Clinical characteristics, disease activity and psychosocial burden of axial spondyloarthritis in Jordan: a multicenter cross-sectional study

Abstract Axial spondyloarthritis (AxSpA) is a chronic inflammatory condition of the spine and sacroiliac joints, associated with a considerable functional and psychosocial burden. This study aimed to investigate the interplay between disease activity and patient-reported outcomes, specifically focusing on how psychosocial factors and functional status serve as predictors of disease severity in Jordanian patients with AxSpA. We conducted a cross-sectional study at two tertiary hospitals in Jordan, including patients diagnosed according to the Assessment of SpondyloArthritis International Society (ASAS) criteria. A total of 79 patients were analyzed, with a mean age of 41.1 ± 11.9 years and a significant diagnostic delay of 5.7 ± 6.1 years. Sixty-seven were diagnosed with ankylosing spondylitis (AS), and twelve with non-radiographic AxSpA (nr-axSpA). Most patients were current smokers (53.2%), and more than half of the patients were retired or unemployed. Notable psychosocial burden was observed according to the Patient Health Questionnaire-9 (PHQ-9) questionnaire, with over half of the patients experiencing depressive symptoms and one-fifth screening positive for fibromyalgia according to the Fibromyalgia Rapid Screening Tool (FiRST). Using the Ankylosing Spondylitis Disease Activity Score (ASDAS), a majority of patients demonstrated high (51.9%) or very high (29.1%) disease activity. Male patients and those with higher ASQOL scores (worse quality of life) were significantly more likely to have very high disease activity. In patients receiving TNF inhibitors, NLR maintained the highest discriminatory ability, with an AUC of 0.676 (95% CI: 0.517–0.834). Significant diagnostic delays, smoking prevalence, work disability, and psychological burden were observed. Longitudinal studies remain essential to confirm these findings and better assess disease progression and treatment outcomes.