Which clinical variables have the most significant correlation with quality of life evaluated by SF-36 survey in Croatian cohort of patient with ankylosing spondylitis and psoriatic arthritis?

Physical component of SF-36 is associated with measures of disease activity in patients with psoriatic arthritis: a real-life study from a tertiary referral centre

Psoriatic arthritis (PsA) can lead to chronic disability. The aim of this study was to explore the association between disease activity and quality of life (QoL) in patients with PsA from the usual clinical practice. The study involved 143 consecutive adult patients with PsA (49.6% women and 50.4% males), with mean age of 57.75 ± 10.91 years, and duration of disease 11.6 ± 9 years. Tender (TJC) and swollen joints count (SJC), Disease activity score (DAS) 28, patient's global assessment (PtGA), physician's global assessment (PhGA), enthesitis score, number of fingers with dactylitis, sedimentation rate (ESR) and C-reactive protein (CRP) were evaluated. The functional assessment of chronic illness therapy - fatigue scale (FACIT-F) questionnaire was used in fatigue assessment and physical health domains of Short Form (SF)-36 questionnaire were chosen to assess subjective QoL: physical functioning (PF), role limitations due to physical health (RP), bodily pain (BP) and general health (GH). Significant correlations (p < 0.001) were found between FACIT-F and all SF-36 domains. DAS28, PtGA and PhGA were significantly correlated to two or three SF-36 domains, while ESR and CRP were not significantly correlated to any of SF-36 domains. Regression analysis showed, when controlling for age, that FACIT-F, dactylitis and DAS28 were the most significant predictors of SF-36 physical health domains. Regression and factor analyses confirmed that FACIT-F was most consistently associated with SF-36 physical health domains. In our real-life study most of the analyzed clinical measures of PsA were significantly associated with physical health domains of SF-36 questionnaire. Considering the strength of those associations, we conclude that PsA activity has mild to moderate impact on health-related Qol.

Health-related quality of life in gout, psoriatic arthritis, rheumatoid arthritis and ankylosing spondylitis, results from a cross-sectional survey in Western Sweden

OBJECTIVES

Inflammatory joint diseases (IJDs) substantially affect health-related quality of life (HRQoL). We aimed to compare HRQoL between patients with gout, psoriatic arthritis (PsA), rheumatoid arthritis (RA), and ankylosing spondylitis (AS): (i) overall; (ii) stratified by sex; and (iii) between women and men with the same IJD diagnosis.

METHOD

A survey including the RAND36-Item Health Survey for assessing HRQoL was sent to patients with a diagnosis of gout, PsA, RA, or AS, registered at a rheumatology clinic or primary care centre during 2015-2017. HRQoL was compared across IJDs. Because of age differences between diagnoses, age-matched analyses were performed.

RESULTS

In total, 2896/5130 (56.5%) individuals responded to the questionnaire. Of these, 868 had gout, 699 PsA, 742 RA, and 587 AS. Physical component summary (PCS) scores were more affected than mental component summary (MCS) scores for all diagnoses (PCS range: 39.7-41.2; MCS range: 43.7-48.9). Patients with gout reported better PCS scores than patients with PsA, RA, and AS, who reported similar scores in age-matched analysis. MCS scores were close to normative values for the general population and similar across IJDs. When comparing women and men with respective IJDs, women reported worse PCS (range, all IJDs: 34.5-37.4 vs 37.5-42.5) and MCS (PsA: 44.0 vs 46.8; RA: 46.1 vs 48.7) scores.

CONCLUSION

We found that patients with gout reported better PCS scores than patients with other IJDs, for whom the results were similar. Women reported overall worse PCS and MCS scores than men.

Non-Physical Disease Facets in Spondyloarthritis: An ASAS Health Index-Based Analysis between Psoriatic Arthritis and Axial Spondyloarthritis

