Background:Anxiety and depression are most common psychiatric disorders in chronic inflammatory rheumatic condition as well as axial spondyloarthritis (axSpA) (1). The prevalence of depression has been reported as 11-64% depending on the criteria used. Also self-reported depression and anxiety were found to be associated with disease activity and function in axSpA (1,2). It is observed that mental health is affected among healthy subjects during the COVID-19 pandemic, but this condition has not been systematically reviewed in axSpA patients.Objectives:We aimed to compare frequency of self-reported depression and anxiety before and during the Covid-19 pandemic in patients with axSpA.Methods:Seventy-six axSpA patients who were evaluated for the presence of depression and anxiety by using Hospital Anxiety and Depression scale (HADs) before pandemic were included in this study. All participants were classified according to the ASAS axSpA classification criteria. Patients were contacted by phone to participate and complete the HADS questionnaire. Demographic and disease related characteristics including BASDAI, BASFI and Patient Acceptable Symptom State (PASS) were recorded during interview. The HADs cut off value was taken as >7 in both groups to define the presence of anxiety or depression. Before and during pandemic period anxiety and depression scores were statistically compared.Results:The demographic and disease related characteristics of axSpA patients with and without anxiety/depression were summarized in Table 1. The frequency of anxiety (43.4% vs %43.4; p>0.05) and depression (46.1% vs 44.7%; p>0.05) were found to be similar before and during pandemic period. Patients with anxiety (HADs>7) and depression (HADs>7) had higher BASDAI and BASFI scores and much less PASS positivity (Table 1). Although the frequency of depression was similar between before and during the pandemic period, symptom severity in depression was slightly increased during the pandemic (Figure 1).Table 1.Patients’ demographics and characteristics according to the presence of anxiety and depressionVariablesPresence of depressionn:35Absence of depressionn:41PPresence of anxiety n:33Absence of anxiety n:43PAge (years) mean ± SD41.8±11.244.1±9.3>0.0542.0±10.943.6±10.0>0.05Male n(%)21(60.0)26(63.4)>0.0518(54.5)29(67.4)>0.05Education time (years) mean ± SD9.6±4.811.0±4.2>0.059.7±5.010.6±4.1>0.05Current smoker n(%)18(51.4)15(36.6)>0.0515(45.5)18(41.9)>0.05Alcohol consumption n(%)12(34.3)12(29.3)>0.0510(30.3)14(32.6)>0.05Current BMI kg/m2 mean ± SD26.0±4.826.8±4.5>0.0526.4±5.026.5±4.3>0.05Sleep time (hours) mean ± SD7.6±1.77.6±1.3>0.057.5±1.67.7±1.4>0.05Current BASDAI mean ± SD2.5±1.61.4±1.6<0.052.7±1.81.3±1.3<0.001Current BASFI mean ± SD2.4±2.11.1±1.3<0.052.4±2.01.2±1.4<0.05PASS positivity n(%)16(45.7)29(70.7)<0.0514(42.4)31(72.1)<0.05Current depression and anxiety scores were correlated with disease activity (HADs Depression vs BASDAI r:0.530, p<0.001; HADs Anxiety vs BASDAI r:0.500, p<0.001) and function (HADs-Depression vs BASFI r:0.519, p<0.001; HADs-Anxiety vs BASFI r:0.391, p<0.001). These relationships were also observed in the pre-pandemic period (HADs-Depression vs BASFI r:0.326, p<0.05; HADs-Anxiety vs BASDAI r:0.342, p<0.05).Conclusion:Depression and anxiety symptoms seems to be comparable before and after the COVID-19 pandemic. Regardless of this period, the presence of both depression and anxiety are associated with disease activity, function and less patient acceptable symptom state.References:[1]Zhao S, Thong D, Miller N, et al. The prevalence of depression in axial spondyloarthritis and its association with disease activity: a systematic review and meta-analysis. Arthritis Res Ther. 2018;20:140.[2]Barişan E, Bayir D, Solmaz D. Aksiyel spondiloartrit hastalarinda anksiyete düzeyinin çeşitli ölçeklerle değerlendirilmesi ve anksiyete ile ilişkili faktörler. Dokuz Eylül Üniversitesi Tip Fakültesi Dergisi. 2019; 129-137.Figure 1.Disclosure of Interests:None declared
