Disease Activity As a Major Determinant of Quality of Life and Physical Function in Patients With Early Axial Spondyloarthritis

Abstract

Objective. To describe health-related quality of life (HRQOL) and physical function in patients with early axial spondyloarthritis (SpA) and to assess their associations with disease activity and radiographic damage.Methods. This was a cross-sectional study drawing upon baseline data of axial SpA patients (Assessment of SpondyloArthritis international Society criteria) from the ESPERANZA cohort. Linear regression analyses were used to evaluate the associations between disease activity and radiographic damage (spine and sacroiliac joints) with HRQOL, physical function, and spinal mobility. Results. In total, 259 patients were included. The mean 6 SD age was 32.2 6 6.9 years, disease duration was 13.3 6 6.8 months, Ankylosing Spondylitis Quality of Life score was 5.9 6 4.8, Bath Ankylosing Spondylitis Functional Index score was 2.4 6 2.3, Bath Ankylosing Spondylitis Metrology Index score was 1.4 6 1.3, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score was 3.8 6 2.3, C-reactive protein (CRP) level was 9.7 6 13.2 mg/liter, and Bath Ankylosing Spondylitis Radiology Index for the spine (BASRI-s) score was 1.7 6 1.6. HRQOL was mainly associated with disease activity on univariate analysis (b values for BASDAI 0.646, patient global visual analog scale [VAS] 0.641, night back pain VAS 0.598, physician VAS 0.560, and CRP level 0.275; P < 0.01 for all), whereas the association with radiographic damage was weaker (standardized b for BASRI-s 0.142; P < 0.05). On multivariate models, HRQOL only remained significantly associated with disease activity (standardized b for BASDAI 0.330; P < 0.01, and physician VAS 0.205 and night back pain VAS 0.210; P 5 0.01). Similarly, physical function was associated with disease activity and radiographic damage on univariate analysis, but only with disease activity (BASDAI b 0.466; P < 0.01) on multivariate analysis. However, spinal mobility was associated with radiographic damage in both univariate and multivariate analyses. Conclusion. Patients with axial SpA already have impaired quality of life and physical function, albeit mildly, at the beginning of their disease course. Both outcomes are mainly associated with disease activity in these patients.

Quality of life and correlation with clinical and radiographic variables in patients with ankylosing spondylitis: a retrospective case series study

“…In the current study, BASDAI was not a major predictor of PF. However, in contrast to our study, Fernández-Carballido et al [ 49 ] suggested that disease activity (measured by BASDAI) was a major determinant of QoL and physical function in patients with axial spondyloarthritis (including AS). One possible explanation of the distinct results might be that the patients enrolled in their study were in early stage of the disorder, during which period physical function was significantly influenced by pain, fatigue and stiffness just evaluated by BASDAI.…”

Clinical, Economic, and Humanistic Burden Associated With Delayed Diagnosis of Axial Spondyloarthritis: A Systematic Review

“…Similarly, most studies that assessed radiographic structural progression showed that patients with a longer delay had more radiographic damage than those with shorter time to diagnosis. Previous studies have shown that radiographic damage is correlated with physical function and spinal mobility in patients with axSpA [82][83][84][85]. Therefore, there is a need for earlier diagnosis and treatment to prevent irreversible structural damage, which may in turn result in reduced mobility and greater functional limitation.…”

In Early Axial Spondyloarthritis, Increasing Disease Activity Is Associated with Worsening of Health-related Quality of Life over Time

“…For example, in the Devenir des Spondyloarthrites Indifférenciées Récentes (DESIR) cohort, patients with early axSpA (symptom duration < 3 yrs) had a mean ASDAS of 2.6 and PCS of 41 23 , and in the Herne 24 and Swiss Clinical Quality Management cohorts 25 (nonradiographic axSpA with a symptom duration > 5 yrs), the mean ASDAS ranged from 2.8 to 3.0 and PCS from 20 to 42, respectively. The ESPERANZA cohort has also found an association between the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Ankylosing Spondylitis Quality of Life (ASQoL) questionnaire 26 . Because 2 different outcome measurements were used, no direct comparisons between this cohort and the SPACE cohort were possible.…”