Abstract:
Introduction. The treatment of ankylosing spondylitis is a complex
and still unresolved problem due to the complexity and polymorphism of
pathogenetic mechanisms and the variability of the clinical course. One
of the important factors modifying the clinical course and resistance to
treatment is alexithymia. A promising way to develop new approaches
to the treatment of ankylosing spondylitis is to study the role of BDNF
in pathogenesis, clinical manifestations, and resistance to therapy. The
objective of this study was to examine BDNF levels in the blood of
patients with ankylosing spondylitis comorbid with alexithymia, as well
as its correlation with the clinical course and treatment efficacy.
Materials and Methods. 127 patients with ankylosing spondylitis
were examined using the BASDAI, ASDAS, BASFI, BASMI, HAQ,
ASAS HI/EF, BAS-G, ASQoL, MAF, PSQI, HAM-D, and MMSE
scales; alexithymia was determined using the Ukrainian TAS-20 adapted
version. The level of BDNF in blood plasma was determined by
enzyme-linked immunosorbent assay.
Results. Patients with AS have been found to have higher levels of
BDNF compared to healthy individuals: 273.13±69.58 pg/ml versus
160.40±61.08 pg/ml (p<0.001). Patients with elevated BDNF levels in
the blood (above the median) had significantly higher disease activity
indicators: ESR – 37.03±22.19 mm/h vs. 22.13±14.29 mm/h (p<0.01);
BASDAI – 6.97±1.73 points vs. 5.42±2.00 points (p<0.01); ASDASESR – 4.04±0.83 points vs. 3.31±0.75 points (p<0.001); functional
capacity of patients by BASMI – 5.19±2.13 points vs. 3.84±1.83 points
(p<0.05); BAS-G – 7.44±1.78 points vs. 5.88±2.01 points (p<0.01). In
these patients, the ASAS HI index was 10.53±3.13 points versus
8.84±3.56 points (p<0.05); ASAS EF – 4.22±1.50 points versus 3.22±1.34 points (p<0.05); there were also higher TAS-20 indicators:
61.22±8.06 points versus 56.19±9.01 points (p<0.05). In patients with
no alexithymia, BDNF levels were lower compared to patients with
possible alexithymia: 222.50±60.10 pg/ml versus 275.93±21.10 pg/ml;
while in patients with alexithymia, BDNF levels were higher than in
patients of these groups: 286.08±82.75 pg/ml. ASAS-20 responders had
lower BDNF levels compared to non-responders: 236.43±59.01 pg/ml
versus 285.37±69.04 pg/ml (p<0.05).
Conclusions. In patients with ankylosing spondylitis, there is an
increase in blood BDNF levels. Alexithymic traits are associated with
higher levels of BDNF in the blood, which indicates the possible
involvement of BDNF in the pathogenetic mechanisms of alexithymia
formation. Elevated BDNF levels are associated with a worse clinical
course of ankylosing spondylitis and are a predictor of treatment
resistance.
