Evaluation of the relationship between disease activity and treatment response and disease perception, anxiety and depression scales in patients diagnosed with ankylosing spondylitis

Background and Aim: Ankylosing spondylitis (AS) is an autoimmune disease that primarily affects the axial skeleton; which leads to pain, abnormal posture, and movement disorders. Symptoms of AS affect patient's functions and activities of daily living, as well as ability to work. Because of symptoms and the changes in physical appearance associated with AS, patients' psychological functions are also influenced by AS. Therefore, AS patients have a higher risk of psychological disorders, especially anxiety and depression, compared to the normal population. Our aim in this study is to evaluate the relationship between depression-anxiety level and disease perception in AS patients with disease activity and treatment response by using depression, anxiety and illness perception scales. Material and Method: The study included 108 AS patients who applied to the Çukurova University Rheumatology Department between March and October 2022 and 40 healthy volunteers. Persons who receiving psychiatric treatment were not included in the study. The patients were divided into 2 groups as active and inactive disease groups according to their BASDAI score. All participants were asked to complete Beck's depression and anxiety scale and hospital anxiety and depression scale. In addition, BASDAI, BASFI, ASDAS-CRP scores were calculated in the AS patient group and they were asked to complete brief illness perception questionnaire. In order to evaluate the relationship between treatment response and anxiety, depression and disease perception in the patient group with active disease, the activity scores of the newly treated patients were recalculated at the 12th week of treatment and they were asked to complete the scales. Results: In our study; 61.1% (n=66) of the patients were male and 38.9% (n=42) were female. The mean age of the patients was 39.6 (min: 20- max: 64) and they were similar to the control group in terms of age and gender. When the scale scores of all AS patients (n=108) and the control group were compared, BECK-A (patient: 15.8±11.4; control: 10.0±6.9) and BECK-D (patient: 12.8±8.6; control: 8.8±6.8) scale scores were found significantly higher in the AS group. When the active and inactive patients were evaluated separately, it was determined that the patients in the active patient group had significantly higher BECK-A, BECK-D, HAD-A and HAD-D scale scores than the healthy control and inactive patient groups. The brief illness perception scale score was also higher in the active patient group than in the inactive patient group (p<0.001). It was determined that there was a positive correlation between VAS, BASFI, BASDAI and ASDAS-CRP values and all scale scores. There was a moderate negative correlation between the CRP value and BECK-A and HAD-A values in the active patient group. BECK-A, BECK-D and HAD-A scale scores were found to be higher in female patients than in male patients. A significant difference was observed between HAD-A and HAD-D scales according to education level. however, there was no statistically significant correlation with age, HLA-B27 positivity, disease duration, smoking, extra-articular involvement. In the evaluation at the 12th week, ESR, CRP, VAS, BASFI, BASDAI, ASDAS-CRP values and scale scores of the patients who responded to treatment were more significantly regressed than their baseline values. Conclusion: The frequency of anxiety and depression in AS patients was higher than the normal population and correlated with disease activity. In patients who receive effective treatment, psychological status is also improved with AS treatment. Keywords: Ankylosing spondylitis, anxiety, depression, disease perception, disease activity