Prevalence of Anxiety, Depression, Sleep Disorders, and Fibromyalgia in Chronic Urticaria Patients: A Comparative Study with Healthy Controls

Yıl 2025, Cilt: 51 Sayı: 3, 379 - 386, 08.12.2025

Arzu Ferhatosmanoğlu , Hanife Baykal Şahin

https://doi.org/10.32708/uutfd.1749086

Öz

Chronic urticaria (CU) is a condition characterized by recurrent pruritic wheals that significantly impair quality of life. This study aimed to evaluate the prevalence of anxiety, depression, sleep disorders, and fibromyalgia syndrome (FMS) in CU patients and to compare these outcomes with controls. The study included 161 CU patients and 155 controls with dermatological conditions other than CU. Comprehensive clinical, sociodemographic, and laboratory data were collected, including metabolic syndrome parameters, psychiatric assessments, and sleep quality measures. 68.3% of the CU patients were female. Compared with males, female patients had later disease onset (p=0.002), lower educational levels (p=0.025), and a higher prevalence of thyroid disease (p=0.024), elevated thyroid autoantibodies (p=0.032), and FMS (p=0.028). Compared to controls, CU patients had significantly higher rates of FMS (p<0.001), moderate to severe depression (p<0.001), increased visual analogue scale (VAS) pain scores (p<0.001), greater antidepressant use (p<0.001), and poorer sleep quality (p<0.001). Uncontrolled CU, determined by Urticaria Activity Score (UAS7), was associated with higher VAS pain scores (p<0.001), increased FMS prevalence (p<0.001), greater depression rates (p=0.008), and more frequent sleep disturbances (p=0.009). Additionally, the Hospital Anxiety and Depression Scale (HADS)-anxiety scores were significantly lower in omalizumab users (p=0.028), indicating an observed association that may reflect improved disease management rather than a direct treatment effect. Our findings highlight the significant physical and psychological burden of CU, especially in women and patients with uncontrolled disease, and emphasize the importance of considering comorbid conditions such as fibromyalgia, depression and sleep disorders.

Anahtar Kelimeler

Anxiety , Depression , Fibromyalgia , Urticaria , Sleep Disorders

Kronik Ürtiker Hastalarında Anksiyete, Depresyon, Uyku Bozuklukları ve Fibromiyaljinin Yaygınlığı: Kontrol Grubu ile Karşılaştırmalı Bir Çalışma

Öz

Kronik ürtiker (KÜ), tekrarlayan kaşıntılı kabarıklıklarla karakterize olan ve yaşam kalitesini önemli ölçüde düşüren bir hastalıktır. Bu çalışmanın amacı, KÜ hastalarında anksiyete, depresyon, uyku bozuklukları ve fibromiyalji sendromu (FMS) prevalansını değerlendirmek ve bu bulguları sağlıklı kontrollerle karşılaştırmaktır. Çalışmaya 161 KÜ hastası ve KÜ dışındaki dermatolojik rahatsızlıkları olan 155 kontrol grubu hastası dahil edildi. Metabolik sendrom parametreleri, psikiyatrik değerlendirmeler ve uyku kalitesi ölçümleri dâhil olmak üzere kapsamlı klinik, sosyodemografik ve laboratuvar verileri toplanmıştır. KÜ hastalarının %68,3'ü kadındı. Kadın hastalarda hastalık başlangıcı anlamlı olarak daha geç (p=0,002), eğitim düzeyi daha düşük (p=0,025), tiroid hastalığı (p=0,024), tiroid otoantikor yüksekliği (p=0,032) ve FMS sıklığı (p=0,028) erkeklere göre daha yüksekti. Kontrol grubuna kıyasla, KÜ hastalarında FMS (p<0,001), orta-şiddetli depresyon (p<0,001), daha yüksek VAS ağrı skoru (p<0,001), antidepresan kullanımı (p<0,001) ve kötü uyku kalitesi (p<0,001) daha yaygındı. Ürtiker Aktivite Skoru (UAS7) ile belirlenen kontrolsüz KÜ, daha yüksek VAS ağrı skoru (p<0,001), artmış FMS prevalansı (p<0,001), daha yüksek depresyon oranı (p=0,008) ve daha sık uyku bozukluğu (p=0,009) ile ilişkiliydi. Ayrıca, omalizumab kullanan hastalarda Hospital Anxiety and Depression Scale (HADS)-anksiyete skorları anlamlı derecede daha düşüktü (p = 0.028). Bu durum, doğrudan bir tedavi etkisinden ziyade daha iyi hastalık yönetimini yansıtan gözlemsel bir ilişkiye işaret etmektedir. Bulgularımız, özellikle kadınlarda ve kontrolsüz hastalığı olanlarda KÜ’nün önemli fiziksel ve psikolojik yükünü ortaya koymakta ve fibromiyalji, depresyon ve uyku bozuklukları gibi eşlik eden durumların dikkate alındığı bütüncül bir yaklaşımın gerekliliğini vurgulamaktadır.

