scholarly journals P244 Determining factors related to poor quality of life in patients with axSpA: results from the British Society for Rheumatology Biologics Register

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
Linda E Dean ◽  
Ovidiu Rotariu ◽  
Gareth T Jones ◽  
Ejaz Pathan ◽  
Gary J Macfarlane
Keyword(s):  
Ankylosing Spondylitis ◽  
Disease Activity ◽  
Sleep Disturbance ◽  
Physical Function ◽  
De Novo ◽  
Spinal Mobility ◽  
British Society ◽  
Widespread Pain ◽  
Biologics Register

Abstract Background The aim when treating people with axial spondyloarthropathies (axSpA) is to maintain/improve their Quality of Life (QoL), traditionally through reducing disease activity. Previously, the Scotland Registry for Ankylosing Spondylitis (SIRAS) demonstrated, however, that although important, disease activity may not be the only factor influencing QoL. Indeed, function was a better predictor, with fatigue, chronic widespread pain and spinal mobility also important. The aim of the current study was to validate the previous findings in a large nationwide population, and determine if other factors, not collected in the previous study (such as mood and sleep) are also important. Methods The British Society for Rheumatology Biologics Register in Ankylosing Spondylitis (BSRBR-AS) is a prospective cohort of axSpA patients from 83 secondary care centres across Great Britain. Clinical data was collected during routine clinic visits and questionnaires provided patient reported outcomes including: the Ankylosing Spondylitis QoL questionnaire (ASQoL: scored 0 (best) to 18 (worst)), the Bath AS indices for disease & physical activity ((BASDAI/BASFI: scored 0 (best) - 10 (worst)), sleep disturbance (Jenkins: 0 (best) - 20 (worst)), depression (hospital anxiety & depression scales: scored 0 (best) - 21 (worst)) and the modification of the 2010 fibromyalgia criteria (widespread pain index (WPI): scored 0 (best) - 19 (worst) & symptom severity score (SSS): 0 (best) -12 (worst)). Using data collected at BSRBR-AS registration, multivariate linear regression models, predicting ASQoL, were used to validate the previous SIRAS model. Additionally, a de-novo forward stepwise model was developed to assess consistency across both populations and to determine if any additional factors (such as mood and sleep) predicted QoL. Results 1,810 BSRBR-AS participants were eligible for the current study, 67% of whom were male, median age 49 years (interquartile range 38-61). 80% of those tested were HLA-B27 positive and the majority of patients (67%) met the modified New York Criteria for AS. Of the five factors included in the SIRAS model; disease activity, physical function, fatigue and widespread pain remained significantly associated with QoL in the BSRBR-AS study. Spinal mobility was no longer significantly associated. Within the de-novo model eight independent factors predicted ASQoL score: disease activity (coefficient 0.31, 95% (confidence interval 0.14, 0.47)), physical function (0.59 (0.45, 0.73)), depression (HADS: 0.16 (0.09, 0.24)), sleep disturbance (0.08 (0.04, 0.13)), activity impairment (0.04 (0.02, 0.05)), fibromyalgia (SSS: 0.24 (0.13, 0.35), WPI: 0.10 (0.03, 0.17)) and tobacco smoking (vs. non-smoker: 0.66 (0.10, 1.21)). Conclusion Current EULAR guidelines for management of axSpA targeting disease activity and physical function are supported by the current findings which suggest both are consistently important predictors of QoL. However, additional factors such as fatigue, sleep disturbance and mood also contribute to QoL and should be considered additional targets within future axSpA management strategies. Disclosures L.E. Dean None. O. Rotariu None. G.T. Jones None. E. Pathan Other; E.P. has received salary funding from Jansen (2019) and Merck (2018). G.J. Macfarlane None.

scholarly journals Determining factors related to poor quality of life in patients with axial spondyloarthritis: results from the British Society for Rheumatology Biologics Register (BSRBR-AS)

2019 ◽  
Vol 79 (2) ◽  
pp. 202-208 ◽  
Author(s):  
Gary J Macfarlane ◽  
Ovidiu Rotariu ◽  
Gareth T Jones ◽  
Ejaz Pathan ◽  
Linda E Dean
Keyword(s):  
Quality Of Life ◽  
Ankylosing Spondylitis ◽  
Disease Activity ◽  
Sleep Disturbance ◽  
De Novo ◽  
Poor Quality ◽  
Previous Model ◽  
British Society ◽  
Widespread Pain