Background:On March 11, 2020, the World Health Organization declared coronavirus disease 2019 (COVID-19) as a pandemic, and mandatory quarantine was applied in Turkey between April and June 2020. With this sanction, sudden changes occurred in a routine lifestyle.Objectives:This study aimed at evaluating physical activity changes, presence of anxiety and depression, altered eating habits and their relationship with disease activity in axial spondyloarthritis (AxSpA) patients during the quarantine period.Methods:AxSpA patients, who were examined in the rheumatology clinic in the last year before the pandemic period and their relatives were included in this study and were contacted by phone to participate. A structured questionnaire form was performed which included the following data: questions about demographic characteristics, medication use, disease activity scales; BASDAI, BASFI, Patient acceptable symptom state (PASS), patient-reported physical activity state, Short Questionnaire to Assess Health enhancing physical activity (SQUASH), Three-Factor Eating Questionnaire (TFEQ-21), and Hospital Anxiety and Depression Scale (HADs).Results:204 AxSpA patients and 106 patients’ relatives were contacted in the study (Figure 1). The frequency of male sex and alcohol consumption was higher in the AxSpA compared to the relatives and, other demographic features were summarized in Table 1. 30% of AxSpA patients and 37% of patient relatives were gained weight with mean 4.5±2.4 and 4.4±3.4 kilograms, respectively. Weight gain were similar male and female in AxSpA (26.2% vs 37.2%, p>0.05). However, the men in the AxSpA group gained more weight than relatives group (26.2% vs 7%, p<0.05). Weight gain group had decreased physical activity than stable group in AxSpA patients (54.8% vs 37.8%, p<0.05). We showed mild negative correlation between BASDAI and BASFI scores with SQUASH- total activity score (r:-0.15, p<0.05; r:-0.25, p<0.001, respectively). Anxiety prevalence were found slightly higher in patients group but not significantly (40.2% vs 32.1%; p>0.05). Depression were much higher in AxSpA group than relatives (43.6% vs 28%, p<0.001). Depression and anxiety were correlated with disease activity (HADs Depression vs BASDAI r:0.380, p<0.001; HADs Anxiety vs BASDAI r:0.418, p<0.001) and function (HADs Depression vs BASFI r:0.342, p<0.001; HADs Anxiety vs BASFI r:0.313, p<0.001). Among eating habits, uncontrolled and emotional eating scores were showed low correlation with anxiety (r:0.169, p<0.05; r:0.163, p<0.05, respectively).Conclusion:One third of our patients were weight gain and approximately half of them had decreased physical activity but we did not show relation between these parameters and disease related factors in the limited period. In addition to that depression and anxiety were detected significant part of AxSpA patients and both of them were correlated with disease activity.Table 1.Study Population CharacteristicsAxSpa n:204 Controls n:106 p valueAge (years) mean ± SD43.1±11.440.6±12.6>0.05Male n(%)125(61.3)26(24.5)<0.001Education time (years) mean ± SD9.8±4.39.7±4.0>0.05Current smoker n(%)77(37.7)31(29.2)>0.05Alcohol consumption n(%)60(29.4)9(8.5)<0.001Current BMI kg/m2 mean ± SD26.8±4.626.5±4.7>0.05Weight gain group n(%)62 (30.4)40(37.7)>0.05Weight stable group n(%)142 (69.6)66(62.3)Current BASDAI mean ± SD1.8±1.5N/ACurrent BASFI mean ± SD1.5±1.8N/APatients treated with biologic drugs n(%)118(57.8)N/APatients treated with conventional drugs n(%)84(41.1)N/APresence of Anxiety n(%)82(40.2)34(32.1)>0.05Presence of Depression n(%)89(43.6)30(28.0)<0.001TFEQ-R21emotional eating mean ± SD5.2±3.15.6±2.7<0.05TFEQ-R21uncontrolled eating mean ± SD14.7±6.317.5±5.4<0.001TFEQ-R21cognitive restraint mean ± SD14.3±4.315±4.2>0.05Stable physical activity n(%)117(57.4)49(46.2)>0.05Decreased physical activity n(%)87(42.6)57(53.8)Acknowledgements:Special thanks to our clinical nurse Alev Vayni for her devoted assistance in interviewing patients to fill out the questionaire.Disclosure of Interests:None declared.
