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Posttraumatic stress disorder and correlates of disease activity among veterans with ankylosing spondylitis

Abstract

The objective of this retrospective study was to evaluate the prevalence of comorbid Posttraumatic stress disorder (PTSD) and the association of PTSD with pain, disease activity, and medication use in ankylosing spondylitis (AS). Veterans with one or more visit to an outpatient rheumatology clinic at a single Veterans Affairs site during a 2-year study period were identified by ICD codes for AS and included if there was documentation of AS diagnosis by a rheumatologist. Data were collected on PTSD diagnosis, demographics, pain scores, disease activity by the Bath AS Disease Activity Index (BASDAI), and medication use. Characteristics were compared by PTSD status using t tests for continuous variables and Chi-square or Fischer’s exact test for categorical variables. Of 113 Veterans with AS, 20 (18%) had a diagnosis of PTSD. Those with PTSD were significantly younger, 52 ± 17 years, as compared to those without PTSD, 59 ± 14 years (p = 0.04). BASDAI was recorded for 30% with a mean score of 4.3 ± 2.0. Those with PTSD had higher mean pain and BASDAI scores as compared to those without PTSD (p = 0.06 for both comparisons). Prescribed medications were similar for both groups in regards to synthetic disease modifying antirheumatic drugs (DMARDs), biologics, and opioids, although those with PTSD were significantly more likely to receive NSAIDs (p = 0.03). Veterans with AS and comorbid PTSD were younger and had higher reported pain and disease activity scores compared to those without PTSD in this single site study. These findings underscore the importance of identifying PTSD in patients with AS.

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Acknowledgements

We would like to acknowledge Dr. Atul Deodhar for his review of the manuscript.

Funding

Dr. Jennifer L. Barton was supported by the NIH (Grant K23-AR-064372). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Department of Veterans Affairs.

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Correspondence to Jean Liew.

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The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the institutional review board of the Veterans Affairs Portland Health Care System and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed consent

Informed consent for individual participants included in the study was waived by the institutional review board of the Veterans Affairs Portland Health Care System, as individuals were not contacted by study coordinators and individual data was de-identified.

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Liew, J., Lucas Williams, J., Dobscha, S. et al. Posttraumatic stress disorder and correlates of disease activity among veterans with ankylosing spondylitis. Rheumatol Int 37, 1765–1769 (2017). https://doi.org/10.1007/s00296-017-3801-7

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Keywords

  • Ankylosing spondylitis
  • Posttraumatic stress disorder
  • Disease activity
  • BASDAI
  • Pain