PR1 DEVELOPMENT OF A CROSS-WALK OF THE ASSESSMENT OF SPONDYLOARTHRITIS INTERNATIONAL SOCIETY HEALTH INDEX (ASAS HI) AND ANKYLOSING SPONDYLITIS QUALITY OF LIFE (ASQOL) SCORES USING DATA FROM PATIENTS WITH ANKYLOSING SPONDYLITIS AND NON-RADIOGRAPHIC AXIAL SPONDYLOARTHRITIS

Abstract Purpose To evaluate the psychometric performance of the Ankylosing Spondylitis Quality of Life (ASQoL) scale in patients with non-radiographic axial spondyloarthritis (nr-axSpA) to assess its appropriateness as an outcome measure in future clinical studies. Methods Patients with active axSpA from a Phase III, randomized, double-blind, placebo-controlled trial (RAPID-axSpA, NCT01087762) were included (N = 325). Modified New York (mNY) classification criteria were used to classify patients as having ankylosing spondylitis or nr-axSpA; those with nr-axSpA were further categorized based on objective signs of inflammation. Psychometric properties of the ASQoL were assessed/documented using a mixture of modern psychometric methods and classical test theory methods. These included exploratory factor analysis and item response theory models to assess the domain structure, test the utility of a single domain relative to subdomains, assess bias, and generate statistics to guide an empirical scoring algorithm. The reliability and validity of scores were evaluated via internal consistency, test–retest reliability, concurrent validity, and known-groups validity. Score responsiveness was assessed via anchor-based clinically meaningful change, supplemented with empirical cumulative distribution function visualizations. Results The ASQoL data were defined by four domains. However, a four-domain solution was found to be inferior to a bifactor solution in which the four domains were included within a total domain. Scoring statistics supported a unit-weighted total score. Within the nr-axSpA population with objective signs of inflammation, the ASQoL mean score had adequate reliability, validity, and ability to detect clinically meaningful change. Conclusions Our findings suggest that the ASQoL is an appropriate outcome measure in interventional clinical trials in patients with nr-axSpA.

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Characteristics and burden of disease in patients with radiographic and non-radiographic axial Spondyloarthritis: a comparison by systematic literature review and meta-analysis

RMD Open ◽

10.1136/rmdopen-2019-001108 ◽

2019 ◽

Vol 5 (2) ◽

pp. e001108 ◽

Cited By ~ 9

Author(s):

Clementina López-Medina ◽

Sofia Ramiro ◽

Desirée van der Heijde ◽

Joachim Sieper ◽

Maxime Dougados ◽

...

Keyword(s):

Quality Of Life ◽

Ankylosing Spondylitis ◽

Treatment Effect ◽

Burden Of Disease ◽

Clinical Presentation ◽

Axial Spondyloarthritis ◽

Pooled Analysis ◽

Treatment Modalities ◽

Disease Treatment

ObjectivesTo compare the clinical characteristics, burden of disease (eg, disease activity, function, quality of life), treatment modalities and treatment effect in patients with radiographic and non-radiographic axial Spondyloarthritis (r-axSpA and nr-axSpA).MethodsA systematic literature review (2009–2018) was performed using the participants, intervention, comparator and outcomes methodology. Studies reporting outcomes (clinical presentation, burden of disease, treatment modalities and treatment effect) of both r-axSpA and nr-axSpA were included. A pooled analysis was performed (standardised means difference and relative risk for continuous and binary variables, respectively) and random or fixed effects methods were used depending on the heterogeneity of the studies.Results60 studies out of 787 references were included. Pooled analysis showed that, compared with patients with nr-axSpA, patients with r-axSpA were more frequently men (69.6% vs 53.6%), smokers (37.7% vs 31.1%) and had higher mean disease duration (8.6 vs 5.0 years) and longer time to diagnosis (6.1 vs 4.2 years). Peripheral manifestations were more prevalent in nr-axSpA, while uveitis and structural damage on MRI of the sacroiliac joints were more prevalent in r-axSpA. C-reactive protein and the Bath Ankylosing Spondylitis Mobility Index were higher in r-axSpA, while Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Functional Index and Ankylosing Spondylitis Quality of Life were similar in both groups. No significant differences were found with regard to treatment effect.ConclusionsPatients with r-axSpA and nr-axSpA share a similar clinical presentation except for peripheral involvement, which is more prevalent among nr-axSpA. Except for a more impaired mobility in r-axSpA, both groups showed a comparable burden of disease, treatment modalities and treatment effect.

