Prevalence and determinants of state and trait anxiety in inflammatory rheumatic diseases

Background: Anxiety is a frequent but often under-recognized comorbidity in patients with inflammatory rheumatic diseases. This study aimed to assess the prevalence of state and trait anxiety in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and axial spondyloarthritis (axSpA), and to identify their sociodemographic, clinical, and psychological correlates and independent determinants. Methods: In this cross-sectional study, 807 consecutive outpatients were recruited. Anxiety was assessed using the State-Trait Anxiety Inventory (STAI-X1 and STAI-X2). Sociodemographic data, disease activity indices, functional disability, pain, pharmacological treatments, and radiographic progression were recorded. Depressive symptoms, perceived stress, fatigue, and coping strategies were evaluated using validated questionnaires. Univariate and multivariable logistic regression models were performed to identify independent determinants of anxiety. Results: Moderate to high levels of state anxiety were observed in 19.8% of patients, while 22.3% exhibited moderate to high trait anxiety. Patients with higher anxiety levels showed greater disease activity, functional disability, pain intensity, radiographic progression, depressive symptoms, perceived stress, fatigue, and more frequent use of dysfunctional coping strategies (all p < 0.001). In multivariable analyses, state anxiety was independently associated with functional disability (OR = 2.11) and radiographic progression (OR = 1.72). Trait anxiety was independently associated with functional disability (OR = 1.58), female sex (OR = 2.13), glucocorticoid use (OR = 1.59), depression (OR = 1.46). Conclusion: Anxiety is highly prevalent and is closely linked to functional disability, disease severity, and maladaptive psychological factors. Distinct determinants characterize state and trait anxiety, supporting the need for routine psychological assessment and integrated, patient-centered care in rheumatology.