부산대학교 도서관

Patients with chronic inflammatory rheumatic disease are known to present frequently associated psychological disorders. Several studies have reported the benefit of biological therapies in spondyloarthritis (SpA), but there are few data regarding its impact on psychological symptoms and well-being. The purpose of this study was to analyze the influence of infliximab as an anti-TNFα therapy on self-reported indices of anxiety and depression in patients with axial chronic SpA and their relation to the main disease activity parameters. We analized 62 patients with SpA, according to the New York modified criteria for 48 Ankylosing Spondilytis and to the European Spondyloarthropathy Study Group for 14 undifferentiated axial SpA, fulfilling Spanish Rheumatology Society criteria for biological therapy. They were enrolled in a prospective multicentric observational study participating 12 hospitals from Catalonia. They received 5 mg/Kg infliximab iv infusion at 0, 2, 6 and every 8 weeks thereafter. At baseline and at 22 weeks patients were assessed for demographic variables, number of swollen joints (NSJ), analytical parameters (ESR and CRP), mobility indices (Schöber modified test and fingertip-to-Floor distance), BASDAI (disease activity) and BASFI (functional status) questionnaires, numerical rate scale (NRS) for pain at night and at total day, and also for self-reported global patient assessment (GPA) of disease activity. Patients were also assessed for self-reported anxiety (STAI-R and STAI-S questionnaires) and psychological disorder (HADS, with cutpoint at >11 points) and its subscales for anxiety (HADA, from 10 points) and depression (HADD, from 7 points). Continuous variables at baseline and at 22 weeks were compared with Student t or Wilcoxon tests, while categorical variables were compared with McNemar’s or Wilcoxon’s tests. A multivariate Binary Logistic Regression analysis was performed taking a > 3 points decrease in the HADS score as the dependent variable. The results showed that HADS score decreased significantly at 22 weeks. The median were from 16,78 (SD:7.90) at baseline to 12,12 (SD:7.09), p<0.001. Also a reduction was observed in the proportion of patients with psychological disorder (HADS > 11), from 74.2% to 41.9%, p=0,029, and with definite depression (HADD score > 7) from 59,7,2% to 41.6%, p=0.01. Other parameters improved significantly as expected, including NSJ, Schöber modified test, ESR, CRP, NRS for pain (at night, total), GPA of disease activity, BASDAI and BASFI indices. In the multivariate analysis, only ESR (OR: 0.908 – 0.996) and BASFI (OR: 0,422 - 0,990) were found to contribute significantly to the improving of HADS. In conclusion, patients with axial spondyloarthritis who received infliximab presented a high incidence of psychological disorders that improve after 22 weeks of therapy assessed by the HADS validated self-reported test. High values of VSG and BASFI were significant predictors of such improvement.