ArticleRheumatology (Oxford, England)2021
Depression and anxiety symptoms at TNF inhibitor initiation are associated with impaired treatment response in axial spondyloarthritis.
Article in Rheumatology (Oxford, England), 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers.
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Who cites it
19 citing papers in PubMed, 28 citations in OpenAlex.
- Stressful life events and lifestyle factors are associated with elevated peripheral TNF-α levels in adults with depression without physical diseases.European archives of psychiatry and clinical neuroscience · 2026Article
- Associations Between Depression and Reduced Quality of Life in Women with Non-Radiographic Axial Spondyloarthritis: A Cross-Sectional Study.Biomedicines · 2026Article
- Disease activity and mental health symptoms in axial spondyloarthritis: concordant or discordant?Rheumatology (Oxford, England) · 2026Article
- Impact of interventions to prevent anxiety and depression in people with inflammatory rheumatological conditions: a systematic review.Rheumatology advances in practice · 2026Review
- Microglia-Targeted Nanotherapeutics in Major Depressive Disorder: An Integrative Perspective on Neuroinflammation and Drug Delivery.Pharmaceutics · 2025Review
- Interrelationships of disease activity, central sensitization, psychosocial and lifestyle factors in axial spondyloarthritis.Rheumatology (Oxford, England) · 2025Article
- Psychological Health in the Management of Patients with Psoriatic Arthritis: An Intricate Relationship.Rheumatology and therapy · 2025Review
- The 2025 British Society for Rheumatology guideline for the treatment of axial spondyloarthritis with biologic and targeted synthetic DMARDs.Rheumatology (Oxford, England) · 2025Article
- Effect of depressive symptoms on treatment response in patients with axSpA: data from the RABBIT-SpA register.RMD open · 2025Observational
- Psychosocial burden of axial spondyloarthritis and impact of different disease domains: a systematic literature review.Rheumatology advances in practice · 2025Review
- Inflammatory activity levels on patients with anti-TNF therapy: most important factors and a decision tree model based on REGISPONSER and RESPONDIA registries.Therapeutic advances in musculoskeletal disease · 2025Article
- Adherence, Fears, and Beliefs about Biologic Drugs in Rheumatoid Arthritis Patients: A North African Pilot Study.Mediterranean journal of rheumatology · 2024Article
- Difficult-to-Manage Axial Spondyloarthritis.Mediterranean journal of rheumatology · 2024Review
- Article
- The Effect of Depression on Disease Activity and Treatment Response in Patients with Inflammatory Arthritis: Results from a Narrative Literature Review.Neuropsychiatric disease and treatment · 2024Review
- Management of Specific Clinical Profiles in Axial Spondyloarthritis: An Expert's Document Based on a Systematic Literature Review and Extended Delphi Process.Rheumatology and therapy · 2023Article
- Depressive symptoms are associated with fatigue, poorer functional status and less engagement in sports in axSpA and PsA: an analysis from the RABBIT-SpA cohort.Arthritis research & therapy · 2023Article
- Article
- Biopsychosocial factors should be considered when evaluating central sensitization in axial spondyloarthritis.Rheumatology international · 2023Article
Corrections and comments
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Authors and funding
5 authors at 3 institutions in 1 country.
Funding
Abstract
objectivesDepression and anxiety are associated with more severe disease in cross-sectional studies of axial spondyloarthritis (axSpA). We examined the association between baseline symptoms of depression or anxiety and response to TNF inhibitors (TNFi) in axSpA.
methodsBiologic naïve participants from a national axSpA register completed the Hospital Anxiety and Depression Scale (HADS) before initiating TNFi. Symptoms of anxiety and depression were each categorized as moderate-severe (≥11), mild (8-10) and 'none' (≤7), and compared against change in disease indices [BASDAI and AS Disease Activity Score (ASDAS)] over time and time to treatment discontinuation using marginal structural models. Inverse-probability weights balanced baseline age, gender, BMI, deprivation, education and baseline values of respective disease indices.
resultsOf the 742 participants (67% male, mean age 45 years), 176 (24%) had moderate-severe and 26% mild depression; 295 (40%) had moderate-severe and 23% mild anxiety. Baseline disease activity was higher in higher HADS symptom categories for both depression and anxiety. Participants with moderate-severe depression had significantly poorer response compared with those with 'none' throughout follow-up. At 6 months, the difference was approximately 2.2 BASDAI and 0.8 ASDAS units after balancing their baseline values. Equivalent comparisons for anxiety were 1.7 BASDAI and 0.7 ASDAS units. Treatment discontinuation was 1.59-fold higher (hazard ratio 95% CI: 1.12, 2.26) in participants with moderate-severe anxiety compared with 'none'.
conclusionsSymptoms of depression and anxiety at TNFi initiation are associated with poorer treatment outcomes. Targeted interventions to optimize mental health have potential to substantially improve treatment response and persistence.
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