MANIFESTATIONS OF NEUROPSYCHIATRIC DISEASE IN PATIENTS WITH ANKYLOSING SPONDYLITIS – NEUROTROPHINS AND THEIR ROLE

Abstract

Ankylosing spondylitis is one of the most significant rheumatological diseases. Its particular importance is primarily determined by the severe clinical course and the associated risk of permanent disability. Within the framework of the contemporary concept of patient-centered medicine, the role of early diagnosis and personalized therapeutic approach in the management of patients with ankylosing spondylitis is essential. Ankylosing spondylitis typically manifests at a young age. It is characterized by its progressive course and persistent disability when not diagnosed and treated in a timely manner. The pathogenesis involves autoinflammatory and autoimmune mechanisms leading to chronic inflammation that affects the axial skeleton, peripheral joints, entheses, eyes, and gastrointestinal tract. The most common complaints arise from the musculoskeletal system — “inflammatory type” of pain localized in the affected regions. Such symptoms are often misinterpreted as disc disease, a diagnostic error that results in delayed recognition of the condition. In addition to the joint damage, patients with ankylosing spondylitis may present with extra-articular manifestations. Diagnosis of ankylosing spondylitis is established on the basis of medical history, clinical examination, imaging findings and genetic analysis. Contemporary therapeutic strategies include both non-pharmacological and pharmacological treatment, physiotherapeutic interventions and surgical procedures in the later stages of the disease. Studies have demonstrated a statistically significant increase in the prevalence of psychiatric disorders among patients with ankylosing spondylitis. Depression, anxiety, and reduced self-esteem occur at higher rates compared to the healthy population. Between 10% and 15% of patients are diagnosed with at least one depressive episode during the course of the disease; approximately 3% exhibit symptoms of anxiety, while the overall percentage of patients with psychiatric disturbances ranges between 8% and 12%. The mechanisms underlying these neuropsychiatric manifestations are of both clinical and research interest. One possible mechanism involves the function of a large class of biologically active molecules known as neurotrophins. These are proteins that play a key role in the growth, development, functioning, and maintenance of the central and peripheral nervous systems. The most thoroughly investigated representatives—nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF)—have been shown in numerous studies to be determinants of patients’ mental health. Transcriptional regulation, post-transcriptional control mechanisms and epigenetic modulation may account for variations in circulating neurotrophin levels and provide a biological basis for the observed neuropsychiatric abnormalities in patients with ankylosing spondylitis. Elucidation of these mechanisms constitutes a promising area of research with substantial potential.