Anahtar Kelimeler

Anksiyete , Depresyon , Fibromiyalji , Ürtiker , Uyku Bozuklukları

Etik Beyan

Yoktur.

Destekleyen Kurum

Yoktur.

Teşekkür

Yoktur.

Kaynakça

• 1. Hon KL, Leung AK, Ng WG, Lo SK. Chronic urticaria: an overview of treatment and recent patents. Recent Patents on Inflammation & Allergy Drug Discovery, 2019;13(1): 27-37.
• 2. Gonçalo M, Gimenéz‐Arnau A, Al‐Ahmad M, Ben‐Shoshan M, Bernstein JA, Ensina LF et al. (The global burden of chronic urticaria for the patient and society. British Journal of Dermatology, 2021;184(2): 226-236.
• 3. Sánchez-Borges M, Ansotegui IJ, Baiardini I, Bernstein J, Canonica GW, Ebisawa M et al. The challenges of chronic urticaria part 1: Epidemiology, immunopathogenesis, comorbidities, quality of life, and management. World Allergy Organization Journal, 2021;14(6): 100533.
• 4. Zuberbier T, Aberer W, Asero R, Latiff AA, Baker D, Ballmer-Weber B et al. AEDV, APAAACI, ASBAI, ASCIA, BAD, BSACI, CDA, CMICA, CSACI, DDG, DDS, DGAKI, DSA, DST, EAACI, EIAS, EDF, EMBRN, ESCD, GA²LEN, IAACI, IADVL, JDA, NVvA, MSAI, ÖGDV, PSA, RAACI, SBD, SFD, SGAI, SGDV, SIAAIC, SIDeMaST, SPDV, TSD, UNBB, UNEV and WAO.
• 5. Huang Y, Xiao Y, Zhang X, Li J, Chen X. and Shen M. A meta-analysis of observational studies on the association of chronic urticaria with symptoms of depression and anxiety. Frontiers in Medicine. 2020;7: 39.
• 6. Oktayoğlu P, Ucmak D, Çağlayan M, Ucar D, Bozkurt M, Em S, et al. Is there an association between chronic urticaria and fibromyalgia syndrome? Archives of Rheumatology, 2014; 29(1):028-034.
• 7. Huang PL. "A comprehensive definition for metabolic syndrome." Disease Models & Mechanisms 2.5-6 (2009): 231-237.
• 8. Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Häuser W, Katz RL et al. (2016, December). 2016 Revisions to the 2010/2011 fibromyalgia diagnostic criteria. In Seminars in Arthritis and Rheumatism (Vol. 46, No. 3, pp. 319-329). WB Saunders.
• 9. Gaig P, Olona M, Lejarazu DM, Caballero MT, Domínguez FJ, Echechipia S et al. Epiodemiology of urticaria in Spain. Journal of Investigational Allergology and Clinical Immunology, 2004; 14: 214-220.
• 10. Jo YH, Yoo HW, Kim SH, Kim YM and Kim HY. Clinical characteristics and treatment response of chronic spontaneous urticaria according to age: a single-center Korean study. Asian Pac J Allergy Immunol. 2022;40(4):374-378.
• 11. Sánchez-Borges M, Caballero-Fonseca F, Capriles-Hulett A, González-Aveledo L and Maurer M. Factors linked to disease severity and time to remission in patients with chronic spontaneous urticaria. J Eur Acad Dermatol Venereol. 2017;31(6):964-971.
• 12. Confino-Cohen R, Chodick G, Shalev V, Leshno M, Kimhi O, Goldberg A. Chronic urticaria and autoimmunity: associations found in a large population study. J Allergy Clin Immunol. 2012;129(5):1307-1313.
• 13. 13.Ghazanfar MN, Kibsgaard L, Thomsen SF, Vestergaard C. Risk of comorbidities in patients diagnosed with chronic urticaria: a nationwide registry-study. World Allergy Organ J. 2020;13(1):100097.
• 14. Weerasubpong P, Jiamton S, Phumariyapong P, Ungprasert P and Kulthanan K. Prevalence of concomitant angioedema in chronic spontaneous urticaria: a systematic review and meta-analysis. Asian Pac J Allergy Immunol. 2023;41(1):12-19.
• 15. Gregoriou S, Rigopoulos D, Katsambas A, Katsarou A, Papaioannou D, Gkouvi A et al. Etiologic aspects and prognostic factors of patients with chronic urticaria: nonrandomized, prospective, descriptive study. J Cutan Med Surg. 2009;13(4):198-203.
• 16. Can PK, Fomina D, Kocaturk E. Chronic inducible urticaria: clinical presentation, diagnosis, and management. Indian J Skin Allergy. 2022;1(1):2-6.
• 17. Ornek Ozdemir S, Kuteyla Can P, Degirmentepe EN, Cure K, Singer R, Kocaturk E. A comparative analysis of chronic inducible urticaria in 423 patients: clinical and laboratory features and comorbid conditions. J Eur Acad Dermatol Venereol. 2024;38:513.