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Predictors of Assessment of Spondyloarthritis International Society (ASAS) Health Index in Axial Spondyloarthritis and Comparison of ASAS Health Index between Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis: Data from the Catholic Axial Spondyloarthritis COhort (CASCO)

Journal of Clinical Medicine ◽

10.3390/jcm8040467 ◽

2019 ◽

Vol 8 (4) ◽

pp. 467 ◽

Cited By ~ 2

Author(s):

Hong Ki Min ◽

Jennifer Lee ◽

Ji Hyeon Ju ◽

Sung-Hwan Park ◽

Seung-Ki Kwok

Keyword(s):

Regression Analysis ◽

Health Status ◽

Ankylosing Spondylitis ◽

Alcohol Consumption ◽

International Society ◽

Structural Damage ◽

Axial Spondyloarthritis ◽

Economic Status ◽

Linear Regression Analysis ◽

Health Index

The Assessment of Spondyloarthritis International Society (ASAS) health index (HI) is a novel tool for approaching disability, health, and functioning in spondyloarthritis (SpA). In the present study we compared ASAS HI between patients with ankylosing spondylitis (AS) and those with nonradiographic axial SpA (nr-axSpA). In addition, we identified predictors of ASAS HI. We designed this cross-sectional study using data from the Catholic Axial Spondyloarthritis COhort (CASCO), a prospective cohort from a single tertiary hospital. We compared baseline characteristics, including ASAS HI, between AS and nr-axSpA, and determined the frequency of each item constituting the ASAS HI. We used linear regression analysis to identify factors associated with ASAS HI. Total of 357 patients with axSpA—261 with AS and 96 with nr-axSpA—were included in analysis. AS patients were older and had higher ASAS HI than nr-axSpA. Among ASAS HI items, pain (item No. 1) and energy/drive (item No. 5) were the most common areas for which axSpA patients experienced discomfort. ASAS HI correlated with other SpA-related parameters such as BASDAI, ASDAS, and BASFI. Multivariable regression analysis of the axSpA group showed that high NSAID intake and mSASSS were positively associated with ASAS HI, whereas higher economic status and alcohol consumption were negatively associated with ASAS HI. Results were consistent in the AS group on subgroup analysis, whereas alcohol consumption was the only factor significantly associated with ASAS HI in the nr-axSpA group. In the present cohort study, patients with AS had poorer health status (higher ASAS HI) than those with nr-axSpA. Items proposed by AS patients (items No. 1 and 5) were the most frequently checked areas as axSpA patients feel discomfort, and this support that ASAS HI could practically assess actual discomfort of axSpA patient. ASAS HI was well correlated with known disease parameters, including activity, function, and quality of life; therefore, ASAS HI could be used in the future to represent the health status of SpA in a systematic way. Spinal structural damage (higher mSASSS), high NSAID intake, alcohol consumption, and economic status were predictors of ASAS HI in patients with axSpA, especially those with AS.

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Sexual Quality of Life in Patients with Axial Spondyloarthritis in the Biologic Treatment Era

The Journal of Rheumatology ◽

10.3899/jrheum.180413 ◽

2019 ◽

Vol 46 (9) ◽

pp. 1075-1083 ◽

Cited By ~ 3

Author(s):

Kari Hansen Berg ◽

Gudrun Elin Rohde ◽

Anne Prøven ◽

Esben Esther Pirelli Benestad ◽

Monika Østensen ◽

...