ObjectiveTo determine modifiable factors associated with poor quality of life (QoL) in patients with axial spondyloarthritis (axSpA).MethodsAnalysis of data from the British Society for Rheumatology Biologics Register in Ankylosing Spondylitis (BSRBR-AS) and validation of a previous model using data from 1810 patients with axSpA recruited during 2012–2017. Data collected included clinical and patient-reported measures. QoL was assessed using the Ankylosing Spondylitis Quality of Life (ASQoL) measure. Linear regression models predicting ASQoL scores were used first to validate a previous model from a national study, to extend this with additional information available in BSRBR-AS and finally to identify a ‘de novo’ model from BSRBR-AS of which factors impact on poor QoL.ResultsFour out of five factors included in a previous model of poor QoL in patients with axSpA were confirmed: Bath Ankylosing Spondylitis Disease Activity Index and Bath Ankylosing Spondylitis Functional Index, fatigue and widespread pain, although the performance of the model was improved by the addition of measures of mood and sleep disturbance. In a de novo model in BSRBR-AS, there were six factors (other than disease activity and function) that predicted ASQoL: depression (β=0.16), sleep disturbance (β=0.08), activity impairment (β=0.04), fibromyalgia (Symptom Severity Scale (β=0.24) and Widespread Pain Index (β=0.10)) and tobacco smoking (β=0.66).ConclusionThis study confirms that poor QoL in patients with axSpA, in addition to high disease activity and poor function, is independently influenced by sleep disturbance, mood and widespread pain. These additional factors are not considered targets for treatment in current European League Against Rheumatism (EULAR) guidelines for managing the condition.

scholarly journals Five Potentially Modifiable Factors Predict Poor Quality of Life in Ankylosing Spondylitis: Results from the Scotland Registry for Ankylosing Spondylitis

2017 ◽  
Vol 45 (1) ◽  
pp. 62-69 ◽  
Author(s):  
Linda E. Dean ◽  
Gary J. Macfarlane ◽  
Gareth T. Jones
Keyword(s):  
Quality Of Life ◽  
Ankylosing Spondylitis ◽  
Disease Activity ◽  
Physical Function ◽  
Spinal Mobility ◽  
Factors Associated ◽  
Modifiable Factors ◽  
Chronic Inflammatory Condition ◽  
Patient Reported

Objective.A chronic inflammatory condition manifesting in young adulthood, ankylosing spondylitis (AS) affects both physical and emotional quality of life (QOL). To inform future intervention strategies, this study aimed to (1) assess the QOL of patients with AS, and (2) identify potentially modifiable factors associated with reporting poor QOL.Methods.The Scotland Registry for Ankylosing Spondylitis collects clinical and patient-reported data on clinically diagnosed patients with AS across Scotland. QOL is measured using the ASQoL questionnaire [range: 0 (high) to 18 (poor)]. Potentially modifiable factors associated with reporting poor QOL (score 12–18) were examined using Poisson regression models, adjusted for a variety of demographic characteristics, plus various nonmodifiable factors. Results are given as risk ratios (RR) with 95% CI.Results.Data were available on 959 patients: 74% male, mean age 52 years (SD 13), median ASQoL 7.0 (interquartile range 2–12). Although many factors were univariately associated with poor QOL, 5 were identified as independent predictors: reporting moderate/severe fatigue (RR 1.60, 95% CI 1.13–2.28), poor physical function [Bath Ankylosing Spondylitis Functional Index (BASFI) ≥ 4: 3.46, 1.76–6.82], chronic widespread pain (CWP; 1.92, 1.33–2.75), high disease activity [Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) ≥ 4: 1.52, 1.09–2.12], and poor spinal mobility [Bath Ankylosing Spondylitis Metrology Index (BASMI) ≥ 4: 1.52, 0.93–2.50]. For these factors, population-attributable risks ranged between 20% (disease activity) and 56% (physical function).Conclusion.We have identified 5 potentially modifiable factors independently associated with poor QOL. These findings provide evidence that in addition to traditional clinical targets (BASDAI, BASFI, and BASMI), focus on nonspecific symptoms (CWP and fatigue), perhaps with nonpharmacological therapies, may yield important improvements in QOL.

