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The following is a summary of “Interrelationships of disease activity, central sensitization, psychosocial and lifestyle factors in axial spondyloarthritis ,” published in the February 2025 issue of Rheumatology by Kieskamp et al. 

Many patients with axial spondyloarthritis (axSpA) have high disease activity despite treatment. Factors beyond inflammation, including pain mechanisms and psychosocial aspects, may contribute. 

Researchers conducted a retrospective study to examine the interrelationships of Axial Spondyloarthritis Disease Activity Score (ASDAS) with central sensitization (CS), psychological, and lifestyle factors in axSpA. 

They included consecutive patients from the prospective Groningen Leeuwarden axSpA (GLAS) cohort in this cross-sectional study. They assessed educational level, body mass index (BMI), CS, illness perception, pain catastrophizing, coping, anxiety, depression, physical activity (mSQUASH), and ASDAS. They applied structural equation modeling (SEM) to analyze the effects of CS, psychosocial, and lifestyle factors on ASDAS. 

The results showed that 332 patients with axSpA were analyzed (59% male, median symptom duration 21 years, mean ASDAS 2.2 ± 0.9). The final SEM model had a satisfactory fit (RMSEA = 0.057, 95% CI 0.45–0.70; CFI = 0.936). Illness perception, CS, and BMI had significant direct effects on ASDAS, while psychological well-being and education were indirectly associated through illness perception. 

Investigators found that factors beyond inflammation, especially illness perception and CS, significantly contributed to ASDAS in treated axSpA patients, highlighting the need for a biopsychosocial approach. 

Source: academic.oup.com/rheumatology/advance-article/doi/10.1093/rheumatology/keaf102/8030224