GI and Psychological Symptoms Strongly Associated with Disease Severity in SpA

5/29/2025

A study published in BMC Rheumatology found that gastrointestinal (GI) and psychological symptoms are closely linked to worse outcomes in adults with spondyloarthritis (SpA), emphasizing the importance of a comprehensive, holistic approach to treatment.

While SpA is primarily known for causing inflammation in the spine and joints, this study revealed that many patients also experience a range of non-musculoskeletal symptoms. These include GI issues like abdominal pain, bloating, and diarrhea, as well as mental health challenges such as depression and feelings of helplessness.

To better understand these connections, researchers studied 98 adults with SpA who did not have inflammatory bowel disease (IBD). They used a mix of surveys and lab tests to assess gastrointestinal symptoms, psychological stress, depression, disease activity, and physical functioning. Disease activity was measured using the Ankylosing Spondylitis Disease Activity Score (ASDAS) and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), both of which track symptom severity and inflammation. The Bath Ankylosing Spondylitis Functional Index (BASFI) was used to evaluate how SpA affects daily activities. Lab tests included markers of inflammation such as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), fecal calprotectin, and secretory IgA.

The findings indicated:

• 65% of participants reported at least two GI symptoms, with abdominal pain and diarrhea being the most common.
• 47% showed signs of depression, and 25% had moderate to severe levels of depression
• Patients with multiple GI symptoms were significantly more likely to also be depressed.
• Higher levels of depression and helplessness were strongly associated with increased disease activity and reduced physical function.
• Individuals with low confidence in managing their condition tended to experience more GI symptoms, higher stress, and poorer health outcomes overall.

Physical exams and tissue analyses further revealed signs of inflammation and structural abnormalities in the intestines even in the absence of a formal IBD diagnosis.

According to researchers, these results highlight the role of the gut-brain axis—the two-way connection between gut health, immune response, and mental well-being. The study suggests that inflammation and stress in the gut may worsen mood symptoms, while psychological distress may, in turn, aggravate gut and disease activity.

Ultimately, these findings support the need for a more comprehensive approach to SpA management—one that addresses both physical and emotional health and incorporates collaboration across specialties to improve patient outcomes and quality of life.

References

• BMC Rheumatology – Impact of gastrointestinal and psychological symptoms on disease activity and functional impairment in patients with spondyloarthritis: a cross-sectional study
• Spondylitis Association of America – IBS Prevalent in People with axSpA; IBS Also Linked to Anxiety and Physical Inactivity
• Spondylitis Association of America – People with IBD Face Greater Risk of Spondyloarthritis, Study Suggests 
• Spondylitis Association of America – BASDAI Calculator