Skip to main content

Advertisement

SpringerLink
Log in

The relationship between disease activity measured by the BASDAI and psychological status, stressful life events, and sleep quality in ankylosing spondylitis

  • Original Article
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

Abstract

Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) is a standard instrument regularly used to assess disease activity of patients with ankylosing spondylitis (AS). However, the well-being of a patient is also affected by impairment of function as well as psychological status and other factors. The objective of this study was to evaluate if psychological status, stressful life events, and sleep quality contribute significantly to BASDAI. Six hundred eighty-three AS patients satisfying the Modified New York Criteria for AS were recruited from the rheumatology clinics of seven hospitals in China. Patients with other concomitant disorders were excluded. Participants were requested to complete a set of clinical examinations and the following questionnaires: Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Zung Self-Rating Anxiety Scale (SAS), Zung Self-Rating Depression Scale (SDS), Pittsburgh Sleep Quality Index Questionnaire (PSQI), Health Assessment Questionnaire for Spondyloarthropathies (HAQ-S), and Social Readjustment Rating Scale (SRRS). Spearman correlation analysis showed that BASDAI was highly associated with degree and duration of morning stiffness, overall pain, nocturnal back pain, overall back pain, anxiety, and BASFI (all P < 0.001), but were not associated with education, HAQ-S, and sleep medication in PSQI (P > 0.05). Multiple stepwise regression analysis indicated that overall pain was the maximal statistical contribution in predicting disease activity (standardized coefficient, 0.335). In hierarchic multiple regression analysis, psychological variables added an only additional 2.7 % to the overall R 2 beyond that accounted for by demographic and medical variables, resulting in a final R 2 of 53.5 %. Although BASDAI is a very good measurement of pain and stiffness and to a certain extent effect of functional impairment in AS, it barely takes into account psychological status, stress life events, and sleep quality These factors should be evaluated by other modalities.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Braun J, Sieper J (2007) Ankylosing spondylitis. Lancet 369(9570):1379–1390

    Article  PubMed  Google Scholar 

  2. Younes M et al (2010) Socioeconomic impact of ankylosing spondylitis in Tunisia. Joint Bone Spine 77(1):41–46

    Article  PubMed  Google Scholar 

  3. El-Miedany YM, El-Rasheed AH (2002) Is anxiety a more common disorder than depression in rheumatoid arthritis? Joint Bone Spine 69(3):300–306

    Article  PubMed  Google Scholar 

  4. DiMatteo MR, Lepper HS, Croghan TW (2000) Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence. Arch Intern Med 160(14):2101–2107

    Article  CAS  PubMed  Google Scholar 

  5. Brionez TF et al (2009) Psychological correlates of self-reported functional limitation in patients with ankylosing spondylitis. Arthritis Res Ther 11(6):R182

    Article  PubMed Central  PubMed  Google Scholar 

  6. Abad VC, Sarinas PS, Guilleminault C (2008) Sleep and rheumatologic disorders. Sleep Med Rev 12(3):211–228

    Article  PubMed  Google Scholar 

  7. Li Y et al (2012) Sleep disturbances are associated with increased pain, disease activity, depression, and anxiety in ankylosing spondylitis: a case–control study. Arthritis Res Ther 14(5):R215

    Article  PubMed Central  PubMed  Google Scholar 

  8. Martindale J et al (2006) Disease and psychological status in ankylosing spondylitis. Rheumatology (Oxford) 45(10):1288–1293

    Article  CAS  Google Scholar 

  9. Haywood KL et al (2002) Disease-specific, patient-assessed measures of health outcome in ankylosing spondylitis: reliability, validity and responsiveness. Rheumatology (Oxford) 41(11):1295–1302

    Article  CAS  Google Scholar 

  10. Zochling J, Braun J, van der Heijde D (2006) Assessments in ankylosing spondylitis. Best Pract Res Clin Rheumatol 20(3):521–537

