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Elevated IL-23 Levels in PsA Patients are Associated with Depression, Anxiety

Patients with psoriatic arthritis (PsA) who have elevated interleukin-23 (IL-23) levels have been linked to higher rates of depression, anxiety, and disease activity.

This article was originally published on Rheumatology Network.

Elevated serum interleukin-23 (IL-23) levels in patients with psoriatic arthritis (PsA) was directly associated with depression, anxiety, and disease activity, according to a study published in Springer.

“Psoriatic disease is frequently limited to the core clinical domains of skin psoriasis, nail involvement, peripheral inflammatory arthritis, axial spondyloarthritis, enthesitis, and dactylitis, while its numerous systemic consequences and comorbidities are ignored,” investigators explained. “The psychosocial burden of PsA has been shown to have a negative effect on the quality of life of the patients. In PsA, psychological disorders can both cause and exacerbate disease development.”

In this observational case-control study, 80 patients with PsA, meeting the Classification Criteria for Psoriatic Arthritis (CASPAR) criteria, and 80 healthy volunteers were matched for age and gender. Information collected included disease history, a clinical assessment, a Disease Activity Index for Psoriatic Arthritis (DAPSA) score, the Psoriasis Area and Severity Index (PASI), and ultrasonographic entheses according to the Madrid Sonographic Enthesitis Index (MASEI). Depression and anxiety were evaluated by the Hospital Anxiety and Depression Scale (HADS). IL-23 was measured and compared with disease activity, depression, and anxiety.

A difference between patients and controls regarding demographic data was not reported. The mean duration of PsA was 6.94 years and the mean duration of psoriasis symptoms was 10.43 years. In total, 36 patients with PsA reported anxiety (45%) and 28 patients experienced depression (35%), compared with the control group who reported significantly less anxiety (n = 16, 20%) and depression (n = 12, 15%). HADS anxiety and depression scores were positively correlated between HADS depression (r: 0.934, p: 0.0001), anxiety (r: 0.932, p: 0.0001), IL-23, DAPSA (r: 0. 0.959, p: 0.0001), PASI (r: 0.765, p: 0.0001), and MASEI (r: 0.545, p: 0.001) scores (p < 0.05). IL-23 was positively linked to DAPSA, PASI, and HADS scores. Additionally, IL-23, DAPSA, and PASI scores were independently associated with depression and anxiety.

Patients who were not responding to treatment (n = 22) were significantly more likely to experience anxiety (n = 20, 90.9%) compared with treatment responders (n = 16, 27.6%). Non-responders were also more likely to report depression (n = 16, 72.7%) compared with treatment responders (n = 12, 20.7%).

The single-centered, cross-sectional study design limited results as did the small number of participants. Future longitudinal studies may be necessary to evaluate the relation between IL-23 and depression, anxiety, and disease activity. Confounding factors regarding depression and anxiety during the COVID-19 pandemic and its effect on psychological status are unknown.

“PsA is a chronic progressive inflammatory condition, involving peripheral arthritis and/or spondylitis associated with psoriasis,” investigators concluded. “PsA also affects mental health. Serum interleukin-23 levels were elevated in PsA patients and were found to be correlated with depression, anxiety, and disease activity.”

The study, "Serum interleukin-23 levels: relation to depression, anxiety, and disease activity in psoriatic arthritis patients" was published in Clin Rheumatol.