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Fear-avoidance beliefs toward physical activity in axial spondyloarthritis and psoriatic arthritis: insights from a cross-sectional study

1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19

 

  1. Rheumatology and Clinical Immunology, Department of Medicine, University of Rome Campus Bio-Medico, School of Medicine, Rome, Italy.
  2. Rheumatology and Clinical Immunology, Department of Medicine, University of Rome Campus Bio-Medico, School of Medicine, Rome; and Clinical and Research Section of Rheumatology and Clinical Immunology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.
  3. Rheumatology and Clinical Immunology, Department of Medicine, University of Rome Campus Bio-Medico, School of Medicine, Rome, Italy; and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, UK.
  4. Department of Human Sciences, European University of Rome, Italy.
  5. Rheumatology and Clinical Immunology, Department of Medicine, University of Rome Campus Bio-Medico, School of Medicine, Rome, Italy.
  6. Rheumatology and Clinical Immunology, Department of Medicine, University of Rome Campus Bio-Medico, School of Medicine, Rome, Italy.
  7. Rheumatology and Clinical Immunology, Department of Medicine, University of Rome Campus Bio-Medico, School of Medicine, Rome, Italy.
  8. Rheumatology and Clinical Immunology, Department of Medicine, University of Rome Campus Bio-Medico, School of Medicine, Rome, Italy.
  9. Rheumatology and Clinical Immunology, Department of Medicine, University of Rome Campus Bio-Medico, School of Medicine, Rome, Italy.
  10. Clinical and Research Section of Rheumatology and Clinical Immunology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.
  11. Rheumatology and Clinical Immunology, Department of Medicine, University of Rome Campus Bio-Medico, School of Medicine, Rome, Italy.
  12. Clinical and Research Section of Rheumatology and Clinical Immunology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.
  13. Rheumatology and Clinical Immunology, Department of Medicine, University of Rome Campus Bio-Medico, School of Medicine, Rome, Italy.
  14. Rheumatology and Clinical Immunology, Department of Medicine, University of Rome Campus Bio-Medico, School of Medicine, Rome, Italy.
  15. Clinical and Research Section of Rheumatology and Clinical Immunology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.
  16. Rheumatology and Clinical Immunology, Department of Medicine, University of Rome "Campus Bio-Medico", School of Medicine, Rome, Italy
  17. Rheumatology and Clinical Immunology, Department of Medicine, University of Rome Campus Bio-Medico, School of Medicine, Rome; and Department of Life, Health and Environmental Sciences, University of L’Aquila, Italy. a.marino@policlinicocampus.it
  18. Rheumatology and Clinical Immunology, Department of Medicine, University of Rome Campus Bio-Medico, School of Medicine, Rome; and Clinical and Research Section of Rheumatology and Clinical Immunology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.
  19. Rheumatology and Clinical Immunology, Department of Medicine, University of Rome Campus Bio-Medico, School of Medicine, Rome; and Clinical and Research Section of Rheumatology and Clinical Immunology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.

CER19586
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Received: 03/12/2025
Accepted : 27/02/2026
In Press: 18/06/2026

Abstract

OBJECTIVES:
Physical activity is central to spondyloarthritis (SpA) management, yet many patients avoid movement due to fear of pain and negative beliefs about exercise. The relationships between fear-avoidance beliefs, disease activity, pain catastrophising, and quality of life remain unclear. This study aimed to assess the prevalence and determinants of fear-avoidance beliefs related to physical activity in patients with axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA), and to identify associated clinical, demographic, and psychological factors.
METHODS:
This monocentric observational study enrolled 159 consecutive patients (70 axSpA, 89 PsA) attending the Rheumatology Unit of Campus Bio-Medico University Hospital. Physical activity avoidance beliefs were assessed with the FABQ-PA (scores ≥15 = high avoidance). Disease activity, quality of life, pain catastrophising, and anxiety/depression were recorded. Group comparisons, Spearman correlations, and uni-/multivariable logistic regression were performed.
RESULTS:
High physical activity avoidance was observed in 31.4% of the cohort (32.9% axSpA, 30.3% PsA). In axSpA, FABQ-PA ≥15 was associated with higher disease activity, greater PC and poorer SF-36 scores. In multivariable models, BASDAI remained significantly associated with high avoidance, with magnification retaining a weaker independent association, whereas SF-36 and other psychometric variables lost significance. In PsA, FABQ-PA was not associated with BASDAI or DAPSA. High avoidance was independently linked to female sex, higher level of helplessness and rumination, and lower SF-36, PhCS, and MCS scores, even after adjusting for disease activity.
CONCLUSIONS:
Physical activity avoidance in SpA reflects distinct but overlapping pathways. In axSpA, avoidance is predominantly associated with inflammatory disease activity, whereas in PsA it is more closely associated with psychological and quality-of-life-related factors.

DOI: https://doi.org/10.55563/clinexprheumatol/ukdj42

Rheumatology Article

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