Kinesiophobia as part of the psychological burden in Spondyloarthritis: a case-control study

Eugenio Capparelli; Maria Iacovantuono; Sergio Del Vescovo; Benedetta Monosi; Chiara Bonini; Luigi Fiannacca; Elisabetta Greco; Eneida Cela; Paola Conigliaro; Greta Giulia Dipietrangelo; Florenzo Iannone; Giuseppe Lopalco; Maria Sole Chimenti

doi:10.1093/rap/rkaf040

Kinesiophobia as part of the psychological burden in Spondyloarthritis: a case-control study

Rheumatol Adv Pract. 2025 Apr 11;9(2):rkaf040. doi: 10.1093/rap/rkaf040. eCollection 2025.

Affiliations

¹ Rheumatology, Allergology and Clinical Immunology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
² Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), UNIBA, Bari, Italy.

Abstract

Objectives: Psychological distress is commonly reported by patients affected by Spondyloarthritis (SpA), with >50% experiencing concomitant depression or anxiety. This case-control study aimed to investigate the psychological dimensions of SpA by assessing and comparing levels of kinesiophobia, depression and health-related quality of life (HRQoL) between SpA patients and a healthy control (HC) group.

Methods: This cross-sectional case-control study included patients with SpA classified by Assessment of SpondyloArthritis international Society classification criteria and a group of HCs matched by sex and age. Inclusion criteria were age ≥18 years and stable therapy for at least 6 consecutive months. Data collection involved interviews and medical records. Psychological assessments were conducted using the Italian version of the Tampa Scale of Kinesiophobia-13 (TSK-IV), Beck's Depression Inventory (BDI) and the 36-item Short Form (SF-36) Health Survey. Statistical analyses included t-test or Mann-Whitney U-test, chi-squared test, correlation analysis and multiple linear regression models.

Results: Among 172 SpA patients and 94 HCs, SpA patients had significantly higher kinesiophobia (P < 0.001) and depression scores (P < 0.01). HRQoL was lower across all SF-36 domains except perceived health change. Axial SpA and peripheral SpA differed in diagnostic and therapeutic delay. Females showed greater kinesiophobia and depressive symptoms than males. Undergoing to second- or subsequent-line biologic therapy was linked to higher kinesiophobia and poorer HRQoL. BDI scores and diagnostic delay were key predictors of kinesiophobia in the SpA population.

Conclusion: Kinesiophobia has a significant impact on psychological well-being in SpA patients. These findings highlight the need for targeted interventions that address not only the physical but also the psychological dimension of SpA.

Keywords: biologic treatments; kinesiophobia; psychological well-being; sex differences; spondyloarthritis; targeted interventions.