Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, 06100 Sihhiye, Ankara, Turkey.
Rheumatol Int. 2012 Feb;32(2):323-30. doi: 10.1007/s00296-010-1616-x. Epub 2010 Nov 16.
The objective of this study was to assess the effect of infliximab on depression, anxiety and quality of life in patients with active ankylosing spondylitis (AS). In this 6-week longitudinal study, 16 patients with AS were assessed. Active disease as defined by BASDAI ≥4.0 was sought for inclusion. Infliximab was administered 5 mg/kg at 0, 2 weeks and 6 weeks. Collected data included age, sex and date of onset of rheumatologic disease. Activity of disease was measured using Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Biological activity was evaluated with erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). ESR and CRP were assessed at baseline and day 42. The Hospital Anxiety and Depression scale (HADS), Beck Depression Inventory (BDI) and 36-item Short Form Health Survey (SF-36) were used to evaluate anxiety, depression and quality of life. BASDAI, SF-36, HADS and BDE were assessed prior to the initial infliximab dose and at 2nd, 14th and 42nd day. Seven (43.8%) AS patients had depression scores above the cut off value for both the HADS depression (HADS-D) and BDI and 4 (25 %) had high HADS anxiety scores at baseline. Significant time effect for BDI and HADS-D scores were observed. Although significantly lower BDI scores were found after first, second and third infusions of infliximab, compared to initial score, the significant decrease in HADS-D appeared after second and third infusions. A significant time effect for HADS-anxiety scores were found as well. All of the subscales of SF-36 improved significantly during the course, with an exception of role emotional, for which the difference approached to the significance. The change in BASDAI scores and CRP and ESR, in the treatment process, were not correlated with the change in depression and anxiety scores. Infliximab which is an anti-TNF-α drug, may be effective in the treatment of depression accompanying AS. Possible implications for the treatment of major depressive disorder were discussed, as well.
本研究旨在评估英夫利昔单抗对活动期强直性脊柱炎（AS）患者抑郁、焦虑和生活质量的影响。在这项为期 6 周的纵向研究中，评估了 16 例 AS 患者。纳入标准为 BASDAI≥4.0 定义的活动性疾病。给予患者英夫利昔单抗 5mg/kg，分别在 0、2 周和 6 周时给药。收集的数据包括年龄、性别和风湿病发病日期。采用 Bath 强直性脊柱炎疾病活动指数（BASDAI）评估疾病活动度。通过红细胞沉降率（ESR）和 C 反应蛋白（CRP）评估生物活性。在基线和第 42 天评估 ESR 和 CRP。采用医院焦虑抑郁量表（HADS）、贝克抑郁量表（BDI）和 36 项简明健康调查问卷（SF-36）评估焦虑、抑郁和生活质量。在首次英夫利昔单抗剂量前以及第 2、14 和 42 天评估 BASDAI、SF-36、HADS 和 BDI。7 例（43.8%）AS 患者的 HADS 抑郁（HADS-D）和 BDI 评分均高于抑郁评分的截断值，4 例（25%）患者在基线时 HADS 焦虑评分较高。BDI 和 HADS-D 评分均有显著的时间效应。尽管与初始评分相比，在首次、第二次和第三次英夫利昔单抗输注后，BDI 评分显著降低，但在第二次和第三次输注后，HADS-D 评分的显著降低出现。HADS 焦虑评分也有显著的时间效应。在整个过程中，SF-36 的所有亚量表均显著改善，除角色情感外，差异接近显著。治疗过程中 BASDAI 评分和 CRP、ESR 的变化与抑郁和焦虑评分的变化无关。英夫利昔单抗是一种抗 TNF-α 药物，可能对治疗伴有 AS 的抑郁症有效。讨论了其对治疗重度抑郁症的可能影响。