Background: Psychosocial health is a key driver of quality of life (QoL) in axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA), but it is often overlooked in clinical practice. We aimed to analyze this aspect of QoL by using the Assessment of SpA International Society−Health Index (ASAS HI) in both SpA phenotypes. Patients and methods: One hundred and eleven patients with axSpA and 90 with PsA were consecutively recruited from two rheumatology centers. In both populations, the categories of stress handling (ASAS HI items #11 and 17) and emotional functions (ASAS HI item #13) were analyzed based on the International Classification of Functioning, Disability, and Health (ICF). A multivariate regression model was used to analyze the explanatory factors associated with positive responses to these items. Results: Thirty-four of the 90 PsA patients (37.8%) and 37/111 of the patients (33.3%) with axSpA reported a positive response to at least one of the stress-handling items. Compared to the patients with PsA, patients with axSpA were less likely to report stress-handling issues (OR 0.48, p < 0.05). Thirty-one of the 90 PsA patients (34.4%) and 44/111 of the patients (39.6%) with axSpA reported positive responses to item #13. In both groups of SpA patients, disease activity and severity (OR 6.6, p < 0.001) were independently associated with alterations in psychosocial health. Compared with those in the axSpA group, the psychosocial health items were better correlated with each other and with the ASAS HI sum score in the PsA group. Conclusions: Psychosocial health is frequently altered in SpA. Both disease activity and severity are associated with this issue. However, psychosocial factors seem to have a greater impact on QoL in PsA than in axSpA.

Disease Characteristics, Quality of Life, and Work Productivity by Enthesitis Site: Real-world Data From the US Corrona Psoriatic Arthritis/Spondyloarthritis Registry

OBJECTIVE

To assess the effect of clinical enthesitis by body site in patients with psoriatic arthritis (PsA).

METHODS

Adults with PsA enrolled in the Corrona Psoriatic Arthritis/Spondyloarthritis Registry (March 2013-March 2018) were included. Enthesitis at enrollment was assessed by the Spondyloarthritis Research Consortium of Canada Enthesitis Index and classified by affected sites (upper, lower, or both). Disease activity (e.g., Clinical Disease Activity Index, Clinical Disease Activity Index for PsA), patient-reported outcomes (PRO; e.g., patient-reported pain and fatigue), and work productivity were compared between those with and without enthesitis using t- or Wilcoxon rank-sum tests for continuous variables and chi-square or Fisher exact tests for categorical variables. The association of enthesitis with disease activity and PRO measures versus no enthesitis was modeled using multivariable-adjusted linear or logistic regression.

RESULTS

Of 2003 patients with PsA, 391 (19.5%) had enthesitis: 80 (20.5%) in upper sites only; 137 (35.0%) in lower sites only; and 174 (44.5%) in both. Regardless of location, disease activity and PRO were worse in patients with versus without enthesitis. In adjusted models, the presence of enthesitis at any site was significantly associated with worse disease activity versus no enthesitis. Enthesitis in lower or both upper and lower sites was associated with higher pain and fatigue scores and greater work impairment versus no enthesitis.

CONCLUSION

Patients with clinical enthesitis had worse disease activity regardless of enthesitis location versus those without enthesitis, and patients with enthesitis in lower or both upper and lower sites had worse pain, fatigue, and work impairment.

Peripheral neuropathy and health-related quality of life in patients with primary Sjögren's syndrome: a preliminary report

Sjögren's syndrome (SS) is a chronic autoimmune disease with a wide spectrum of possible organ involvement. Peripheral (PNS) and central nervous system (CNS)-related symptoms may occur in the course of the disease. The aim of this study was to compare the health-related quality of life (HR-QOL) in SS patients with and without peripheral neuropathy. The study involved 50 patients with primary Sjögren's syndrome (pSS). All patients underwent neurological clinical examination followed by nerve conduction studies (NCS) and rheumatological examination. Thirty-six-item Short Form Health Survey (SF-36) was used for evaluating HR-QOL. To assess pSS activity, the EULAR Sjögren's Syndrome Disease Activity Index (ESSDAI) and EULAR Sjögren's Syndrome Patient Reported Index (ESSPRI) were used. For the assessment of clinical disability due to peripheral neuropathy, the Overall Disability Sum Score scale (ODSS) was used. Additional evaluation of pain was performed with the use of the Visual Analogue Scale (VAS) and a semistructured interview. Twenty-three (46%) patients were diagnosed with peripheral neuropathy. The most common PNS manifestation was sensorimotor neuropathy (47%). Neurological symptoms preceded the diagnosis of pSS in eight patients. The following domains of the SF-36 form were significantly lower scored by patients with peripheral nervous system involvement: role-physical [0 (0-100) vs. 75 (0-100)], role-emotional [67 (0-100) vs. 100 (0-100)], vitality [40 (10-70) vs. 50 (20-75)], bodily pain [45 (10-75) vs. 55 (0-100)], and general health [20 (5-50) vs. 30 (0-50)] (p ≤ 0.05). Our study showed that peripheral neuropathy was a common organ-specific complication in SS patients. In pSS patients, coexisting neurological involvement with symptoms such as pain and physical disability may be responsible for diminished HR-QOL.

