AB0151 EXPRESSION OF ANXIETY AND DEPRESSION IN PATIENTS WITH ANKYLOSING SPONDILITE DEPENDING ON THE STATE OF THE AUTONOMIC NERVOUS SYSTEM AND INTENSITY OF THE PAIN SYNDROME
Authors: Irina Blaginina, Olga Rebrova, Anna Blagodarenko, Pavel Bakhtoyarov, Olga Yavorskaya
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Chronic pain syndrome, immanent in the majority of immune-inflammatory processes, is one of the pathophysiological mechanisms of the development of emotional and affective disorders. It has been proven that high levels of "pro-inflammatory" mediators are predictors of depression, and increased anxiety leads to an imbalance in the autonomic nervous system (ANS). It is also known that the pain syndrome worsens the autonomic supply of the organism. However, this problem remains insufficiently studied today. <h3>Objectives</h3> To assess the severity of anxiety and depression in patients with ankylosing spondilite, depending on the state of the ANS and pain syndrome. <h3>Methods</h3> The study included 75 patients with ankylosing spondylitis (AS), who studied the frequency of anxiety-depressive disorders and their severity on the Spielberger anxiety and Hamilton depression scales. The autonomic status was investigated according to the methods "Wayne-patient" - WP, filled by the patient (more than 15 points - possible autonomic dysfunction (AD)) and "Wayne-doctor" - WD, filled by a doctor (more than 25 points - confirms the presence of signs of AD); we evaluated the indicators of heart rate variability (HRV) - mode (Mo), mode amplitude (AMo), autonomic equilibrium index (AEI), regulatory systems tension index (TI), the standard deviation of the normal RR intervals (SDNN), the square root of the mean squares of the difference between successive RR intervals (RMSSD) and the balance ratio of the activity of the sympathetic and parasympathetic divisions of the ANS (LF/HF). Pain syndrome and the patient's own health index (POH) were assessed by a visual analogue scale (VAS) by patients, and by a physician - by counting the number of painful joints (NPJ), index BASDAI and ASDAS indices. <h3>Results</h3> In 25.3% of patients with AS, a high situational anxiety was observed and in 36% of patients high personal anxiety (PA) was observed. Depressive disorders were found in 57 patients with AS (76%). The severity of pain in the joints and the spine influenced the increase in PA (F = 2.75, p = 0.047; F = 3.54, p = 0.037, respectively) and the level of depressive disorders (F = 3.28, p = 0.03; F = 3.44, p = 0.047, respectively), and the level of depression is also POH (F = 3.49, p = 0.048). 68% patients had an AD (according to WP and WD methods). They constituted the 1st group of observation, and the remaining 24 patients were included in the 2nd group. In group 1, signs of anxiety disorders were identified in 84.3% of cases, and in patients without AD in 45.8% of cases. Depressive disorders were observed in 94% patients with autonomic disorders (11 cases of psychotic, 37 - non-psychotic depression) and in 37.5% in patients without signs of AD - signs of non-psychotic depression. In both groups, there was a decrease in SDNN and RMSSD in comparison with normative ones, which indicates an increase in sympathetic regulation. In the 1 st group, there was a more significant increase in LF/HF (4.15 ± 0.64) and a decrease in SDNN (22.4 ± 5.6 ms) than in the 2nd (3.0 ± 0.86; 29.1 ± 8.4 ms), which indicates the connection between the strengthening of the sympathetic regulation link and the presence of signs of psycho-emotional disorders. The growth of AMo in the 1st group (47.9 ± 8.4%) reflects the degree of mobilizing influence of the sympathetic division and indicates an increase in the activation of the central contour and the growth of sympathetic regulation in patients with AS with AD. <h3>Conclusion</h3> Patients with AS have a high incidence of clinically significant anxiety and depression, which were affected by the intensity of the pain syndrome. The presence of autonomic imbalance and dysregulation of the sympathetic link of the ANS also contribute to the strengthening of psycho-emotional disorders in this category of patients. <h3>Disclosure of Interests</h3> None declared