Background:Non-steroidal anti-inflammatory drugs (NSAIDs) is the first line treatment option in axial spondyloarthritis (axSpA) patients suffering from pain and stiffness. However there is only limited data regarding the concomitant use of NSAIDs during tumour necrosis factor inhibitor (TNFi) treatment.Objectives:To evaluate longitudinal concomitant NSAIDs use with the TNFi treatment and the determinant of the ASAS-NSAID index in patients with axSpA.Methods:In total 429 axSpA patients (253 [59%] male; 272 [63%] with AS and 157 [37%] with non-radiographic (nr)-axSpA) who have followed up one year were included in this observational study. The data regarding disease activity and serum CRP levels were collected on 12, 24 and 52nd week. At each visit NSAID usage, type, dosage and frequency were recorded in order to calculate ASAS-NSAID index. The longitudinal relationship between NSAID-index and other factors tested by using generalized estimating equations (GEE) which is a technique for longitudinal data analysis allowing the use of all available data even deviated from normality.Results:At baseline 127/138 (92%) patients starting TNFi and 239/291 (82%) conventionally treated patients were using NSAID. Both the rate (p=0.007) and the median (IQR) ASAS-NSAID index were higher in biologic treatment group (100 [50] vs 70.8 [89.4]; p<0.001). During follow-up ASAS-NSAID index was decreased significantly in patients treated with TNFi (median 100 to 8.0;p<0.001), however ASAS-NSAID index was not changed in conventionally treated patients (p=0.154) (Figure 1). In univariate longitudinal analysis revealed that ASAS-NSAID index was significantly associated with BASDAI, ASDAS, BASFI scores and patient global assessment of disease activity, serum levels of CRP and education. We established two multivariable models (Table 1) to assess the associated factors/covariates with ASAS-NSAID index over time (one with ASDAS and the other BASDAI+CRP as disease activity index) and showed that BASDAI and patient global assessment of disease activity were independent determinants of NSAID dosage in biologic treated patients. However, in multivariate analysis there was no significant predictor for NSAID index in conventional treatment group.Conclusion:Our results showed that NSAID prescription was significantly higher in axSpA patients who have TNFi indication. NSAID use was decreased significantly over time with TNFi and still independently determined by disease activity. However, it is stable in conventionally treated axSpA patients.Table 1.The factors associated with ASAS-NSAII index in biologic treated patientsModel 1Model 2B95%CIpB95% CIpBASFI-0.55-4.384; 4.2750.9800.943-3.795; 5.6820.696BASMI0.951-1.511; 3.4130.449-0.098-2.430; 2.2340.934PGA0.5350.210; 0.8600.0010.7590.432; 1.0860.000CRP-0.068-0.220; 0.0840.380BASDAI5.7182.487; 8.9490.001ASDAS-CRP1.771-6.571; 10.1130.677PGA:Patient global assessmentDisclosure of Interests:None declared
BackgroundChronic inflammation in inflammatory arthritis can trigger both peripheral and central sensitization (CS) through central modifications of pain pathways. CS is an abnormal pain management mechanism involving the central nervous system.ObjectivesTo evaluate the frequency of CS and neuropathic pain (NP) in patients with psoriatic arthritis (PsA) and its relationship with disease activity and functional status.MethodsPatients classified as PsA according to CASPAR classification criteria were included in this cross-sectional study. Disease activity was evaluated with DAPSA, VAS, pain and fatigue level (0-100 mm), quality of life with HAQ, CS with CS inventory (CSI). A score of 40 point was used to predict the presence of CS. CS score of <30 was also categorized as subclinical, 30 -39 as mild, 40-49 as moderate, 50-59 as severe and ≥60 as extreme. NP was evaluated with the DN4 (Douleur Neuropathique en 4 questions) scale. The presence of anxiety and depression were evaluated by using the Hospital Anxiety and Depression questionnaire (HADS) and fibromyalgia syndrome (FMS) by ACR 2016 criteria.Resultsİn total 114 PsA patients (78 [68.4%] female, mean age: 48.8 ±11.6 years, median disease duration was 4 [9] years) were included in the study. The median DAPSA score was 15.2(16), with approximately half of the patients were in remission or low disease activity. The proportion of patients with LEI≥1 was 28.9%, median BSA was 1(2), BASDAI was 3.8(3.6), BASFI was 2[4]. Of our patients 39.8% were receiving biological treatment. 