Skip to main content

Advertisement

SpringerLink
Log in

Infliximab, a TNF-alpha antagonist treatment in patients with ankylosing spondylitis: the impact on depression, anxiety and quality of life level

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

Abstract

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.

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

Fig. 1

Similar content being viewed by others

References

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

    Article  PubMed  Google Scholar 

  2. Barlow JH, Macey SJ, Struthers GR (1993) Gender, depression, and ankylosing spondylitis. Arthritis Care Res 6:45–51

    Article  PubMed  CAS  Google Scholar 

  3. Martindale J, Smith J, Sutton CJ, Grennan D, Goodacre L, Goodacre JA (2006) Disease and psychological status in ankylosing spondylitis. Rheumatology 45:1288–1293

    Article  PubMed  CAS  Google Scholar 

  4. Zink A, Braun J, Listing J, Wollenhaupt J (2000) Disability and handicap in rheumatoid arthritis and ankylosing spondylitis—results from the German rheumatological database. J Rheumatol 27:613–622

    PubMed  CAS  Google Scholar 

  5. Evans DL, Charney DS, Lewis L et al (2005) Mood disorders in the medically ill: scientific review and recommendations. Biol Psychiatry 58:175–189

    Google Scholar 

  6. Raison CL, Capuron L, Miller AH (2006) Cytokines sing the blues: inflammation and the pathogenesis of depression. Trends Immunol 27:24–31

    Article  PubMed  CAS  Google Scholar 

  7. Alesci S, Martinez PE, Kelkar S, Ilias I, Ronsaville DS, Listwak SJ, Ayala AR, Licinio J, Gold HK, Kling MA, Chrousos GP, Gold PW (2005) Major depression is associated with significant diurnal elevations in plasma interleukin-6 levels, a shift of its circadian rhythm, and loss of physiological complexity in its secretion: clinical implications. J Clin Endocrinol Metab 90:2522–2530

    Article  PubMed  CAS  Google Scholar 

  8. Thomas AJ, Davis S, Morris C, Jackson E, Harrison R, O’Brien JT (2005) Increase in interleukin-1beta in late-life depression. Am J Psychiatry 162:175–177

    Article  PubMed  Google Scholar 

  9. Tuglu C, Kara SH, Caliyurt O, Vardar E, Abay E (2003) Increased serum tumor necrosis factor-alpha levels and treatment response in major depressive disorder. Psychopharmacology 170:429–433

    Article  PubMed  CAS  Google Scholar 

  10. Lanquillon S, Krieg JC, Bening-Abu-Shach U, Vedder H (2000) Cytokine production and treatment response in major depressive disorder. Neuropsychopharmacology 22:370–379

    Article  PubMed  CAS  Google Scholar 

  11. Kubera M, Maes M, (2000) Serotonin–immune interactions in major depression. In: Patterson, Kordon, Christen (eds) Neuro–immune interactions in neurologic and psychiatric disorders. Springer-Verlag, Berlin, pp 79–87

  12. O’Brien SM, Scott LV, Dinan TG (2004) Cytokines: abnormalities in major depression and implications for pharmacological treatment. Hum Psychopharmacol 19:397–403

    Article  PubMed  Google Scholar 

  13. Persoons P, Vermeire S, Demyttenaere K, Fischler B, Vandenberghe J, Oudenhove LV et al (2005) The impact of major depressive disorder on the short- and long-term outcome of Crohn’s disease treatment with infliximab. Aliment Pharmacol Ther 22:101–110

    Article  PubMed  CAS  Google Scholar 

  14. Lichtenstein GR, Bala M, Han C, DeWoody K, Schaible T (2002) Infliximab improves quality of life in patients with Crohn’s disease. Inflamm Bowel Dis 8:237–243

    Article  PubMed  Google Scholar 

  15. Minderhoud IM, Samsom M, Oldenburg B (2007) Crohn’s disease, fatigue, and infliximab: is there a role for cytokines in the pathogenesis of fatigue? World J Gastroenterol 13:2089–2093

    PubMed  CAS  Google Scholar 

  16. Tyring S, Gottlieb A, Papp K, Gordon K, Leonardi C, Wang A et al (2006) Etanercept and clinical outcomes, fatigue, and depression in psoriasis: double-blind placebo-controlled randomized phase III trial. Lancet 367:29–35

    Article  PubMed  CAS  Google Scholar 

  17. Van der Linden S, Valkenburg HA, Cats A (1984) Evaluation of diagnostic criteria for ankylosing spondylitis. Arthritis Rheum 27:361–367

    Article  PubMed  Google Scholar 

  18. Braun J, Pham T, Sieper J et al (2003) International ASAS consensus statement for the use of anti-tumour necrosis factor agents in patients with ankylosing spondylitis. Ann Rheum Dis 62:817–824

