Patient‐reported Disease Activity in an Axial Spondyloarthritis Cohort during the COVID‐19 Pandemic

Abstract

Objective Response to the coronavirus disease 2019 (COVID‐19) pandemic has resulted in shelter‐in‐place orders and major changes to individuals’ daily lives. The impact of such stressors on disease activity in individuals with axial spondyloarthritis (axSpA) is unclear. The aim of this study is to examine whether stress, anxiety, and depression are associated with patient‐reported disease activity, after accounting for important factors. Methods We administered a survey to an axSpA cohort from a single center with well‐defined demographic and disease characteristics. We included questions about job status changes, exercise, medication use, disease activity (by the Bath Ankylosing Spondylitis Disease Activity Index [BASDAI]), and psychological factors (stress, depressive symptoms, and anxiety). Separate multivariable linear models examined the associations between perceived stress, anxiety, and depression with the BASDAI. Results After adjustment for potential confounders, those with higher levels of stress had a statistically significant 0.54‐point higher BASDAI, on average, compared with those with lower levels of stress (95% confidence interval [CI]: 0.11, 0.97). Those with higher levels of anxiety also had a statistically significant higher BASDAI, on average, compared with those with lower levels of anxiety (β: 0.95, 95% CI: 0.18, 0.99). The association between depression and BASDAI was not statistically significant. We did not find differences in these associations among subgroups of age, job status, or county of residence. Conclusion Individuals with axSpA with higher levels of stress and anxiety had significantly higher disease activity levels, although with a difference below clinical importance. Further planned studies will evaluate the trajectory of disease activity.

Minimal Impact of the COVID‐19 Pandemic on Disease Activity and Health‐Related Quality of Life in Patients With Ankylosing Spondylitis Receiving Bimekizumab: Exploratory Analyses From a Phase 2b Open‐Label Extension Study

“…Our findings differ from some real‐world studies evaluating the implications of the pandemic on patients with rheumatic disease, which may reflect the clinical trial setting of this study and differences in patient populations, study design approaches, and use of alternative outcome measures ( 4 , 6 , 7 , 9 , 10 ). For example, disease activity in this study population at the start of the pandemic was low overall and patients may have been less susceptible to pandemic‐related effects as a result.…”

“…Restrictions are also likely to have limited patients’ physical activity, potentially leading to poorer patient outcomes given that AS symptoms can be exacerbated by reduced exercise. Real‐world studies evaluating the implications of the pandemic on disease activity and HRQoL in patients with axSpA have found inconsistent results ( 4 , 5 , 6 , 7 , 8 , 9 , 10 ).…”

Impact of COVID-19 containment measures on patients with rheumatic and musculoskeletal disease in the UK and Europe: the REUMAVID study (phase1)

“…One notable difference between lockdown measures was that British patients were more likely to continue to exercise outdoors. Exercise and outdoor activity reduce anxiety and depression, improve overall well-being [ 25 , 26 ], maintain mobility and reduce pain in patients with RMDs [ 5 ]. British patients also felt that they received better-quality RMD-specific guidance on COVID-19, which is likely to have provided some reassurance at a time of great uncertainty.…”

Poor health and functioning in patients with axial spondyloarthritis during the COVID-19 pandemic and lockdown: REUMAVID study (phase 1)

“…1 People with axial spondyloarthritis (axSpA), in particular, may have felt this impact harder due to a lack of physical activity during the periods of home confinements. 2 Most studies evaluating the impact of the pandemic on patients with axSpA have focused on disease outcomes such as the risk of contracting an infection or the clinical evolution after doing so. Data on evaluating the impact of the pandemic and lockdown measures on the overall health of patients with axSpA, regardless of the risk of contracting the COVID-19 infection, however, are limited.…”