Health-Related Quality of Life in Patients with Ankylosing Spondylitis: Relationship with Disease-Related Variables

2020 ◽  
Vol 16 (4) ◽  
pp. 311-318 ◽  
Author(s):  
Gehan Elolemy ◽  
Ahmed Aboughanima ◽  
Sahar Ganeb ◽  
Haytham Elziat
Keyword(s):  
Quality Of Life ◽  
Ankylosing Spondylitis ◽  
Physical Health ◽  
Disease Activity ◽  
Functional Status ◽  
Spinal Mobility ◽  
Peripheral Arthritis ◽  
Radiographic Severity ◽  
Sf 36

Background: Ankylosing spondylitis (AS) is a chronic progressive inflammatory disease leading to functional limitations and subsequently impaired quality of life (QoL). Despite the fact that QoL was recognized as a significant perception, it was excluded from the core domains (defined by the Assessment of Spondyloarthritis International Society), because of ambiguity of measurement choice. Aim: To assess QoL in patients with AS using a generic; Short Form-36 (SF-36) and a diseasespecific; Ankylosing Spondylitis quality of life (ASQoL) instruments and to explore its relationship to the clinical characteristics, disease activity, functional status, and radiographic severity. Methods: A total of 47 AS patients who fulfilled modified New York criteria were included. Disease activity, functional status, spinal mobility, and radiographic severity were assessed by Bath AS Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI), Bath AS Metrology Index (BASMI) and Bath AS Radiology Index (BASRI) respectively. SF-36 and ASQoL instruments evaluated Qol. Results: Physical health was more affected especially in patients with peripheral arthritis by SF-36 (p=0.008) and ASQoL (p=0.022) scores. Both SF-36 total and ASQoL scores correlated significantly with BASDAI (r = -0.329, p = 0.024 and r = 0.420, p = 0.003), BASFI (r = -0.399, p = 0.005 and r = 0.513, p=0.001) and BASMI (r = -0.382, p = 0.008 and r = 0.482, p= 0.001) respectively. Conclusion: QoL was impaired in AS patients with highest impact on physical health especially in association with peripheral arthritis. SF-36 and ASQol have a comparable achievement in the evaluation of QoL in AS patients and both physical function and spinal mobility were identified as predictors of poor QoL.

Efficacy and safety of adalimumab in Chinese adults with active ankylosing spondylitis: results of a randomised, controlled trial

2013 ◽  
Vol 73 (3) ◽  
pp. 587-594 ◽  
Author(s):  
Feng Huang ◽  
Jieruo Gu ◽  
Ping Zhu ◽  
Chunde Bao ◽  
Jianhua Xu ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Ankylosing Spondylitis ◽  
Disease Activity ◽  
Physical Function ◽  
Chinese Patients ◽  
Inactive Disease ◽  
Inadequate Response ◽  
Efficacy And Safety ◽  
Chinese Adults

Background and objectivesEfficacy of adalimumab for ankylosing spondylitis (AS) has been established for Western populations but not in the Chinese population. This study is the first to evaluate the efficacy and safety of adalimumab in Chinese patients with AS.MethodsChinese adults with active AS who had an inadequate response or were intolerant to ≥1 non-steroidal anti-inflammatory drugs were randomised to adalimumab 40 mg (N=229) or matching placebo (N=115) subcutaneously every other week (EOW) for 12 weeks, followed by a 12-week open-label adalimumab 40 mg EOW phase. The primary efficacy endpoint was the percentage of patients meeting the Assessment in Spondyloarthritis International Society (ASAS20) response criteria at week 12. The recently developed AS Disease Activity Score (ASDAS), as well as efficacy measures of spinal mobility, disease activity, physical function and quality of life were evaluated.ResultsAt week 12, adalimumab treatment resulted in a significantly greater percentage of ASAS20 responders than placebo (67.2% versus 30.4%, respectively; p<0.001). Differences in ASAS20 were observed as early as week 2 (42.8% vs 6.1%, respectively; p<0.001). The percentages of patients achieving ASAS40, ASAS 5/6 and ASDAS inactive disease were significantly greater with adalimumab than placebo at week 12 (all p<0.001). Tuberculosis was reported in one patient. No cases of malignancy, lymphoma, demyelinating disease or lupus-like syndrome were reported during the study.ConclusionsAdalimumab significantly reduced the signs and symptoms, improved physical function and quality of life of Chinese patients with active AS, and was generally safe and well tolerated in this population.

scholarly journals AB0825 TIME-COURSE CHANGE IN AXIAL MOBILITY IN PSORIATIC ARTHRITIS PATIENTS UNDER bDMARD

