The effect of anti-inflammatory treatment on depressive symptoms in spondyloarthritis: does the type of drug matter?
OBJECTIVE: To investigate the effect of pharmacological treatment of SpA on depressive symptoms and explore whether this effect differs between drug classes. METHODS: Data from the observational Assessment of SpondyloArthritis international Society Health Index Validation Study were used. Patients w...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10234195/ https://www.ncbi.nlm.nih.gov/pubmed/36205588 http://dx.doi.org/10.1093/rheumatology/keac580 |
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author | Webers, Casper Kiltz, Uta Braun, Jürgen van der Heijde, Désirée Boonen, Annelies |
author_facet | Webers, Casper Kiltz, Uta Braun, Jürgen van der Heijde, Désirée Boonen, Annelies |
author_sort | Webers, Casper |
collection | PubMed |
description | OBJECTIVE: To investigate the effect of pharmacological treatment of SpA on depressive symptoms and explore whether this effect differs between drug classes. METHODS: Data from the observational Assessment of SpondyloArthritis international Society Health Index Validation Study were used. Patients were assessed at baseline and after initiation of NSAIDs/conventional synthetic DMARDs (csDMARDs)/TNF inhibitors (TNFis). Depressive symptoms were assessed with the Hospital Anxiety and Depression Scale depression subscale [HADS-D; 0–21 (best–worst)]. Covariables included demographics and disease characteristics, including disease activity [Ankylosing Spondylitis Disease Activity Score (ASDAS)/BASDAI]. The change in HADS-D from baseline was compared between treatments (NSAIDs/csDMARDs/TNFis) with analysis of variance and multivariable regression analysis. RESULTS: A total of 304 patients were included; 102/45/157 initiated NSAIDs/csDMARDs/TNFis and 260 (85%) / 44 (15%) had axial/peripheral SpA. At baseline, the mean HADS-D was 6.9 (s.d. 4.2); 126 (42%) were possibly depressed (HADS-D ≥8) and 66 (22%) were probably depressed (HADS-D ≥11). At follow-up, depressive symptoms significantly improved in all treatment groups. In multivariable regression without disease activity measures, initiating TNFis compared with NSAIDs was associated with greater improvement in depressive symptoms [β = −1.27 (95% CI −2.23, −0.32)] and lower odds of possible depression at follow-up [odds ratio 0.47 (95% CI 0.23, 0.94)]. This association was attenuated after additional adjustment for disease activity (ASDAS/BASDAI) but not CRP. csDMARDs did not differ from NSAIDs regarding their effect on HADS-D. Between-drug class results were confirmed in axial SpA (axSpA), although less clear in peripheral SpA. CONCLUSION: Treatment of active SpA also improves depressive symptoms. Especially in axSpA, TNFis have a greater effect than NSAIDs, which is mainly explained by a stronger effect on disease activity. We found no evidence for a direct link between CRP-mediated inflammation and depressive symptoms in SpA. |
format | Online Article Text |
id | pubmed-10234195 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-102341952023-06-02 The effect of anti-inflammatory treatment on depressive symptoms in spondyloarthritis: does the type of drug matter? Webers, Casper Kiltz, Uta Braun, Jürgen van der Heijde, Désirée Boonen, Annelies Rheumatology (Oxford) Clinical Science OBJECTIVE: To investigate the effect of pharmacological treatment of SpA on depressive symptoms and explore whether this effect differs between drug classes. METHODS: Data from the observational Assessment of SpondyloArthritis international Society Health Index Validation Study were used. Patients were assessed at baseline and after initiation of NSAIDs/conventional synthetic DMARDs (csDMARDs)/TNF inhibitors (TNFis). Depressive symptoms were assessed with the Hospital Anxiety and Depression Scale depression subscale [HADS-D; 0–21 (best–worst)]. Covariables included demographics and disease characteristics, including disease activity [Ankylosing Spondylitis Disease Activity Score (ASDAS)/BASDAI]. The change in HADS-D from baseline was compared between treatments (NSAIDs/csDMARDs/TNFis) with analysis of variance and multivariable regression analysis. RESULTS: A total of 304 patients were included; 102/45/157 initiated NSAIDs/csDMARDs/TNFis and 260 (85%) / 44 (15%) had axial/peripheral SpA. At baseline, the mean HADS-D was 6.9 (s.d. 4.2); 126 (42%) were possibly depressed (HADS-D ≥8) and 66 (22%) were probably depressed (HADS-D ≥11). At follow-up, depressive symptoms significantly improved in all treatment groups. In multivariable regression without disease activity measures, initiating TNFis compared with NSAIDs was associated with greater improvement in depressive symptoms [β = −1.27 (95% CI −2.23, −0.32)] and lower odds of possible depression at follow-up [odds ratio 0.47 (95% CI 0.23, 0.94)]. This association was attenuated after additional adjustment for disease activity (ASDAS/BASDAI) but not CRP. csDMARDs did not differ from NSAIDs regarding their effect on HADS-D. Between-drug class results were confirmed in axial SpA (axSpA), although less clear in peripheral SpA. CONCLUSION: Treatment of active SpA also improves depressive symptoms. Especially in axSpA, TNFis have a greater effect than NSAIDs, which is mainly explained by a stronger effect on disease activity. We found no evidence for a direct link between CRP-mediated inflammation and depressive symptoms in SpA. Oxford University Press 2022-10-07 /pmc/articles/PMC10234195/ /pubmed/36205588 http://dx.doi.org/10.1093/rheumatology/keac580 Text en © The Author(s) 2022. Published by Oxford University Press on behalf of the British Society for Rheumatology. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Clinical Science Webers, Casper Kiltz, Uta Braun, Jürgen van der Heijde, Désirée Boonen, Annelies The effect of anti-inflammatory treatment on depressive symptoms in spondyloarthritis: does the type of drug matter? |
title | The effect of anti-inflammatory treatment on depressive symptoms in spondyloarthritis: does the type of drug matter? |
title_full | The effect of anti-inflammatory treatment on depressive symptoms in spondyloarthritis: does the type of drug matter? |
title_fullStr | The effect of anti-inflammatory treatment on depressive symptoms in spondyloarthritis: does the type of drug matter? |
title_full_unstemmed | The effect of anti-inflammatory treatment on depressive symptoms in spondyloarthritis: does the type of drug matter? |
title_short | The effect of anti-inflammatory treatment on depressive symptoms in spondyloarthritis: does the type of drug matter? |
title_sort | effect of anti-inflammatory treatment on depressive symptoms in spondyloarthritis: does the type of drug matter? |
topic | Clinical Science |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10234195/ https://www.ncbi.nlm.nih.gov/pubmed/36205588 http://dx.doi.org/10.1093/rheumatology/keac580 |
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