61.4% of the patients had at least one comorbidity.CS was detected in 49 (42.9%) and NP in 24 (23.7%) patients. The median CSI score was 35.5 (IQR 29) Among patients with CS and NP the percentage of female was higher. DAPSA, PGA, PhGA, Pain VAS, TJC were found to be significantly higher and HAQ scores were found to be worse in patients with CS and NP. In addition,the percentage of patients with a LEI ≥1 was found 44.9% in patients with CS, and body mass index was found to be higher in patients with NP(Table 1).Duration of disease, CRP, ESR, BSA, usage of biological therapy, treatment with GCs, comorbidities were similar between the groups. Anxiety were higher in patient with CS and NP, and depression was higher in only CS patients. While all 11 patients with FMS had NP, only 8 had CS. Sixteen (%32.7) patients with CS also had NP and 16 (66.7%) patients with NP had also CS. The positive correlation between PGA, PhGA, DAPSA, HAQ and CS severity in PsA patients(Figure 1).ConclusionThe results of the present study revealed that both CS and NP are common in PsA, and FMS accompanies 22.4% of those patients. CS and NP affect quality of life and functionality. In PsA patients, especially in cases where treatment goals cannot be achieved, it may be useful to evaluate the presence of concomitant CS and NP.Table 1.Comparison of characteristics of PsA patients with and without central sensitization and neuropathic painVariablesPatient withCSn:49Patient withoutCSn:65pPatientwithNPn:24Patient withoutNPn:77pFemale gender,n(%)38(81.6)40(58.5)0.00819(90.5)45(60)0.009Age,y,mean(SD)51(11)47.7(11)0.43950.1(10)48.2(11.6)0.487BMI,kg/m2, median(IQR)29.3(8)28.2(7.7)0.74932.3(9.6)26.9(5.9)0.011TJC, median(IQR)2(4)0(1)0.0031(11)0(2)0.021SJC, median(IQR)0(0)0(0)0.9960(0)0(0)0.533PGA, median(IQR)50(48)30(20)<0.00160(60)30(25)<0.001PhGA, median(IQR)20(30)20(10)0.00130(20)20(20)0.001Pain VAS, median(IQR)50(38)20(30)<0.00160(60)30(50)<0.001LEI≥1,n(%)22(44.9)11(16.9)0.00110(41.7)19(24.4)0.100DAPSA, n(%)17.9(11)9.7(11.9)<0.00120.2(13)11.7(11)0.003Biological therapy, n(%)18(37.5)27(41.5)0.71210(41.7)27(35.1)0.558HAQ,median(IQR)1(0.85)0.38(0.75)<0.0011.38(1.3)0.5(0.8)<0.001Anxiety, n(%)18(40)5(8.1)<0.0019(40.9)12(16.2)0.020Depression, n(%)15(33.3)4(6.5)<0.0015(22.7)11(14.9)0.514FMS, n(%)13(35.6)8(12.9)0.00611(45.8)10(13)0.001Figure 1.The positive correlation between PGA, PhGA, DAPSA, HAQ and CS severity in PsA patientsREFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNone Declared.
BackgroundRheumatoid arthritis (RA) is a chronic inflammatory disease in which, for many reasons of the nature of the disease, patients tend to perform less physical activity (PA) than recommended in the guidelines (1). Many variables associated with a level of PA in patients have been described (2). However, there are limited studies about related factors with PA in RA patients.ObjectivesTo investigate the relationship between PA level and exercise self-efficacy, body awareness, and fatigue severity in RA patients.MethodsA total of 80 RA patients (women/men=61/19, age=56.83±11.56 years) who were diagnosed according to the ACR 2010 criteria and followed in university outpatient clinic were included in our study. All patients were assessed regarding physical characteristics (age, body-mass index), exercise status (yes/no), and occupational status (working/not working/retired). Physical activity level by International Physical Activity Questionnaire, exercise self-efficacy by Exercise Self-Efficacy Scale, body awareness by Body Awareness Questionnaire, and fatigue by Bristol Rheumatoid Arthritis Multidimensional Scale was assessed.ResultsPatients’ characteristics are presented in Table 1. It was observed that patients have low PA levels. Significant correlation was found between PA and exercise self-efficacy (r=0.410, p<0.001), body awareness (r=0.374, p=0.001), and fatigue (r=-0.482, p<0.001).Table 1.The characteristics of patientsMean ± SD, median (25/75 quartiles) or n (%)Age, years56.83 ±11.56Body mass index, kg/m227.84 ±5.57Time of diagnosis, years11.49 ±10.92Exercise status Yes53 (66.3) No27 (33.8)Occupational status Working16 (20.0) Not working30 (37.5) Retired34 (,42.5)IPAQ Walking, MET-min/week371 (198/693) Moderate, MET-min/week270 (0/840) Vigorous, MET-min/week0 (0/0) Total, MET-min/week693 (268/ 1533)IPAQ sub-group Inactive55 (68.8) Minimal Active19 (23.8) Very Active6 (7.4)Exercise self-efficacy score, 0-1800646.62 ±339.40Body awareness score, 18-12684.77 ±16.41Bristol rheumatoid arthritis multidimentional fatigue score, 0-7019.06 ±12.83IPAQ: International Physical Activity Questionnaire.ConclusionOur study showed that RA patients had low PA and PA was related to exercise self-efficacy and fatigue moderately and body awareness weakly. We think that it may be important to assess these variables and to plan interventions to improve these variables while planning PA programs of the patients.References[1]Tierney M, Fraser A, Kennedy N. Physical activity in rheumatoid arthritis: a systematic review. J Phys Act Health. 2012;9(7): 1036–48.[2]Hernández-Hernández, M. V., & Díaz-González, F. (2017). Role of physical activity in the management and assessment of rheumatoid arthritis patients. Reumatologia clinica, 13(4), 214–220.Disclosure of InterestsNone declared
