{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T22:06:28Z","timestamp":1785881188393,"version":"3.56.0"},"reference-count":46,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T00:00:00Z","timestamp":1778630400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      At diagnosis, patients exhibited high disease activity (BASDAI 4.6\u202f\u00b1\u202f2.0, ASDAS 2.6\u202f\u00b1\u202f0.9) and substantial prevalence of depressive symptoms (PHQ-9\u202f\u2265\u202f10 in 36.5%) and fatigue (FACIT-\n                      <jats:italic>F<\/jats:italic>\n                      \u202f&amp;lt;\u202f39 in 69.5%). One-year follow-up showed significant improvements in disease activity, functional impairment, HRQoL, mental well-being, and fatigue (all\n                      <jats:italic>p\u202f&amp;lt;<\/jats:italic>\n                      \u202f0.05). 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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1823684","type":"journal-article","created":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T04:46:57Z","timestamp":1778647617000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Interrelations of disease activity, health-related quality of life, and mental health in axial spondyloarthritis: the Rheuma-VOR cohort"],"prefix":"10.3389","volume":"13","author":[{"given":"Lina Judit","family":"Schiestl","sequence":"first","affiliation":[{"name":"Division of Rheumatology and Clinical Immunology, Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University","place":["Mainz, Germany"]},{"name":"Department of Gynecology and Obstetrics, University Medical Center of the Johannes Gutenberg University","place":["Mainz, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Wendt","sequence":"additional","affiliation":[{"name":"Division of Rheumatology and Clinical Immunology, Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University","place":["Mainz, Germany"]},{"name":"Department of Internal Medicine I, University Medical Center Kiel","place":["Kiel, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabian","family":"Proft","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, corporate member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin","place":["Berlin, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirsten","family":"Hoeper","sequence":"additional","affiliation":[{"name":"Center for Rheumatology Lower Saxony, Hannover e.V","place":["Hannover, Germany"]},{"name":"Department of Rheumatology and Immunology, Hannover Medical School","place":["Hanover, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Torsten","family":"Witte","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Immunology, Hannover Medical School","place":["Hanover, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gunter","family":"Assmann","sequence":"additional","affiliation":[{"name":"Center of Rheumatology and Clinical Immunology, Ruhr-University Bochum","place":["Bochum, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Schwarting","sequence":"additional","affiliation":[{"name":"Division of Rheumatology and Clinical Immunology, Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University","place":["Mainz, Germany"]},{"name":"Center for Rheumatology Rhineland-Palatinate","place":["Bad Kreuznach, Germany"]},{"name":"University Center for Autoimmunity, University Medical Center of the Johannes Gutenberg University","place":["Mainz, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Dreher","sequence":"additional","affiliation":[{"name":"Division of Rheumatology and Clinical Immunology, Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University","place":["Mainz, Germany"]},{"name":"University Center for Autoimmunity, University Medical Center of the Johannes Gutenberg University","place":["Mainz, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,13]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"408","DOI":"10.1001\/jama.2024.20917","article-title":"Axial spondyloarthritis: a review","volume":"333","author":"Bittar","year":"2025","journal-title":"JAMA"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1016\/S0140-6736(24)02263-3","article-title":"Axial spondyloarthritis","volume":"405","author":"Navarro-Comp\u00e1n","year":"2025","journal-title":"Lancet"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1468","DOI":"10.1093\/rheumatology\/keab544","article-title":"Age at onset in axial spondyloarthritis around the world: data from the assessment in SpondyloArthritis international society peripheral involvement in Spondyloarthritis 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