Positive and negative affective states and disease activity in ankylosing spondylitis

Abstract

The aim of the study was to explore the influence of psychological affective states such as cheerfulness and bad mood on self-reported disease activity in patients with ankylosing spondylitis (AS) while controlling for demographic and clinical variables. Patients attending a biological therapy unit were selected for a cross-sectional study if they met the criteria for AS and were already receiving treatment. Their psychological affective state was assessed with the state version of the State-Trait Cheerfulness Inventory. Clinical variables included were patient-reported disease activity using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and acute-phase reactants. We performed univariate and multivariate analyses to verify the robustness of the relationship between psychological affective states and disease activity. We also explored whether disease activity, measured either by self-report or by acute-phase reactants, was influenced by patient's overall affective state. In the recruited 31 patients with AS, overall affective state contributed significantly to the variance in BASDAI scores, adding 21.8% to the overall R-square of the predictive power of clinical and demographic variables (combined R-square = 17%). A higher positive affective state was associated with lower values of C-reactive protein (p < 0.05). Results of a bootstrapping procedure showed that the relationship between C-reactive protein levels and BASDAI scores was mediated by overall affective state. In patients with AS, affective state can induce variability in self-reported disease activity. Patients' overall affective state can explain the relationship between acute-phase reactants and self-reported scores. These findings suggest interesting possibilities for the monitoring of disease activity in AS.

Upswings in Cheerful Mood and Disease Activity in Patients with Rheumatoid Arthritis

“…Specifically, in the area of rheumatic diseases, it refers to how patients' level of musculoskeletal impairment influences the way they interpret the symptoms and effects of their disease. This idea is empirically supported by the results of the present study and of other studies with rheumatic diseases [11] regarding the mediating effect of emotional variables (i.e., state cheerfulness) in the relationship between levels of C-reactive protein and the DAS-28. The results of the present study indicate that the subjectively rated severity of symptoms is clearly co-determined by the patient's emotional state, which in turn is certainly, but not exclusively, influenced by the objective disease status.…”

“…We measured disease activity with self-reported procedures via a questionnaire and also with clinical indicators. In the present research, we followed the approach of the recent study published by Delgado-Domínguez et al [11] on patients with AS. We also intended to clarify whether the relevance of cheerful mood found by the abovementioned study was due to what patients' mood indicated at the time of the assessment even after controlling for the same dimension in its trait manifestation-a fact that was not considered in the study conducted by Delgado-Domínguez et al [11].…”

“…Specifically, cheerfulness and bad mood have been defined as affective states (i.e., how individuals behave, feel, or think at the time of the assessment) and traits (i.e., how individuals usually behave, feel, or think) of sense of humor [10]. Previous studies have shown that the cheerfulness dimension is positively correlated with health [11]. The cheerful mood comprises elements of a joyful, happy mood, along with feelings related to being inclined to humor and a low threshold for smiling and laughter in general [10].…”

“…We expected to find a negative relationship between cheerfulness and disease activity in patients with RA. Along the lines of the findings obtained with AS [11], we intended to explore the possibility of using mediation procedures and to analyze how cheerful mood affects the relation between clinical indicators of RA and self-reported RA. Evidence of mediation implies that cheerful mood accounts for some of the relationship between clinical indicators of RA and self-reported RA.…”

“…In the area of study of rheumatic diseases, the authors of a recent study [11] explored the relationship between the affective dimensions of sense of humor in their state manifestation and disease activity in patients with ankylosing spondylitis (AS). Results revealed that the affective dimensions of sense of humor contributed significantly to the self-reported disease activity beyond clinical and demographic variables in AS patients.…”