Long‐Term Association Between Disease Activity and Disability in Early Axial Spondyloarthritis: Results From a Prospective Observational Study of Inflammatory Back Pain

Abstract

Objective Our primary objective was to study the long‐term association between disease activity and disability in axial spondyloarthritis (SpA). Our secondary objective was to define patient profiles according to their level of disability. Methods We analyzed data collected during the first 5 years of follow‐up of a large early axial SpA cohort, the Devenir des Spondylarthropathies Indifferénciées Récentes (DESIR) cohort. Multivariable models were built to study the association between the Health Assessment Questionnaire for Ankylosing Spondylitis (HAQ‐AS) and the Ankylosing Spondylitis Disease Activity Score with C‐reactive protein (ASDAS‐CRP), adjusting for potential confounders. Hierarchical multivariable analysis was conducted using the chi‐square automatic interaction detector (CHAID) method, to help determine how variables best cluster to explain HAQ‐AS. Results Data from 644 patients and 5,152 visits were analyzed. HAQ‐AS was longitudinally, independently, and positively associated with ASDAS‐CRP (adjusted B [adjB] 0.205 [95% confidence interval (95% CI) 0.187, 0.222]), the enthesitis score (adjB 0.011 [95% CI 0.008, 0.015]), the Bath Ankylosing Spondylitis Metrology Index (adjB 0.087 [95% CI 0.069, 0.105]), and female sex (adjB 0.172 [95% CI 0.120, 0.225]). The CHAID decision tree revealed ASDAS‐CRP as the first variable with discriminative power on HAQ‐AS. The cutoffs that separated different patient disability profiles were obtained. Conclusion Disease activity contributes longitudinally to disability and is hierarchically superior to any other variable in explaining this health domain. Enthesitis and spinal mobility are also key drivers of disability in early axial SpA. ASDAS‐CRP cutoffs that separated different patient disability profiles largely mimicked the cutoffs previously defined for ASDAS‐CRP disease activity states.

Work participation in patients with axial spondyloarthritis: high prevalence of negative workplace experiences and long-term work impairment

“…Multivariate regression identified worse global functioning (ASAS-HI), impaired physical function (BASFI) and higher disease activity (BASDAI) as the main predictors of impaired WP. Other studies have already identified a correlation between these PROs and treatment,11 17 32–34 suggesting that treatments which target alleviating symptoms related to physical function and disease activity will likely also improve WP. BASDAI subvariables only reached significance in the univariate models, suggesting they were not able to explain any variance beyond the other predictors.…”

Exploring physical function and physical activity in axial spondyloarthritis: Beyond clinical remission or low disease activity

“…6 With the increased application of TA B L E 3 Gender, HLA-B27, and hip involvement comparison in patients with axSpA. In axSpA patients, DA is a critical factor affecting HRQoL, 4 with the ASDAS being an appropriate measure of DA. 21 Recent international recommendations emphasize the importance of measuring and controlling DA to achieve inflammation abrogation and improve treatment outcomes.…”

“…This restriction results in reduced PA, while the ongoing pain and inflammation also limited PF by causing stiffness and restricting joint mobility. 4 Additionally, DA often coincides with fatigue, leading to decreased energy levels and reduced motivation for physical activities. 27 This fatigue impedes daily tasks and adherence to exercise routines, negatively impacting both PF and PA.…”

“…A patient-reported history of hip involvement was present in 95 (26.8%) patients. The median CRP level was 0.45 (0.18-1.27) and the median ESR level was 6 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14). Further, the median ASDAS-CRP was 1.14 (0.75-1.61), which indicates an inactive to low DA.…”

Work-Related Issues and a High Burden of Disease Are Frequent in Axial Spondyloarthritis: What Should We Be Doing Better?

“…1 Many other studies and a recent systematic literature review have confirmed a link between disease activity and HRQOL. 5,16,17 The magnitude of this link varies according to the statistical methods used and the population analyzed. One important point to consider when discussing the link between PROs and disease activity is that in axSpA, disease activity scores are deeply influenced by the patient's assessment of their symptoms.…”