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Pharmacological management of spondyloarthritis with NSAIDs, csDMARDs or TNF inhibitors improves comorbid symptoms of depression.
According to a study, pharmacological therapy of active spondyloarthritis resulted in a remarkable reduction of depressive symptoms and odds of (possible/ probable) depression. Casper Webers et al. sought to assess how the pharmacological management of spondyloarthritis affected depressive symptoms and determine whether this impact varied among medication classes.
The ASAS Health Index Validation Study observational data was utilized. Patients were evaluated before as well as after starting non-steroidal anti-inflammatory drugs (NSAIDs), conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), and tumor necrosis factor inhibitors (TNFi). The Hospital Anxiety and Depression Scale depression-subscale (HADS-D, 0-21 [best-worst]) was used to evaluate depressive symptoms. Features of the disease and demographics such as disease activity (ASDAS/BASDAI) were the covariables.
Using multivariable regression analysis and Analysis of Variance (ANOVA), the alteration in HADS-D from baseline was evaluated across treatments (NSAID/csDMARD/TNFi). Overall, 304 subjects were incorporated; 102/45/157 started using NSAIDs, csDMARDs, or TNFi, and 260/44 (85%/15%) had axial or peripheral spondyloarthritis. The mean (standard deviation [SD]) HADS-D at baseline was 6.9 (4.2). Notably, 126 people (42%) were depressive (HADS-D≥8), and 66 people (22%) were probably depressed (HADS-D≥11) at baseline.
All therapy groups exhibited a substantial improvement in depression symptoms at the follow-up. When TNFi was started against NSAID, there was a larger improvement in depressed symptoms (B= -1.27) and a decreased risk of potential depression at follow-up (OR = 0.47), according to multivariable regression analysis without disease activity markers. Additional disease activity adjustments (ASDAS/BASDAI) attenuated this correlation but not C-reactive protein (CRP).
Regarding how they affected HADS-D, csDMARDs were not different from NSAIDs. Findings between medication classes were verified in axial spondyloarthritis, although less clear in peripheral spondyloarthritis. Depressive symptoms were improved by spondyloarthritis treatment. TNFi has a greater impact than NSAIDs, particularly in the case of axial spondyloarthritis, which is primarily explained by a more significant impact on disease activity. In spondyloarthritis, there is no proof that CRP-mediated inflammation causes symptoms of depression.
Rheumatology (Oxford)
The effect of anti-inflammatory treatment on depressive symptoms in spondyloarthritis: does the type of drug matter?
Casper Webers et al.
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