Residual Disease in Patients with Axial Spondyloarthritis: A Post-Hoc Analysis of the QUASAR Study

Abstract

In this study, we evaluated the presence of residual disease in patients with axial spondyloarthritis (axSpA) in remission/low disease activity (LDA) status. This cross-sectional post-hoc analysis of the QUASAR study involving 23 rheumatology centres across Italy included adults with axSpA classified according to the Assessment of SpondyloArthritis International Society criteria. Patients with inactive disease (score < 1.3) or at least LDA status (score < 2.1) at baseline visit according to Ankylosing Spondylitis Disease Activity Score were investigated to evaluate how residual disease activity impacts patients’ quality of life. They were assessed using the Ankylosing Spondylitis Quality of Life (ASQoL) and EuroQoL 5-Dimension 5-Level (EQ-5D-5L) questionnaires. This study included 480 patients with axSpA (mean age, 47.5 ± 12.9 years, 64% male). In total, 123 patients (25.6%) had inactive disease and 262 (54.6%) had at least LDA. Using the ASQoL, ranges of 10–25% and 20–40% of patients with inactive disease and with LDA status, respectively, experienced tiredness/fatigue. Despite being classified with inactive disease, 48.8% of patients reported light pain/discomfort according to the EQ-5D-5L, with 4.1% reporting moderate pain/discomfort, whereas 55.7% of patients with LDA reported light pain/discomfort and 13% had moderate pain/discomfort. Using the ASQoL questionnaire, in patients with at least LDA, a higher proportion of women compared with males and a higher proportion of patients > 48 years of age (vs. patients ≤ 48 years) experienced tiredness. In this post-hoc analysis, ≥25% of axSpA patients in remission/LDA status were still burdened by residual disease, mainly characterised by pain and fatigue.

Pain in axial spondyloarthritis: role of the JAK/STAT pathway

“…Although classified with inactive disease after advanced therapy, approximately 50% of patients had mild pain/ discomfort, and ∼4% reported moderate pain/discomfort according to the EuroQoL 5-Dimension 5-Level (EQ-5D-5L) questionnaire. Among axSpA patients in clinical remission/LDA, ≥25% of patients in remission/LDA status were still burdened by residual disease, which was mainly characterized by pain and fatigue (39). Similar findings were also observed in a study from Singapore (40), as onethird of the 262 patients with axSpA who achieved LDA were burdened with residual disease in musculoskeletal manifestations, including pain and fatigue.…”

“…While considered in remission or LDA, a high proportion of patients with SpA continue to manifest a significant reduction in their QoL (35)(36)(37)(38)(39)(40). Patients with axSpA frequently have an elevated burden of disease with a significant reduction in their QoL attributed to chronic inflammation that leads to chronic pain, joint stiffness, structural damage, and reduced function in addition to fatigue (41,42).…”

“…To date, there are only a few studies that have specifically explored the residual burden of disease in patients with axSpA (38)(39)(40). A cross-sectional study performed across 23 rheumatology centers in Italy included 480 adults with axSpA classified according to the Assessment in SpondyloArthritis International Society (ASAS) criteria and evaluated how residual disease impacts patients' QoL (39).…”

“…To date, there are only a few studies that have specifically explored the residual burden of disease in patients with axSpA (38)(39)(40). A cross-sectional study performed across 23 rheumatology centers in Italy included 480 adults with axSpA classified according to the Assessment in SpondyloArthritis International Society (ASAS) criteria and evaluated how residual disease impacts patients' QoL (39). Although classified with inactive disease after advanced therapy, approximately 50% of patients had mild pain/ discomfort, and ∼4% reported moderate pain/discomfort according to the EuroQoL 5-Dimension 5-Level (EQ-5D-5L) questionnaire.…”

Treatment of rheumatic diseases. Different nosologies, common problems

“…Так, назначенная пациенту базисная терапия обычно не сразу дает желаемое клиническое улучшение. Кроме того, она бывает недостаточно эффективной, после подавления активности болезни может возникать обострение, и даже у пациентов, которые находятся в состоянии ремиссии, зачастую сохраняются остаточные артралгии [40]. В таких случаях врач сталкивается с необходимостью дифференцированной оценки характера болевого синдрома, поскольку подходы к лечению боли, имеющей разную природу, существенно различаются.…”