SAT0391 DEPRESSIVE SYMPTOMS ARE ASSOCIATED WITH HIGHER DISEASE ACTIVITY AND WORSE FUNCTIONAL STATUS IN AXSPA: A CROSS-SECTIONAL ANALYSIS FROM RABBIT-SPA
Authors: A. Regierer, A. Weiß, X. Baraliakos, D. Poddubnyy, I. Schwarze, J. Braun, J. Sieper, A. Zink, A. Strangfeld
Journal: Annals of the Rheumatic Diseases (2020)

Background: Axial spondyloarthritis (axSpA) is a potentially severe chronic inflammatory disease with impact on function and quality of life. About 20-30% of axSpA patients show symptoms of depression or are diagnosed with depression [1]. Depression may influence outcome, especially patient reported outcomes. Objectives: To assess differences in baseline characteristics and outcome parameters between patients with and without symptoms of depression using WHO-5 score. Methods: RABBIT-SpA is a prospective longitudinal cohort study including axSpA patients enrolled at start of a new conventional treatment (including NSAID) or bDMARD. WHO-5 score was used to identify depressive symptoms categorised into 3 groups using validated cut-offs: moderate to severe depressive symptoms &lt;=28, mild depressive symptoms 29-50, good well-being &gt;50. Baseline values of patients categorised as having moderate to severe depressive symptoms were compared with the rest of the patients using t-test. Spearman correlation coefficient was calculated to analyse the relationship between WHO-5 score and other outcome parameters. Results: A total of 848 axSpA patients were included in this analysis (table 1). Moderate to severe depressive symptoms were found in 221 patients (30%), 226 (31%) had mild depressive symptoms and 285 (39%) reported a good well-being. Percentages of patients with inflammatory back pain, peripheral arthritis or enthesitis as well as the number of affected joints (44 JC) and entheseal sites (using SPARCC) were higher in the group of patients with moderate to severe depressive symptoms. Table 1. Parameter WHO-5 (&lt;=28) Moderate severe N=221 WHO-5 (29-50/&gt;50) Mild/well-being N=511 Age, mean 43.8 44.1 Female, n (%) 100 (45.2) 229 (44.8) Disease duration, years, mean 6.8 6.5 Inflammatory back pain, n (%) 195 (88.6) 416 (81.6) Enthesitis, n (%) 49 (22.3) 78 (15.4) Peripheral arthritis (44 JC), n (%) 64 (29.1) 134 (26.3) Uveitis, n (%) 45 (20.4) 76 (15) IBD, n (%) 13 (5.9) 31 (6.1) Psoriasis, n (%) 35 (15.8) 58 (11.4) CRP positive (≥5mg/l), n (%) 115 (59) 243 (55.1) HLA-B27, n (%) 151 (72.6) 354 (74.2) BMI≥30, n (%) 66 (30) 117 (23.6) Comorbidities ≥3, n (%) 50 (22.6) 89 (17.4) Current smoking, n (%) 102 (47.2) 185 (36.7) All analysed outcome parameters (e.g. ASDAS, ASAS-HI, BASDAI, BASFI, patient global, physician global, pain, sleep) were significantly worse in the group of patients with moderate to severe depressive symptoms versus the other patients (table 2). This includes physician-reported, patient-reported and composite scores. Table 2. Parameter WHO-5 (&lt;=28) Moderate severe N=221 WHO-5 (29-50/&gt;50) Mild/well-being N=511 p-value PhysGA (NRS 0-10) 6.2 (1.6) 5.4 (1.9) 0.0001 ASDAS 6.1 (1.6) 4.2 (1.8) 0.0001 BASDAI (NRS 0-10) 3.5 (0.8) 2.9 (0.9) 0.0001 BASFI (NRS 0-10) 5.5 (2.2) 3.2 (2.2) 0.0001 ASAS-HI (0-17) 9.8 (3.1) 5.8 (3.1) 0.0001 PatGA (NRS 0-10) 7 (1.8) 5.4 (2.3) 0.0001 PatPain (NRS 0-10) 6.9 (1.9) 5.2 (2.3) 0.0001 PatSleep (NRS 0-10) 7.2 (2.4) 4.6 (2.9) 0.0001 Results are presented as mean ± SD. WHO-5 was highly correlated with all outcome parameters regardless of gender. Figure 1 shows the correlation of BASDAI and WHO-5 stratified for gender. Figure 1. Conclusion: Almost one third (30%) of axSpA patients in this analysis reported scores indicative of depressive symptoms and depression. The strong correlation of WHO-5 scores with patient and physician reported outcomes may be relevant for the management of patients with axSpA. References: [1]Redeker I, et al. Ann Rheum Dis 2018;0:1–8. doi:10.1136 Acknowledgments: RABBIT-SpA is supported by a joint, unconditional grant from AbbVie, Amgen, Janssen-Cilag, Lilly, MSD, Mylan, Novartis, Pfizer, and UCB. Disclosure of Interests: Anne Regierer Speakers bureau: Novartis, Celgene, Janssen-Cilag, Anja Weiß: None declared, Xenofon Baraliakos Grant/research support from: Grant/research support from: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Consultant of: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Speakers bureau: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Denis Poddubnyy Grant/research support from: AbbVie, MSD, Novartis, and Pfizer, Consultant of: AbbVie, Bristol-Myers Squibb, Eli Lilly, MSD, Novartis, Pfizer, Roche, UCB, Speakers bureau: AbbVie, Bristol-Myers Squibb, Eli Lilly, MSD, Novartis, Pfizer, Roche, UCB, Ilka Schwarze: None declared, Juergen Braun Grant/research support from: Abbvie (Abbott), Amgen, BMS, Boehringer, Celgene, Celltrion, Centocor, Chugai, Eli Lilly and Company, Medac, MSD (Schering Plough), Mundipharma, Novartis, Pfizer (Wyeth), Roche, Sanofi- Aventis, and UCB Pharma, Consultant of: Abbvie (Abbott), Amgen, BMS, Boehringer, Celgene, Celltrion, Centocor, Chugai, EBEWE Pharma, Eli Lilly and Company, Medac, MSD (Schering-Plough), Mundipharma, Novartis, Pfizer (Wyeth), Roche, Sanofi-Aventis, and UCB Pharma, Speakers bureau: Abbvie (Abbott), Amgen, BMS, Boehringer, Celgene, Celltrion, Centocor, Chugai, EBEWE Pharma, Eli Lilly and Company, Medac, MSD (Schering-Plough), Mundipharma, Novartis, Pfizer (Wyeth), Roche, Sanofi-Aventis, and UCB Pharma, Joachim Sieper Consultant of: AbbVie, Boehringer Ingelheim, Eli Lilly and Company, Janssen, Merck, Novartis, Pfizer, Roche, and UCB Pharma, Speakers bureau: AbbVie, Boehringer Ingelheim, Eli Lilly and Company, Janssen, Merck, Novartis, Pfizer, Roche, and UCB Pharma, Angela Zink Speakers bureau: AbbVie, Amgen, BMS, Gilead, Hexal, Janssen, Lilly, MSD, Pfizer, Roche, Sanofi Aventis, UCB, Anja Strangfeld Speakers bureau: AbbVie, BMS, Pfizer, Roche, Sanofi-Aventis