Keyword(s):

Quality Of Life ◽

Ankylosing Spondylitis ◽

Disease Activity ◽

Axial Spondyloarthritis ◽

Activity Index ◽

Statistical Tests ◽

Linear Regression Analysis ◽

Biologic Treatment ◽

Sexual Quality Of Life

Objective.To examine the relationship between demographics, disease-related variables, treatment, and sexual quality of life (SQOL) in men and women with axial spondyloarthritis (axSpA).Methods.AxSpA patients were consecutively recruited from 2 rheumatology outpatient clinics in southern Norway. A broad spectrum of demographics, disease, treatment, and QOL data were systematically collected. SQOL was assessed using the SQOL-Female (SQOL-F) questionnaire (score range 18–108). Appropriate statistical tests were applied for group comparison, and the association between independent variables and SQOL-F was examined using multiple linear regression analysis.Results.A total of 360 (240 men, 120 women) axSpA patients with mean age 45.5 years and disease duration 13.9 years were included. Seventy-eight percent were married/cohabiting, 26.7% were current smokers, 71.0% were employed, 86.0% performed > 1-h exercise per week, and 88.0% were HLA-B27–positive. Mean (SD) values for disease measures were C-reactive protein (CRP) 8.5 (12.1) mg/l, Bath Ankylosing Spondylitis Disease Activity Index 3.1 (2.1), Bath Ankylosing Spondylitis Global Score (BAS-G) 3.8 (2.5), Bath Ankylosing Spondylitis Functional Index 2.7 (2.2), and Health Assessment Questionnaire 0.6 (0.5). The proportion of patients using nonsteroidal antiinflammatory drugs was 44.0%, synthetic disease-modifying antirheumatic drugs (DMARD) 5.0%, and biologic DMARD 24.0%. Mean (SD) total sum score for SQOL was 76.6 (11.3). In multivariate analysis, female sex, increased body mass index, measures reflecting disease activity (BAS-G and CRP), and current biologic treatment were independently associated with a lower SQOL.Conclusion.Our data suggest that inflammation in patients with axSpA even in the biologic treatment era reduces SQOL.

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AB1180 The intensive exercise programme for non-radiographic axial spondyloarthritis and for ankylosing spondylitis may improved quality of life and disease activity

10.1136/annrheumdis-2017-eular.2589 ◽

2017 ◽

Author(s):

M Husakova ◽

K Pavelka ◽

M Spiritovic ◽

A Levitova

Keyword(s):

Quality Of Life ◽

Ankylosing Spondylitis ◽

Disease Activity ◽

Axial Spondyloarthritis ◽

Exercise Programme ◽

Intensive Exercise

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Presence of Fibromyalgia Syndrome and Its Relationship with Clinical Parameters in Patients with Axial Spondyloarthritis

January 2018 - Pain Physician ◽

10.36076/ppj/2019.22.e579 ◽

2019 ◽

Vol 6 (22;6) ◽

pp. E579-E585

Author(s):

Gonca Saglam

Keyword(s):