    Article  PubMed  CAS  Google Scholar 

  19. Akkoc Y, Karatepe AG, Akar S, Kirazli Y, Akkoc N (2005) A Turkish version of the Bath Ankylosing Spondylitis disease activity index: reliability and validity. Rheumatol Int 25:280–284

    Article  PubMed  Google Scholar 

  20. Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67:361–370

    Article  PubMed  CAS  Google Scholar 

  21. Aydemir Ö, Güvenir T, Küey L, Kültür S (1997) The reliability and validity of Turkish form of Hospital Anxiety and Depression Scale. Turk psikiyatri Derg 8:280–287 (in Turkish)

    Google Scholar 

  22. Beck AT, Steer RA, Garbin MG (1988) Psychometric properties of the Beck depression inventory: twenty-five years of evaluation. Clin Psychol Rev 8:77–100

    Article  Google Scholar 

  23. Hisli N (1989) Beck depression envanterinin üniversite öğrencileri için geçerliliği, güvenilirliği. A reliability and validity study of Beck Depression Inventory in a university student sample. J Psychol (Psikoloji Dergisi) 7:3–13 (in Turkish)

    Google Scholar 

  24. Koçyiğit H, Aydemir Ö, Ölmez N, Memiş A (1999) The reliability and validity of SF-36 for Turkish language. Ege Fizik Tedavi ve Rehabilitasyon Dergisi 12:102–106 (in Turkish)

    Google Scholar 

  25. Walker EA, Gelfand MD, Gelfand AN et al (1996) The relationship of current psychiatric disorder to functional disability and distress in patients with inflammatory bowel disease. Gen Hosp Psychiatry 18:220–229

    Google Scholar 

  26. Katon WJ, Ciechanowski P (2002) Impact of major depression on chronic medical illness. J Psychosom Res 53:859–863

    Google Scholar 

  27. Ware JE (1995) The status of health assessment 1994. Annu Rev Public Health 16:327–354

    Google Scholar 

  28. Beusterien KM, Steinwald B, Ware JE (1996) Usefulness of the SF-36 Health Survey in measuring health outcomes in the depressed elderly. J Geriatr Psychiatry Neurol 9:13–21

    Google Scholar 

  29. Coulehan JL, Schulberg HC, Block MR et al (1997) Treating depressed primary care patients improves their physical, mental, and social functioning. Arch Intern Med 157:1113–1120

    Google Scholar 

  30. Yonkers KA, Samson JA (2008) Mood disorders measures. In: Rush AJ, First MB, Blacker D (eds) Handbook of psychiatric measures, 2nd edn. American Psychiatric Publishing, Arlington VA, pp 499-528

  31. Eren İ, Şahin M, Cüre E et al (2007) Interactions between psychiatric symptoms and disability and quality of life in ankylosing spondylitis patients. Arch Neuropsychiatry 44:1–9

    Google Scholar 

  32. Müller N, Schwarz MJ (2007) The immune-mediated alteration of serotonin and glutamate: towards an integrated view of depression. Mol Psychiatry 12:988–1000

    Google Scholar 

  33. Myint AM, Kim YK (2003) Cytokine-serotonin interaction through IDO: a neurodegeneration hypothesis of depression. Med Hypothesis 61:519–525

    Google Scholar 

  34. Zhu CB, Blakely RD, Hewlett WA (2006) The proinflammatory cytokines interleukin-1beta and tumor necrosis factor-alpha activate serotonin transporters. Neuropsychopharmacol 31:2121–2131

    Google Scholar 

  35. Raison C A study of infliximab for treatment resistant major depression emory university. http://clinicaltrials.gov/show/NCT00463580

Download references

Author information

Authors and Affiliations

  1. Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, 06100, Sihhiye, Ankara, Turkey

    I. Ertenli, S. Kiraz, S. B. Apras, A. Akdogan, O. Karadag, M. Calguneri & U. Kalyoncu

  2. Department of Psychiatry, Faculty of Medicine, Hacettepe University, Ankara, Turkey

    S. Ozer

Authors
  1. I. Ertenli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. Ozer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Kiraz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S. B. Apras
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A. Akdogan
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. O. Karadag
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. M. Calguneri
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. U. Kalyoncu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to U. Kalyoncu.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ertenli, I., Ozer, S., Kiraz, S. et al. Infliximab, a TNF-alpha antagonist treatment in patients with ankylosing spondylitis: the impact on depression, anxiety and quality of life level. Rheumatol Int 32, 323–330 (2012). https://doi.org/10.1007/s00296-010-1616-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00296-010-1616-x

Keywords

Search

Navigation