    Article  PubMed  Google Scholar 

  11. Zung WW (1971) A rating instrument for anxiety disorders. Psychosomatics 12(6):371–379

    Article  CAS  PubMed  Google Scholar 

  12. ZUNG WW (1965) A self-rating depression scale. Arch Gen Psychiatry 12:63–70

    Article  CAS  PubMed  Google Scholar 

  13. Holmes TH, Rahe RH (1967) The social readjustment rating scale. J Psychosom Res 11(2):213–218

    Article  CAS  PubMed  Google Scholar 

  14. Daltroy LH et al (1990) A modification of the Health Assessment Questionnaire for the Spondyloarthropathies. J Rheumatol 17(7):946–950

    CAS  PubMed  Google Scholar 

  15. Tsai PS et al (2005) Psychometric evaluation of the Chinese version of the Pittsburgh Sleep Quality Index (CPSQI) in primary insomnia and control subjects. Qual Life Res 14(8):1943–1952

    Article  CAS  PubMed  Google Scholar 

  16. Lin Z et al (2011) Multicenter validation of the value of BASFI and BASDAI in Chinese ankylosing spondylitis and undifferentiated spondyloarthropathy patients. Rheumatol Int 31(2):233–238

    Article  PubMed Central  PubMed  Google Scholar 

  17. Ozgocmen S, Godekmerdan A, Ozkurt-Zengin F (2007) Acute-phase response, clinical measures and disease activity in ankylosing spondylitis. Joint Bone Spine 74(3):249–253

    Article  PubMed  Google Scholar 

  18. Batmaz I et al (2013) Sleep quality and associated factors in ankylosing spondylitis: relationship with disease parameters, psychological status and quality of life. Rheumatol Int 33(4):1039–1045

    Article  PubMed  Google Scholar 

  19. Wideman TH, Adams H, Sullivan MJ (2009) A prospective sequential analysis of the fear-avoidance model of pain. Pain 145(1–2):45–51

    Article  PubMed  Google Scholar 

  20. Vlaeyen JW, Crombez G, Linton SJ (2009) The fear-avoidance model of pain: we are not there yet. Comment on Wideman et al. “A prospective sequential analysis of the fear-avoidance model of pain” [Pain, 2009] and Nicholas “First things first: reduction in catastrophizing before fear of movement” [Pain, 2009]. Pain 146(1–2): p. 222; author reply 222–3

  21. Robertson LP, Davis MJ (2004) A longitudinal study of disease activity and functional status in a hospital cohort of patients with ankylosing spondylitis. Rheumatology (Oxford) 43(12):1565–1568

    Article  CAS  Google Scholar 

  22. Ortancil O et al (2010) Psychological status and patient-assessed health instruments in ankylosing spondylitis. J Clin Rheumatol 16(7):313–316

    PubMed  Google Scholar 

  23. Smith BW, Zautra AJ (2008) The effects of anxiety and depression on weekly pain in women with arthritis. Pain 138(2):354–361

    Article  PubMed Central  PubMed  Google Scholar 

  24. Smith MT, Haythornthwaite JA (2004) How do sleep disturbance and chronic pain inter-relate? Insights from the longitudinal and cognitive-behavioral clinical trials literature. Sleep Med Rev 8(2):119–132

    Article  PubMed  Google Scholar 

  25. Sastre JP et al (1996) Importance of the ventrolateral region of the periaqueductal gray and adjacent tegmentum in the control of paradoxical sleep as studied by muscimol microinjections in the cat. Neuroscience 74(2):415–426

    Article  CAS  PubMed  Google Scholar 

  26. Demarco GJ, Baghdoyan HA, Lydic R (2003) Differential cholinergic activation of G proteins in rat and mouse brainstem: relevance for sleep and nociception. J Comp Neurol 457(2):175–184

    Article  CAS  PubMed  Google Scholar 

  27. Casey KL et al (2001) Temporal and spatial dynamics of human forebrain activity during heat pain: analysis by positron emission tomography. J Neurophysiol 85(2):951–959

