Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Mar 6;9(1):28.
doi: 10.1186/s41927-025-00478-y.

Impact of gastrointestinal and psychological symptoms on disease activity and functional impairment in patients with spondyloarthritis: a cross-sectional study

Ángelo Arzuaga-Hernández  1   2 , Omar-Javier Calixto  1   2   3 , Oscar Gómez  4 , Juliette De Ávila  3 , Julián Andrés Sucerquia-Quintero  5 , Juan Manuel Bello-Gualtero  1   2 , Cristian Flórez-Sarmiento  3   6 , Wilson Bautista-Molano  2   3 , Consuelo Romero-Sánchez  7   8   9
Affiliations

Impact of gastrointestinal and psychological symptoms on disease activity and functional impairment in patients with spondyloarthritis: a cross-sectional study

Ángelo Arzuaga-Hernández et al. BMC Rheumatol. .

Abstract

Introduction: Spondyloarthritis (SpA) exhibits predominantly musculoskeletal symptoms but also significant gastrointestinal (GI) and psychological manifestations. Subclinical gut inflammation is common in SpA, with frequent symptoms such as abdominal pain and diarrhea. Psychological issues like depression and anxiety are also prevalent, with a negative impact on quality of life. This study aimed to evaluate the presence of GI and psychiatric symptoms in SpA patients without inflammatory bowel disease (IBD) and their association with disease characteristics.

Methods: Cross-sectional study, which included SpA patients from two rheumatology outpatient clinics. Patients were assessed for GI, and depressive symptoms (PHQ-9), perceived stress (PSS-10), disease activity (ASDAS, BASDAI) and functionality (BASFI). Laboratory tests included C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), fecal calprotectin, and Secretory IgA. Statistical analysis involved Spearman correlation, linear regression, and multiple correspondence discriminant analysis (MCDA).

Results: Among 98 SpA patients, 79.6% had axial SpA. High disease activity and functional impairment were common. 65.3% reported ≥ 2 GI symptoms, predominantly abdominal pain and diarrhea. Depression (PHQ-9 ≥ 10) was observed in 46.7% of patients, being moderate to severe in 25.0%. Depression, perceived helplessness, and lack of self-efficacy were associated with high disease activity and GI symptoms. MCDA identified strong correlations between depression, GI symptoms, and disease activity.

Conclusion: This study highlights the association between GI and psychological symptoms with disease activity and functionality in SpA patients. Depression and perceived helplessness are prevalent and closely associated with high disease activity and GI symptoms, suggesting the need for interdisciplinary management from early stages to improve patient outcomes.

Keywords: Depression; Gastrointestinal symptoms; Mental health; Spondyloarthritis.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was designed in compliance with the Helsinki Declaration, and approved by Hospital Militar Central Institutional Ethics Committee (HMC-2017-023). The patients provided written informed consent form. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Multiple correspondence discriminant analysis. Discriminant analysis of multiple correspondence between depression (PHQ9) and disease activity (BASDAI), gastrointestinal symptoms, abdominal pain, and fatigue
See this image and copyright information in PMC

References

    1. Stolwijk C, Boonen A, van Tubergen A, Reveille JD. Epidemiology of Spondyloarthritis. Rheum Dis Clin North Am. 2012;38:441–76. 10.1016/j.rdc.2012.09.003. - PMC - PubMed
    1. Muñoz-Fernández S, de Miguel E, Cobo-Ibáñez T, et al. Early spondyloarthritis: results from the pilot registry ESPIDEP. Clin Exp Rheumatol. 2010;28:498–503. - PubMed
    1. Citera G, Bautista-Molano W, Peláez-Ballestas I, et al. Prevalence, demographics, and clinical characteristics of Latin American patients with spondyloarthritis. Adv Rheumatol. 2021;61:2. - PubMed
    1. Gracey E, Vereecke L, McGovern D, et al. Revisiting the gut–joint axis: links between gut inflammation and spondyloarthritis. Nat Rev Rheumatol. 2020;16:415–33. - PubMed
    1. Caplan L, Kuhn KA. Gastrointestinal and hepatic disease in spondyloarthritis. Rheum Dis Clin North Am. 2018;44:153–64. 10.1016/j.rdc.2017.09.004. - PubMed

LinkOut - more resources