Factores psicológicos en la espondilitis anquilosante. Estudio de prevalencia y factores determinantes.

Abstract

PSYCHOLOGICAL SYMPTOMS IN ANKYLOSING SPONDYLITIS. STUDY OF THEIR PREVALENCE AND DETERMINANTS <br/><br/>INTRODUCTION: In recent years the importance of psychological factors in inflammatory diseases such as rheumatoid arthritis or systemic lupus erythematosus has been recognized. However, in Ankylosing Spondylitis (AS) little attention has been paid to these factors; few studies have evaluated the presence of psychological disorders in this disease. <br/><br/>OBJECTIVE: To establish the prevalence of symptoms of anxiety and depression in patients with AS and to identify demographic, clinical, analytical, metrological and radiological data that may predict their presence.<br/><br/>PATIENTS AND METHODS: Cross-sectional study performed in 160 AS patients attended in accordance with a standard protocol. The following variables were evaluated: age, sex, marital status, educational level, employment status, time of evolution, age of onset, presence of peripheral arthritis, visual analogue scale (VAS) of pain, night pain, disease activity evaluated by patient (VAS), presence of uveitis, previous surgery, comorbidity, smoking habit, BASFI, HAQEA, BASDAI, HLA B27, ESR, RCP, modified Schober test, thoracic expansion, occiput-wall distance, radiological sacroileitis and BASRI of cervical and lumbar spine and hips. Depression was assessed with the adapted Spanish language version of Beck's Depression Inventory (BDI). Scores of 18 or above were taken as representative of depression. Anxiety was assessed by the State Trait Anxiety Inventory (STAI) including the subscales of Trait (T) and State (S). Scores of 8 or above on either subscale were considered to reflect presence of Anxiety symptoms. In the statistical study, we performed a descriptive study and an analytical study including bivariate and multivariate analyses with logistic regression models for qualitative variables and linear regression models for quantitative variables.<br/><br/>RESULTS: Symptoms of Depression were found in 23.1% of patients, State Anxiety in 23.1% and Trait Anxiety in 24.4%. BDI and STAI S and T scores were associated with pain, night pain, disease activity evaluated by the patient, BASFI, HAQEA, BASDAI and BASRI in lumbar spine. BDI scores were associated with Anxiety. STAI S scores were also associated with BDI and STAI T and STAI T scores with comorbidity, ERS, Modified Schober's test, BDI and STAI S. In Hierarchical Regression Analysis, BASFI was the only independent variable associated with Depression and Anxiety. Variables included in this analysis explained 26.4% of values for Depression, 24.4% for STAI S and 23.7% for SRAI T.<br/><br/>CONCLUSIONS: Psychological symptoms of Depression and Anxiety are frequent in patients with AS and are related fundamentally to activity and functional capacity. The functional capacity observed by BASFI is the only independent determinant of the presence of psychological symptoms. An association was found between symptoms of Depression and symptoms of Anxiety.