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1716-1717
Author(s):  
M. Rato ◽  
F. Pinheiro ◽  
S. Garcia ◽  
B. M. Fernandes ◽  
S. Ganhão ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Ankylosing Spondylitis ◽  
Disease Activity ◽  
Physical Function ◽  
Time Course ◽  
Functional Limitation ◽  
Spinal Mobility ◽  
University Hospital ◽  
The Impact

Background:Spinal mobility is assessed frequently in patients with psoriatic arthritis (PsA) usingBath Ankylosing Spondylitis Metrology Index(BASMI) to provide baseline measurement, monitor changes over time and to assess the impact of clinical interventions. BASMI comprises 4 measures of spinal mobility (cervical rotation, tragus-to-wall distance, modified Schober’s test and lumbar lateral flexion) and one hip mobility measurement (intermalleolar distance).Objectives:The aim of this study is to investigate the time-course change of BASMI in PsA patients after 6 months ofBiologic Disease-modifying Antirheumatic Drug(bDMARD) therapy. The authors also pretend to evaluated, at baseline and after 6 months of treatment, the association between BASMI, disease activity scores and physical function.Methods:An observational retrospective study was performed in patients with PsA under bDMARD followed in the Rheumatology department of a tertiary university hospital. Were included patients treated with only one bDMARD. Demographic and clinical data were collected from the Rheumatic Diseases Portuguese Register. For spinal mobility calculation BASMI was used. Disease activity was evaluated withAnkylosing Spondylitis Disease Activity Score(ASDAS) andBath Ankylosing Spondylitis Activity Index(BASDAI). Physical function was assessed withBath Functional Index(BASFI). The variation of BASMI, ASDAS, BASDAI and BASFI was calculated as the difference between values registered at 6 months and at baseline and presented as Δ. Correlations between ΔBASMI, ΔASDAS and ΔBASFI was calculated using Pearson test.Results:A total of 55 patients were included. Thirty patients were males (54.5%). The mean age at diagnosis was 44.6 ± 12.6 years and the median disease duration at start of bDMARD was 5.4 years (min: 0.30; max: 25.5). In total, 19 (34.5%) patients had predominant axial involvement, 36 (65.5%) peripheric and 36 (65.5%) enthesopathic. Almost all patients fulfilled the CASPAR criteria for PsA (n=50, 90.9%). According to ASDAS criteria, at the baseline 20 patients (36.4%) had high disease activity and 34 (61,8%) very high. The most used bDMARD was etanercept (n=21, 38,3%) followed by golimumab (n=19, 34.5%) and adalimumab (n=8, 14.5%). Three patients were treated with infliximab, two with certolizumab and other two with secukinumab. Forty-one patients (75.9%) were concomitantly treated with conventional synthetic DMARDs. Axial PsA patients had more limitations in spinal mobility (BASMI mean 4.5 ± 1.5) and more functional limitation (BASFI mean 6.8±1.9) than patients with predominant peripheric involvement (BASMI mean 3.3± 1.2, p=0.004; BASFI mean 5.4±3, p=0,0048). Statistically significant differences in ASDAS and BASDAI in these two groups were not observed (p=0.332 and p=0.605, respectively). For all patients, BASMI did not vary significantly (p=0.691) at baseline (mean 3.7± 1.4) and after 6 months (mean 3.8±1.3) of treatment. Although the ΔBASMI for etanercept was negative (mean -0.12±0.9) and for golimumab positive (0.14±0.8), it was not statistically significant. At baseline there is a significant positive association between BASMI and ASDAS (r=0.435, p=0.001), BASMI and BASDAI (r=0.567, p<0.001) and BASMI and BASFI (r=0.510, p<0.001). However, there was not a statistically significant association between ΔBASMI and: ΔASDAS, ΔBASDAI and ΔBASFI (r=0.158; p=0.269, r=0.019; p=0.096 and r=0.121; p=0.397, respectively).Conclusion:In PsA patients treated with bDMARDs, at least in short-term follow-up, BASMI does not improve with time. Changes in BASMI did not correlate with changes in activity disease and in functional outcome. Studies with longer follow-up and with more patients are needed to better evaluate these associations.Disclosure of Interests:Maria Rato: None declared, Filipe Pinheiro: None declared, Salomé Garcia: None declared, Bruno Miguel Fernandes: None declared, Sara Ganhão: None declared, Rita Gaio: None declared, Miguel Bernardes Speakers bureau: Abbvie, Amgen, Biogen, Eli-Lilly, Glaxo-Smith-Kline, Pfizer, Janssen, Novartis, Alexandra Bernardo: None declared, Lúcia Costa: None declared

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