Psychosocial burden of axial spondyloarthritis and impact of different disease domains: a systematic literature review.

Objective: To assess the psychosocial impact of axial spondyloarthritis (axSpA).

Methods: A literature search was conducted in two stages: stage 1 included all patients with axSpA and stage 2 focused on patients with inadequate response to prior TNF inhibitor treatment. Selection criteria included population (adults with axSpA), outcomes of interest (psychosocial factors potentially impacted by axSpA, e.g. quality of life, mental health and work productivity) and context [disease-related (disease activity, pain) and -unrelated (gender, race, ethnicity, behaviour) factors potentially affecting psychosocial outcomes). Search results were categorized based on the core domains of disease activity, pain, morning stiffness, fatigue, physical function and overall functioning and health in patients with axSpA.

Results: A total of 197 articles were included in this review, most of which were observational, with only one randomized controlled trial (RCT). The evidence suggests an association between greater disease burden and poorer psychosocial outcomes as well as a bidirectional relationship between disease components and psychosocial outcomes, both contributing to the overall disease burden. However, while many studies reported on psychosocial outcomes, potential relationships with disease domains or activity were not evaluated. Furthermore, there were inconsistencies across studies in how these outcomes were measured, such as the use of different tools and/or scales.

Conclusion: Given the paucity of RCTs examining psychosocial outcomes in axSpA, future research should focus on standardizing assessment of psychosocial impairments experienced by patients and establishing appropriate interventions and management strategies to ensure the holistic treatment of patients with axSpA and to optimize treatment response and outcomes.