Disease Activity in Axial Spondylarthritis Patients Linked With Current State of Health Care Stress

Patients with axial spondyloarthritis who experienced higher levels of perceived stress and anxiety during the current shelter-in-place orders had significantly higher disease activity levels compared with patients with less stress and anxiety, according to a study published online in ACR Open Rheumatology. (ACR Open Rheumatol. 2020;10.1002/acr2.11174. doi:10.1002/acr2.11174)

“Although the estimated average difference in the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) comparing between stress and anxiety levels was less than the minimal clinically important difference of 1.0 reported by Pavy et al, the differences between groups may become more apparent upon longitudinal follow‐up of this cohort,” researchers wrote. 

The study included 203 patients with ankylosing spondylitis at the University of California, San Francisco. Participants responded to an online survey in April 2020 that included questions about job status changes, exercise, medication use, disease activity, stress, depressive symptoms, and anxiety.

After adjusting for confounders including baseline disease activity, researchers found patients with higher levels of stress had an average 0.54‐point higher BASDAI compared with patients with lower levels of stress. Patients with higher levels of anxiety also had a statistically significant higher BASDAI, on average. 

The study found no statistically significant association between levels of depression and axial spondyloarthritis disease activity levels. 

“These findings highlight stress and anxiety as independent predictors of patient‐reported disease activity among individuals with axial spondyloarthritis,” researchers wrote, “particularly while shelter‐in‐place measures were in effect.” 

—Jolynn Tumolo