Quality Of Life ◽

Ankylosing Spondylitis ◽

Sleep Quality ◽

Disease Activity ◽

Disease Activity Score ◽

Axial Spondyloarthritis ◽

Functional Index ◽

Quality Of Life Scale ◽

Life Scale

Background: Fibromyalgia syndrome (FMS) is a disorder with a population prevalence of 1% to 5%. There are insufficient data in the literature on the incidence of FMS in patients with axial spondyloarthritis (SpA), with only a limited number of studies conducted. Objectives: The aim of this study was to determine the presence of FMS in patients diagnosed with axial SpA and to investigate the effect of this coexistence on clinical and laboratory assessments in patients with ankylosing spondylitis. Study Design: This research involved a retrospective analysis of prospectively collected data. Setting: The research took place in an outpatient rheumatology clinic. Methods: This study included 125 patients diagnosed with axial SpA according to the Assessment of Spondyloarthritis International Society criteria. The presence of FMS was investigated according to the 2010 American College of Rheumatology criteria. Pain during activity, resting, and at night was examined using the Visual Analog Scale. Ankylosing Spondylitis Disease Activity Scores were used for assessment of disease activity, Ankylosing Spondylitis Quality of Life Scale was used for quality of life, Bath Ankylosing Spondylitis Functional Index was used for functionality, and Pittsburgh Sleep Quality Index was used for sleep quality. Results: Incidence of FMS was 29.6% in the study population, which consisted of patients who were all diagnosed with axial SpA. Comparison of patient groups with and without FMS revealed no statistically significant differences in age, weight, body mass index, marital status, family history, and smoking history (P > .05), with a higher rate of female patients in the group with FMS at 55% (P < .05). Ankylosing Spondylitis Disease Activity Score-C-Reaktif Protein, Ankylosing Spondylitis Disease Activity Score-Erythyrocyte Sedimentation Rate, Ankylosing Spondylitis Quality of Life Scale, Bath Ankylosing Spondylitis Functional Index, Pittsburgh Sleep Quality Index, and Visual Analog Scale pain scores were significantly higher in the group with FMS (P < .05). Limitation: The study involved a limited number of patients. Conclusions: FMS is observed in one-third of patients with axial SpA. The presence of FMS negatively affects quality of life, functional status, sleep quality, disease activity, and pain level of patients with ankylosing spondylitis. The possibility for coexistence of FMS should be kept in mind when determining the treatment protocols for patients with axial spondyloarthritis, and adjunctive treatment should be given if necessary

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Physical activity and sedentary behaviour and their associations with clinical measures in axial spondyloarthritis

Rheumatology International ◽

10.1007/s00296-019-04494-3 ◽

2019 ◽

Vol 40 (3) ◽

pp. 375-381 ◽

Cited By ~ 2

Author(s):

Elaine H. Coulter ◽

Marie Therese McDonald ◽

Sara Cameron ◽

Stefan Siebert ◽

Lorna Paul

Keyword(s):

Quality Of Life ◽

Physical Activity ◽

Ankylosing Spondylitis ◽

Sedentary Behaviour ◽

Exercise Capacity ◽

Axial Spondyloarthritis ◽

Spinal Mobility ◽

Accelerometer Data ◽

Clinical Measures

AbstractEngaging in physical activity (PA) is a key aspect in the management of axial spondyloarthritis (axial SpA), however, its relationship with clinical measures is unknown. Previous research has mainly focused on subjective methods of measuring PA and sedentary behaviour (SB). The aim of this study was to explore the associations between objectively measured PA and SB with clinical measures in people with established axial SpA. Fifty participants were recruited from secondary-care rheumatology outpatient services in Glasgow, UK. Clinical measures collected included; Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI), Ankylosing Spondylitis Quality of Life (ASQOL) and the Six Minute Walk Test (6MWT). PA and SB were measured using the activPAL3 tri-axial accelerometer. Data from forty-five participants were included (23 males, average age 49 ± 12 years). Participants accumulated an average of 93.2 ± 41.5 min/day walking with an average of 7200 ± 3397 steps/day. The majority of the day (65%) was spent sitting, accumulated in prolonged bouts. Walking time and steps taken/day were associated with better BASFI (r = − 0.395, p = 0.007 and r = − 0.404, p = 0.006), ASQOL (r = − 0.375, p = 0.011 and r = − 0.361, p = 0.015) and 6MWT (r = 0.396, p = 0.007 and r = 0.421, p = 0.004); while longer walking events were associated with better BASMI (rho = − 0.352, p = 0.018), BASFI (rho = − 0.316, p = 0.034) and 6MWT (rho = 0.404, p = 0.006). SB was associated with worse ASQOL (r = 0.380, p = 0.010) and 6MWT (6MWT, r = − 0.357, p = 0.016). In people with axial SpA PA is associated with better function, exercise capacity and spinal mobility, while SB is associated with lower exercise capacity and poor quality of life. These findings support the promotion of PA and reduction of SB in people with axial SpA.