BackgroundPolymyalgia Rheumatica (PMR) is an inflammatory disease which does not have specific diagnostic tests or pathological symptoms and is defined with clinical characteristics. Among the acute phase reactants (APR), erythrocyte sedimentation rate (ESR) and C-Reactive Protein (CRP) are laboratory findings used in the diagnosis and follow-up. Although abnormal ESR and CRP levels are included in the criteria for the classification of PMR, ESR and CRP can be observed as normal in 13% of PMR patients.ObjectivesIn the study, it was aimed to determine the incidence of normal APR rates in patients diagnosed with PMR and to identify the distinguishing characteristics of these patients.MethodsPMR patients who were clinically diagnosed at a single center were reviewed. After the presence of bursitis was demonstrated with ultrasonography (USG) in patients with normal ESR and CRP rates, they were accepted to have PMR. Patients with normal rates of ESR and CRP were compared against patients with high levels of ESR and/or CRP.ResultsIn all 54 patients who were diagnosed with PMR (63% female, and mean age 65.39±7.39 years), >45 minute morning stiffness was present. Symptom duration median (IQR) was 3.5 (3) months, and ESR and CRP were found to be high in 72.2% and 83.3% of the patients, respectively. ESR and CRP were normal in 8 patients (14%), and serum amyloid A (SAA) was determined to be high in all these patients. At the time of the diagnosis, 51 patients (94%) had shoulder pain, and 41 patients (75%) suffered from hip pain. At the time of the diagnosis, median (IQR) ESR was found as 59.5 (49) mm/hour and CRP as 16.25 (38) mg/L. In 20 patients, SAA median (IQR) was 36 (26) U/L. The initial median (IQR) steroid dosage at the beginning of the treatment was prednisolone 20 mg/day. As steroid sparing therapy, methotrexate was started in 27 patients, and azathioprine was started in 4 patients.In the group with normal levels of ESR and CRP, diagnosis median (IQR) ESR was 28 (4) mm/hour and CRP was 3.9 (1) mg/L, while in the group with high levels of ESR and CRP, diagnosis median (IQR) ESR was 76.5 (26) mm/hour, and CRP was 35.5 (60) mg/L. When the groups with normal and high levels of ESR and CRP were compared, it was found that diagnosis age was lower (p=0.027) in the normal ESR and CRP group, while the symptom duration was longer (p<0.001). When the patients were evaluated in terms of presence of at least one comorbidity, comorbidity was determined to be significantly lower in this group (p=0.01). Rheumatoid factor positivity, presence of anemia, and platelet count at the time of diagnosis and PMR exacerbation and giant cell arthritis development in the follow-up were similar.In the multiple regression analysis, when diagnosis age, symptom duration, and comorbidity were evaluated together, long symptom duration was independently associated with PMR with ESR and CRP normal levels (OR=0.045, %95 CI 0.03-0.676, p=0.025).Table 1.Comparison between the characteristics of the patients with normal levels of ESR and CRP and those with high levels of ESR and CRPESR and CRP Normal n:8ESR and/or CRP High n:46pDiagnosis age, mean (±SD) (year)61.8 (8.3)68.57 (7.5)0.027Symptom duration, median (IQR) (month)6 (1)3 (1)<0.001Gender, female, n (%)7 (87.5)27 (58.7)0.234Anemia at the time of diagnosis, n (%)3 (37.5)23 (50)0.706Platelet count at the time of diagnosis, median (IQR)315 (85)288 (103)0.495SAA at the time of diagnosis,median (IQR)*33 (34)51.6 (94)0.165Rheumatoid factor, n (%)1 (12.5)2 (4.3)0.388Presence of at least one comorbidity, median (IQR)3 (37.5)39 (84.8)0.010Exacerbation of PMR, n (%)0 (0)15 (32.6)0.089Giant cell arthritis development, n (%)0 (0)3 (6.5)1*SAA was measured in 20 patients.ConclusionSignificantly younger age of diagnosis, longer symptom duration and less comorbidity were determined in the group with normal levels of ESR and CRP compared to the group with high levels of ESR and CRP. While bursitis can be demonstrated with USG in patients who are clinically evaluated to have PMR, APRs such as SAA other than ESR and CRP can also be used.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNone Declared.
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