6.

The prevalence of depression in axial spondyloarthritis and its association with disease activity: a systematic review and meta-analysis

Sizheng Zhao  1   2 , Daniel Thong  2 , Natasha Miller  1 , Stephen J Duffield  1 , David M Hughes  3 , Laura Chadwick  1   2 , Nicola J Goodson  4   5
Affiliations
Meta-Analysis

The prevalence of depression in axial spondyloarthritis and its association with disease activity: a systematic review and meta-analysis

Sizheng Zhao et al. Arthritis Res Ther. .

Abstract

Background: Depression is common among patients with axial spondyloarthritis (axSpA), but reports of its prevalence are highly variable. We performed a systematic review to (i) describe the prevalence of depression in axSpA, (ii) compare its prevalence between axSpA, ankylosing spondylitis (AS) and non-radiographic axSpA (nr-axSpA) cohorts, and (iii) compare disease activity and functional impairment between those with and without depression.

Methods: We searched Medline, PubMed, Web of Science, PsycINFO, CINAHL Plus, the Cochrane library and conference abstracts of the European League Against Rheumatism, British Society for Rheumatology and American College of Rheumatology using a predefined protocol in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Meta-analysis was performed using quality-effects model.

Results: Fifteen original articles and one abstract were included for analysis; 14 studies described AS cohorts and two nr-axSpA. Three screening criteria and one diagnostic criterion were used to define depression. Prevalence ranged from 11 to 64% depending on criteria and thresholds used. Pooled prevalence of at least moderate depression was 15% using the Hospital Anxiety and Depression Scale (HADS) threshold of ≥ 11. The prevalence of depression was similar between axSpA, AS and nr-axSpA cohorts. Patients with depression had significantly worse disease activity, including higher BASDAI by 1.4 units (95% CI 1.0 to 1.9), ASDAS by 0.5 units (95% CI 0.3 to 0.7) and ESR by 3.5 mm/h (95% CI 0.6 to 6.4). They also had greater functional impairment with higher BASFI and BASMI by 1.2 units (95% CI 0.6 to 1.8) and 0.6 units (95% CI 0.3 to 0.8), respectively. Mean age of each study cohort inversely correlated with depression prevalence.

Conclusions: Depression is common among axSpA patients and is associated with more severe disease activity and functional impairment. Identifying and managing depression should form part of their holistic care. Further longitudinal studies are needed to explore the impact of depression on treatment outcomes and axSpA treatment on symptoms of depression.

Keywords: Ankylosing spondylitis; Axial spondyloarthritis; Comorbidity; Depression; Disease activity; Functional impairment; Mental health; Meta-analysis; Prevalence.

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Figures

Fig. 1
Fig. 1
Pooled prevalence of depression in axSpA cohorts, grouped by criteria and threshold
Fig. 2
Fig. 2
Measures of disease activity and functional impairment are worse in axial spondyloarthritis patients with comorbid depression. Effect sizes shown as weighted mean difference (WMD)
See this image and copyright information in PMC

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References

    1. van der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum. 1984;27(4):361–368. doi: 10.1002/art.1780270401. - DOI - PubMed
    1. Rudwaleit M, Jurik AG, Hermann KG, Landewe R, van der Heijde D, Baraliakos X, et al. Defining active sacroiliitis on magnetic resonance imaging (MRI) for classification of axial spondyloarthritis: a consensual approach by the ASAS/OMERACT MRI group. Ann Rheum Dis. 2009;68(10):1520–1527. doi: 10.1136/ard.2009.110767. - DOI - PubMed
    1. van Tubergen A, Weber U. Diagnosis and classification in spondyloarthritis: identifying a chameleon. Nat Rev Rheumatol. 2012;8(5):253–261. doi: 10.1038/nrrheum.2012.33. - DOI - PubMed
    1. Martindale J, Shukla R, Goodacre J. The impact of ankylosing spondylitis/axial spondyloarthritis on work productivity. Best Pract Res Clin Rheumatol. 2015;29(3):512–523. doi: 10.1016/j.berh.2015.04.002. - DOI - PubMed
    1. Bair MJ, Robinson RL, Katon W, Kroenke K. Depression and pain comorbidity: a literature review. Arch Intern Med. 2003;163(20):2433–2445. doi: 10.1001/archinte.163.20.2433. - DOI - PubMed