Association of inflammation and serum adipocytokines with depression and anxiety burden in axial spondyloarthritis.

To investigate the relationships between serum adipocytokines, body mass index (BMI), disease activity, and symptoms of depression and anxiety in patients with axial spondyloarthritis (axSpA). Ninety-three patients with axSpA and 100 age- and sex-matched healthy controls were assessed. Serum adipocytokines (resistin, leptin, fetuin-A, visfatin) and ghrelin, BMI, and disease activity (BASDAI, ASDAS-CRP) were measured. Depression and anxiety were evaluated using the Beck Depression Inventory-II (BDI-II) and Beck Anxiety Inventory (BAI). Patients with axSpA exhibited higher BDI-II (6.76 ± 6.81 vs 2.81 ± 3.31, p < 0.001) and BAI scores (6.67 ± 7.71 vs 3.89 ± 3.88, p < 0.05) than controls, with the somatic domain most pronounced. Depressive and anxiety symptoms correlated strongly with disease activity (ASDAS-CRP and BASDAI) but not with BMI or spinal involvement. Leptin and ghrelin reflected BMI, whereas fetuin-A and resistin were independently associated with affective symptoms: doubling of fetuin-A increased BDI-II and BAI scores by ~ 4 and 3 points, respectively, whereas doubling of resistin decreased them by ~ 2.5 points. Resistin was inversely correlated with BASDAI (r = -0.33, p < 0.05) and anxiety (r = -0.42, p < 0.001). Other adipocytokines showed limited associations with clinical or psychological measures. Depressive and anxiety symptoms in axSpA are primarily driven by inflammatory burden rather than BMI or structural disease severity. Fetuin-A and resistin exert opposing effects on affective symptoms, highlighting disease-specific immunometabolic pathways. Early identification of psychological distress and integrated management with anti-inflammatory therapy are warranted.