    CAS  PubMed  Google Scholar 

  28. Gunaydin R et al (2009) Fatigue in patients with ankylosing spondylitis: relationships with disease-specific variables, depression, and sleep disturbance. Clin Rheumatol 28(9):1045–1051

    Article  PubMed  Google Scholar 

  29. O Abdulaziez, TA (2012) Sleep problems in ankylosing spondylitis: polysomnographic pattern and disease related variables. The Egyptian Rheumatologist 34(2):59–65

  30. Evers AW et al (2005) Common burden of chronic skin diseases? Contributors to psychological distress in adults with psoriasis and atopic dermatitis. Br J Dermatol 152(6):1275–1281

    Article  CAS  PubMed  Google Scholar 

  31. Zautra AJ et al (1999) Field research on the relationship between stress and disease activity in rheumatoid arthritis. Ann N Y Acad Sci 876:397–412

    Article  CAS  PubMed  Google Scholar 

  32. Gourion D (2009) Events of life and links with severe depression at different ages. Encéphale 35(Suppl 7):S250–S256

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This project was supported by the National Natural Sciences Foundation of China (31070806), Clinical Subject (2007 and 2010) of Ministry of Public Health of China and from the Foundation of Guangdong province of China (2005A30801005 and 2008B080701086), State Board of Education Fund for the Doctoral (20060558046), Guangzhou Science and Technology Plan Projects (2006Z2-E0221), and 5010 Subject of Sun Yat-sen University (2009–2010).

Disclosures

None.

Author information

Authors and Affiliations

  1. Department of Rheumatology and Immunology, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, China

    Yutong Jiang, Mingcan Yang, Zaiying Hu, Zhiming Lin, Yanli Zhang, Zetao Liao, Shuangyan Cao, Yanlin Wei, Li Li, Qiuxia Li, Qing Lv, Jun Qi, Jianlin Huang, Tianwang Li, O. Jin, Yunfeng Pan & J. Gu

  2. Department of Rheumatology and Immunology, Beijing Jishuitan Hospital, Beijing, China

    Husheng Wu & Hui Song

  3. Department of Rheumatology, Hainan Provincial People’s Hospital, Haikou, China

    Feng Zhan

  4. Department of Urology and Rheumatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China

    Shengyun Liu, Guanmin Gao & Zhangsuo Liu

  5. Department of Immunology and Rheumatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

    Zhaoxian Hu, Peigen He & Shengtao Zhang

  6. Department of Rheumatology, Fuzhou General Hospital of Nanjing Military Command, Fuzhou, China

    Yinong Li

  7. Department of Immunology and Rheumatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

    Lingxun Shen & Anbing Huang

Authors
  1. Yutong Jiang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mingcan Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Husheng Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hui Song
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Feng Zhan
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Shengyun Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Guanmin Gao
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Zhangsuo Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Zhaoxian Hu
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Peigen He
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Shengtao Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Zaiying Hu
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Zhiming Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Yanli Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Yinong Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Lingxun Shen
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Anbing Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Zetao Liao
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Shuangyan Cao
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. Yanlin Wei
    View author publications

    You can also search for this author in PubMed Google Scholar

  21. Li Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  22. Qiuxia Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  23. Qing Lv
    View author publications

    You can also search for this author in PubMed Google Scholar

  24. Jun Qi
    View author publications

    You can also search for this author in PubMed Google Scholar

  25. Jianlin Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  26. Tianwang Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  27. O. Jin
    View author publications

    You can also search for this author in PubMed Google Scholar

  28. Yunfeng Pan
    View author publications

    You can also search for this author in PubMed Google Scholar

  29. J. Gu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. Gu.

Additional information

Yutong Jiang and Mingcan Yang stay equal as the first authors.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jiang, Y., Yang, M., Wu, H. et al. The relationship between disease activity measured by the BASDAI and psychological status, stressful life events, and sleep quality in ankylosing spondylitis. Clin Rheumatol 34, 503–510 (2015). https://doi.org/10.1007/s10067-014-2688-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-014-2688-x

Keywords

Search

Navigation