Liew J, et al. – The physicians undertook this study to assess the prevalence of comorbid posttraumatic stress disorder (PTSD) and the association of PTSD with pain, disease activity, and medication use among veterans with ankylosing spondylitis (AS). They reported that veterans with AS and comorbid PTSD were younger and had higher pain and disease activity scores compared to those without PTSD. These findings highlighted the importance of identifying PTSD in patients with AS.

• The physicians utilized ICD codes for AS and identified veterans with one or more visit to an outpatient rheumatology clinic at a single Veterans Affairs site during a 2-year study period.
• They selected patients if there was documentation of AS diagnosis by a rheumatologist.
• Data were collected on PTSD diagnosis, demographics, pain scores, disease activity by the Bath AS Disease Activity Index (BASDAI), and medication use.
• Characteristics were compared by PTSD status using t tests for continuous variables and Chi-square or Fischer’s exact test for categorical variables.
• Out of 113 Veterans with AS, 20 (18%) had a diagnosis of PTSD.
• Those with PTSD were significantly younger, 52 ± 17 years, as compared to those without PTSD, 59 ± 14 years (p = 0.04).
• For 30% with a mean score of 4.3 ± 2.0, BASDAI was recorded.
• Those with PTSD had higher mean pain and BASDAI scores as compared to those without PTSD (p = 0.06 for both comparisons). 
• For both groups, prescribed medications were similar in regards to synthetic disease modifying antirheumatic drugs (DMARDs), biologics, and opioids, although those with PTSD were significantly more likely to receive NSAIDs (p = 0.03).