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Content validity of the ASQoL for use in a non-radiographic axial spondyloarthritis population: a qualitative study

Quality of Life Research ◽

10.1007/s11136-020-02552-z ◽

2020 ◽

Vol 29 (11) ◽

pp. 3155-3166

Author(s):

Mark C. Hwang ◽

Mona Martin ◽

Kristina Harris ◽

Philip Geerdts ◽

Jeffrey L. Stark ◽

...

Keyword(s):

Quality Of Life ◽

Ankylosing Spondylitis ◽

Qualitative Study ◽

Axial Spondyloarthritis ◽

Cognitive Interview ◽

Response Options ◽

Distinct Subgroup ◽

Concept Elicitation ◽

Qualitative Interview Study

Abstract Purpose The ankylosing spondylitis quality of life (ASQoL) instrument is widely used to assess health-related quality of life in patients with ankylosing spondylitis (AS). We assessed the relevance of the ASQoL items in patients with non-radiographic axial spondyloarthritis (nr-axSpA), a distinct subgroup within the axSpA disease spectrum. Methods This observational, cross-sectional, qualitative interview study recruited patients from clinic settings. Interviews from patients with axSpA who participated in a prior qualitative study were also used. Patients initially underwent a concept elicitation interview using open-ended questions to evaluate relevance of the concepts measured by the ASQoL. They then completed the ASQoL and underwent a cognitive interview to assess their understanding of the items, instructions and response options. Transcripts from patients who participated in the previous qualitative study (who did not complete the ASQoL or undergo cognitive interview) were evaluated to identify expressions of the concepts in the ASQoL. Results A total of 18 patients with nr-axSpA participated. The concept elicitation interview findings supported the relevance of the ASQoL items. Cognitive interviews determined that the ASQoL was easily understood; the 13 new patients chose a response for each item that matched their experience with nr-axSpA. Transcripts for the five previously interviewed patients confirmed the concepts presented in the ASQoL items were relevant and important to their experience of living with nr-axSpA. Conclusions Our results represent an important first step in confirming the relevance of the concepts in the ASQoL to patients with nr-axSpA, supporting quantitative assessment of ASQoL validity in this population.

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ASAS Health Index as an Addition to Routine Clinical Practice

The Journal of Rheumatology ◽

10.3899/jrheum.201440 ◽

2021 ◽

pp. jrheum.201440

Author(s):

Rubén Queiro ◽

Sara Alonso-Castro ◽

Mercedes Alperi

Keyword(s):

Quality Of Life ◽

Ankylosing Spondylitis ◽

Disease Activity ◽

Structural Damage ◽

Activity Index ◽

Functional Limitations ◽

Disease Activity Index ◽

Health Index ◽

Quality Of Life Scale

We have read with great interest the recent editorial published in The Journal by Dr. Kiltz, et al, referring to the possibility of using the Spondyloarthritis international Society Health Index (ASAS HI) as an all-in-one in the assessment of axial spondyloarthritis (axSpA)1. AxSpA has been evaluated over the years with different tools that have tried to determine the degree of activity [Bath Ankylosing Spondylitis Disease Activity Index (BASDAI)/Ankylosing Spondylitis Disease Activity Score (ASDAS)], functional limitations (Bath Ankylosing Spondylitis Functional Index), mobility restrictions (Bath Ankylosing Spondylitis Metrology Index), structural damage accumulated over time (Bath Ankylosing Spondylitis Radiology Index/modified Stoke Ankylosing Spondylitis Spinal Score), or quality of life (Ankylosing Spondylitis Quality of Life scale) of these patients.

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