• 18. Sánchez J, Amaya E, Acevedo A, Celis A, Caraballo D and Cardona R. Prevalence of inducible urticaria in patients with chronic spontaneous urticaria: associated risk factors. J Allergy Clin Immunol Pract. 2017;5(2):464-470.
• 19. Silpa-Archa N, Kulthanan K, Pinkaew S. Physical urticaria: prevalence, type and natural course in a tropical country. J Eur Acad Dermatol Venereol. 2011;25(10):1194-1199.
• 20. Reddy S, Babu S, Priya R, Reddy A. Clinical characteristics of patients with chronic urticaria and adherence to management guidelines by postgraduate students in dermatology: a retrospective single center study. Indian J Dermatol. 2021;66(6):705.
• 21. Sirufo MM, Bassino EM, De Pietro F, Ginaldi L, De Martinis M. Sex differences in the efficacy of omalizumab in the treatment of chronic spontaneous urticaria. Int J Immunopathol Pharmacol. 2021;35.
• 22. Kocaturk E, Baskan EB, Kucuk OS, Celik G, Tuncel T, Aksoy H, et al. Omalizumab versus cyclosporin-A for the treatment of chronic spontaneous urticaria: can we define better-responding endotypes? An Bras Dermatol. 2022;97(5):592-600.
• 23. Abdel-Meguid AM, Reda MF, Rady MF, Sabry A, Emam RM. Does chronic urticaria affect quality of sleep and quality of life? J Public Health Res. 2024;13(2):22799036241243268.
• 24. Choi GS, Nam YH, Park CS, Kim MY, Jo EJ, Park HK, et al. Anxiety, depression, and stress in Korean patients with chronic urticaria. Korean J Intern Med. 2020;35(6):1507-1516.
• 25. Emre E, Tazegul G. Evaluation of anxiety, depression and quality of life in patients with chronic urticaria. Asthma Allergy Immunol. 2021;19(1):1-6.
• 26. Latif OMA. Impact of severity of CSU on sleep, anxiety and depressive symptoms in adults. Dermatology. 1990;123(6):769-774.
• 27. Ates H, Firat S, Buhari GK, Keren M, Cifci B, Erkekol FÖ. Relationships between quality of life, sleep problems, and sleep quality in patients with chronic idiopathic urticaria. J Cosmet Dermatol. 2022;21(9):4072-4079.
• 28. He GY, Tsai TF, Lin CL, Shih HM, Hsu TY. Association between sleep disorders and subsequent chronic spontaneous urticaria development: a population-based cohort study. Medicine (Baltimore). 2018;97(34):e11992.
• 29. Acar EM, Şaş S. Evaluation of fibromyalgia frequency in chronic urticaria patients and its association with urticaria severity. Ahi Evran Med J. 2022;6(3):276-281.
• 30. Koca TT, Nazik H, Mülayim MK, Öztürk P. The relation of chronic idiopathic urticaria with fibromyalgia, sleep disturbance and anxiety. J Contemp Med. 2019;9(2):151-155.
• 31.Memet B, Vurgun E, Barlas F, Metz M, Maurer M, Kocatürk E. In Chronic Spontaneous Urticaria, Comorbid Depression Linked to Higher Disease Activity, and Substance P Levels. Front Psychiatry. 2021 May 26;12:667978.
• 32. Sánchez-Díaz M, Rodríguez-Pozo JÁ, Latorre-Fuentes JM, Salazar-Nievas MC, Alejandro ML, Arias-Santiago S. Sleep Quality as a Predictor of Quality-of-Life and Emotional Status Impairment in Patients with Chronic Spontaneous Urticaria: A Cross-Sectional Study. Int J Environ Res Public Health. 2023 Feb 16;20(4):3508.
• 33. Seetasith A, Holden M, Hetherington J, Keal A, Salmon P, Bernstein JA, et al. Real-world outcomes in patients with chronic spontaneous urticaria receiving omalizumab: insights from a clinical practice survey. Curr Med Res Opin. 2024 Jun 3:1-8.
• 34. Xiao Y, Huang X, Jing D, Huang Y, Chen L, Zhang X, Zhao S, Zhang M, Luo Z, Su J, Kuang Y, Li J, Zhu W, Zhang J, Chen X, Shen M. The Prevalence of Atopic Dermatitis and Chronic Spontaneous Urticaria are Associated with Parental Socioeconomic Status in Adolescents in China. Acta Derm Venereol. 2019 Mar 1;99(3):321-326.
• 35. Zhao Z, Huang Y, Chen D, Wang Y. Global health implications of urticaria burden (1990–2021): a comprehensive analysis of trends across nations and regions. Arch Med Sci. 2025. doi:10.5114/aoms/202415.