Interrelations of disease activity, health-related quality of life, and mental health in axial spondyloarthritis: the Rheuma-VOR cohort

Background Axial spondyloarthritis (axSpA) is a chronic inflammatory rheumatic disease characterized by pain and stiffness of the axial skeleton, peripheral manifestations like arthritis, dactylitis and enthesitis, extra-musculoskeletal manifestations, and reduced health-related quality of life (HRQoL). Depressive symptoms and fatigue are common, yet few studies have assessed these outcomes at diagnosis and during early treatment. Objective To evaluate mental health, fatigue, HRQoL, and their association with disease activity and functional status in patients with axSpA at diagnosis and after 1 year of rheumatologic care. Methods Rheuma-VOR is a multicenter, proof- of concept study in Germany implementing structured preselection and early referral for suspected axSpA. We included 238 patients with confirmed axSpA, of whom 76 completed a 12-month follow-up. Disease activity (BASDAI, ASDAS), functional status (BASFI, BASMI, FFbH), mental health (PHQ-9, WHO-5), fatigue (FACIT-F), and HRQoL (EQ-5D) were assessed at baseline and follow-up. Associations between disease activity, function, and patient-reported outcomes (PROs) were analyzed using correlation and multivariable regression. Results At diagnosis, patients exhibited high disease activity (BASDAI 4.6 ± 2.0, ASDAS 2.6 ± 0.9) and substantial prevalence of depressive symptoms (PHQ-9 ≥ 10 in 36.5%) and fatigue (FACIT- F 39 in 69.5%). One-year follow-up showed significant improvements in disease activity, functional impairment, HRQoL, mental well-being, and fatigue (all p 0.05). Higher patient-reported disease activity (BASDAI) consistently predicted depressive symptoms and fatigue, whereas functional capacity (FFbH) was the strongest predictor of HRQoL. Physician-assessed disease activity (ASDAS) and functional impairment (BASFI) had smaller or time-limited effects. Conclusion In axSpA, patient-reported disease activity and functional capacity are key determinants of mental health, HRQoL, and fatigue. Early diagnosis and initiation of guideline-concordant therapy are associated with improvements across physical and psychological domains, supporting systematic screening and interdisciplinary management strategies.