Thomas Cox

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Introduction: While the musculoskeletal symptoms of axial spondyloarthritis (axSpA) are well appreciated, emerging evidence demonstrates that patients newly diagnosed with axSpA experience a substantial mental health burden. There is increasing awareness of the need for mental health screening and integrated psychological support as part of comprehensive axSpA management. The primary aims of our study were to assess the prevalence of depression and anxiety in patients with a new diagnosis of axSpA within the past 24 months and to establish the relationship between axSpA disease activity and the severity of anxiety or depression symptoms. The secondary exploratory analysis was to assess the relationship between interventions received (none, biologics, physiotherapy, and patient support groups) and the severity of anxiety or depression symptoms.Methods: We conducted a single-centre cross-sectional observational study in a tertiary axSpA rheumatology clinic. Of the 95 eligible patients, 66 patients (response rate 69.5%) completed a comprehensive questionnaire assessing patient demographics, disease activity using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), quality of life using the Ankylosing Spondylitis Quality of Life (ASQoL) score, and depressive and anxiety symptoms using standardised screening tools, Patient Health Questionnaire-9 (PHQ-9) and Generalised Anxiety Disorder-7 (GAD-7), respectively. Linear regression analysis was performed to assess the correlation between BASDAI and PHQ-9, as well as GAD-7.Results: Based on the PHQ-9 scores, 81.8% (54/66) of patients had a score of 5 or more, which is equivalent to having symptoms of mild depression. Of these, 57.4% (n = 31/54) reported moderate-severe symptoms of depression (PHQ-9 ≥10). Similarly, 65.2% (n = 43/66) reported anxiety symptoms, with 53.3% (n = 23/43) experiencing moderate-severe symptoms of anxiety (GAD-7 ≥10). Linear regression analysis demonstrated a strong positive correlation between disease activity (BASDAI) and depression (coefficient = 1.77, 95% CI 1.30-2.23, R² = 0.473, p < 0.0001) and between disease activity and anxiety (coefficient = 1.32, 95% CI 0.79-1.85, R² = 0.279, p < 0.0001). Multivariate analysis demonstrated that disease activity independently predicted both depressive (coefficient 1.79, p value < 0.0001) and anxiety symptoms (coefficient 1.33, p value < 0.0001), even after adjusting for age, gender, employment status, diagnostic delay, and quality of life.Conclusion: This study demonstrates a high prevalence of undiagnosed depression and anxiety in newly diagnosed axSpA patients, with disease activity as an independent predictor of mental health burden. These findings support the urgent need for routine mental health screening at diagnosis and the integration of psychological care within holistic axSpA management. Further prospective research is required to evaluate optimal screening strategies and psychological intervention models to address this substantial treatment gap.

Why does Lean fail to stick so often? Thomas Cox and Andre DeMerchant join me on Episode 547 to make the case that the missing precondition is psychological safety, and that it has to exist at the top before any…

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