AB0322 ASSOCIATION OF DEPRESSIVE SYMPTOMS ASSESSED BY BDI II WITH PHYSICAL ACTIVITY IN PATIENTS WITH PRIMARY SJÖGREN´S SYNDROME
Authors: S. Beider, T. Witte, D. Ernst
Journal: Annals of the Rheumatic Diseases (2021)

Background: Patients with primary Sjögren´s syndrome (pSS) suffer from pain, oral or ocular dryness and fatigue. Such symptoms can have a detrimental impact on health-related quality of life. The prevalence of mental health disorders in patients with pSS is considerably higher than in the general population [1]. Regular physical activity, such as nordic walking, improves aerobic capacity and may reduce reported fatigue [2]. According to current European League Against Rheumatism (EULAR) recommendations, management of pSS concomitant diseases should be evaluated in patients presenting with fatigue and pain, and severity scored using specific tools [3]. Objectives: This study analyses the frequency and severity of depressive symptoms in patients with pSS and their relationship to fatigue and physical activity. Methods: In this monocentric, cross-sectional study, patients with pSS attending our Rheumatology clinic between January 2019 and March 2020 completed standardized questionnaires: Beck´s depression inventory second edition (BDI II) and the international physical activity questionnaire short form (IPAQ-SF). Data were analyzed using SPSS 26 (IBM, Armonk, NY, USA). The tests include bivariate and partial correlations and nonparametric Kruskal-Wallis-Test. Results: In total, 134 patients were included. The majority were female (117/134, 87.3 %), and the patients median age was 57 [21 – 85] years. Median duration of disease-related symptoms at inclusion was 56 months (range 0-388 months). Physical activity was low in 44. 8 % (n = 60), moderate in 32.1 % (n = 43), and high in 23.1 % (n = 31) of patients. Depressive symptoms of varying severity were identified in 76/134 (56.7%) of patients. Severe depression occurred in 10/76 (13.2%) and moderate depression in 14/76 (18.4%) patients. The remaining 52/76 (68.4%) patients had minimal or mild depression. Over two-thirds (67.7%) of patients reporting high physical activity showed no depression and no one with a high level of physical activity had severe depression. There was a clear association between the BDI II depression score and the level of physical activity (p = 0.003) regardless of age and illness duration. However, not all the symptoms assessed by BDI II had the same impact. From 21 items of the BDI II Inventory, symptoms such as loss of energy and fatigue were profoundly relevant, being reported by over 75 % of patients. The main depressive symptoms, which had a strong negative correlation with the level of physical activity were loss of energy (p &lt; 0.001), sadness (p=0.018), inability to make decisions (p=0.007) and loss of pleasure (p=0.004). Somatic symptoms of decreased activation such as fatigue (p=0.026) and concentration difficulty (p=0.013) were also significant. The cognitive, self-negative symptoms were not associated with the level of physical activity. Conclusion: A negative correlation of physical activity with fatigue and depression in patients with pSS has been demonstrated. The somatic symptoms of decreased activation played a profound role in this association, while the cognitive self-negotiation symptoms were not influenced by physical activity in our patients. Such symptoms as fatigue and loss of energy could potentially be reduced by exercises and functional training and consequently decrease the level of depression. An intervention study in this regard would be recommended. References: [1]Cui, Y., et al., Anxiety and depression in primary Sjögren’s syndrome: a cross-sectional study. BMC psychiatry, 2018. 18(1): p. 1-8. [2]Strömbeck, B., E. Theander, and L. Jacobsson, Effects of exercise on aerobic capacity and fatigue in women with primary Sjögren’s syndrome. Rheumatology, 2007. 46(5): p. 868-871. [3]Ramos-Casals, M., et al., EULAR recommendations for the management of Sjögren’s syndrome with topical and systemic therapies. Annals of the rheumatic diseases, 2020. 79(1): p. 3-18. Disclosure of Interests: None declared