Anxiety Plays a Significant Role in Physical Activity Avoidance Among Patients with PsA

Damiano Currado, MD

Credit: Fondazione Policlinico Universitario Campus Bio-Medico

Patients with psoriatic arthritis (PsA) were more likely to avoid physical activity based on anxiety symptoms and physical function, as opposed to disease activity, according to data presented at the 2024 European Congress of Rheumatology (EULAR) conference.¹

“According to EULAR recommendations, regular physical activity is strongly recommended in patients with inflammatory arthritis, to maintain adequate joint movement and reduce cardiovascular risk, which is increased in PsA,” wrote a team of investigators led by Damiano Currado, MD, associated with the Fondazione Policlinico Universitario Campus Bio-Medico, Clinical and Research Section of Rheumatology and Clinical Immunology, Italy.¹ “However, the presence of pain and joint deformities could limit the ability of PsA patients to exercise. Furthermore, psychosocial factors are important determinants of pain experience in patients with inflammatory arthritis.”

Researchers often employ the Fear Avoidance Beliefs Questionnaire (FABQ), a 16-item assessment designed to evaluate a person’s fear-avoidance believes regarding physical activity and work, to determine how these psychological factors can impact the experience of pain, as well as the development of chronic pain and disability, among this patient population. Previous results have indicated patients exhibiting fear avoidance beliefs are less active and less likely to tackle pain-related problems.¹

As exercise has shown clear beneficial effects on wellbeing, disease activity, and comorbidities among this patient population, motivating patients to participate in physical activity is important. A systematic review of 13 studies evaluating exercise among this patient population showed physical activity improved the general symptoms of the disease, including pain and fatigue, quality of life, and reduced certain cardiovascular risk factors.²

To assess the prevalence of physical activity avoidance, and any relevant variables linked to avoidance, such as psychological domains, investigators conducted a single-center, cross-sectional, observational study on patients with PsA. The FABQ physical activity (FABQ PA) focused on how a patient’s fear of pain may impact their inclination to avoid exercise. A score of ≥ 15 indicated high levels of fear-avoidance believes related to physical activity. Univariate and multivariable linear regressions were performed to determine any psychometric, pathology-related, or demographic factors. Eligible patients met the Classification Criteria for Psoriatic Arthritis (CASPAR) criteria.¹

Among enrolled participants, the mean age was 57 years, 69.2% were female, and the mean body mass index (BMI) was 27. The mean FABQ PA was 11.4, the Hospital Anxiety and Depression Scale (HADS) for anxiety score was 8.17, and the HADS depression score was 7.23. In terms of disease activity, the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score was 5.45 and the Disease Activity in PsA (DAPSA) score was 14.3.¹

The median FABQ PA score was 11.4. However, 27.69% of patients exhibited a FABQ PA score of ≥ 15 and 37.1% reported concomitant fibromyalgia. The proportion of patients with both fibromyalgia and a FABQ PA ≥ 15 was 52.9%. The median Pain Catastrophizing Scale (PSC) was 20.97 and the median 36-item Short Form Physical Component Score (SF-36 PCS) value was 35.3.¹

Those with a higher fear-avoidance score based on the FABQ were shown to have higher PCS, SF-36 PCS, and BASDAI when compared with patients who reported a FABQ PA score of < 15 (P = .030, .002, and .0002, respectively).¹

According to a multivariable linear regression, independent predictors of physical activity avoidance were anxiety symptoms—as determined by HADS—and the SF-36 PCS. However, the FABQ was not independently linked to any disease activity index.¹

References

1. ^{Minerba M, Currado D, Marino A, Berardicurti, et al. Prevalence and Predictive Factors of Physical Activity Avoidance in Patients with Psoriatic Arthritis. Presented at: EULAR. Vienna, Austria. June 12 – 15, 2024.}
2. ^{Kessler J, Chouk M, Ruban T, Prati C, Wendling D, Verhoeven F. Psoriatic arthritis and physical activity: a systematic review. Clin Rheumatol. 2021;40(11):4379-4389. doi:10.1007/s10067-021-05739-y}