Disease Activity and Patient-Reported Health Measures in Relation to Cytokine Levels in Ankylosing Spondylitis

INTRODUCTION

Ankylosing spondylitis (AS) is a lifelong condition where spinal inflammation causes chronic back pain and restriction of spinal function. While proinflammatory cytokines participate in the disease process, their relation with disease activity, spinal function, and quality of life is less well understood.

METHODS

Cross-sectional study of serum levels of four inflammatory cytokines (IL-6, TNF, IL-23, and IL-17A) in AS patients not on biologics. Disease characteristics and simultaneous spinal function tests and patient-reported health measures (Bath Functional Index (BASFI), Dougados Functional Index (DFI), Modified Health Assessment Questionnaire (MHAQ), and routine laboratory parameters were recorded. The composite ASDAS-CRP score was used to classify disease activity as absent, low, or high.

RESULTS

In 164 AS patients (age 46 years, 70.1% males, 90.9% HLAB27 positive, ASDAS-CRP 1.8), disease activity was classified as inactive in 14%, low in 54%, and high in 31%. ASDAS-CRP correlated well with MHAQ, DFI, BASFI, and spinal mobility across patients with low and high disease activity (all p < 0.05). Cytokine levels did not correlate with ASDAS-CRP, ESR, BASFI, or spinal mobility scores and were comparable between patients with no, low, or high disease activity regardless of gender or disease duration (all p > 0.2).

CONCLUSIONS

A large proportion of AS not on biologics have active disease far into the disease course. This impacts negatively on quality of life, work ability, and spinal mobility. Serum cytokine levels are poor markers for these central disease features in AS management.

FUNDING

Abbott Norway AS and Arthritis Foundation of Western Australia.

Factors associated with disease-specific quality of life in Taiwanese patients with ankylosing spondylitis: a cross-sectional study

OBJECTIVE

The aim of this study was to assess the factors associated with disease-specific quality of life in Taiwanese patients with ankylosing spondylitis.

DESIGN

A cross-sectional study.

SETTING

A regional teaching hospital in southern Taiwan.

PARTICIPANTS

Adult patients with ankylosing spondylitis recruited from the outpatient rheumatology clinics of the study hospital.

PRIMARY OUTCOME MEASURE

Disease-specific quality of life assessed by the Evaluation of Ankylosing Spondylitis Quality of Life (EASi-QoL).

RESULTS

Of the 265 patients, 57% were 20-49 years of age, with a male preponderance (75.5%). Multiple stepwise linear regression analysis indicated that a higher disease activity, assessed by the Ankylosing Spondylitis Disease Activity Score, was significantly and independently associated with a lower quality of life in all four domains (physical function, disease activity, emotional well-being and social participation) of the EASi-QoL. In addition, various independent factors, including educational level, nature of occupation, disease duration, dietary habit and body mass index, were significantly associated with different domains of the EASi-QoL.

CONCLUSIONS

Our findings indicated that, in addition to disease activity and perceived health status, a number of other factors could significantly impact the different aspects of quality of life in patients with ankylosing spondylitis, which warrant special consideration and support from healthcare providers.

Patient-reported outcomes in European spondyloarthritis patients: a systematic review of the literature

OBJECTIVE

This review aims to summarize the current literature on patient-reported outcomes (PROs) in spondyloarthritis (SpA).

PATIENTS AND METHODS

We performed a systematic literature review to identify studies (original articles and narrative and systematic reviews) regarding PROs (health-related quality of life [HRQoL], satisfaction, preferences, adherence/compliance, and persistence) in SpA patients published in the European Union through December 2016. International databases (Medline/PubMed, Cochrane Library, ISI Web of Knowledge, Scopus) were searched using keywords in English. The methodological quality of the studies was assessed using the Oxford Centre for Evidence-Based Medicine criteria.

RESULTS

A total of 26 publications met the inclusion criteria. Generally, studies indicated that SpA has a negative impact on patients' HRQoL. In patients with ankylosing spondylitis, physical domains were more affected than emotional ones, whereas for psoriatic arthritis, both physical and psychological factors were strongly affected by the disease. Data indicated that biological agents (BAs) greatly contributed to improvement in HRQoL in both ankylosing spondylitis and psoriatic arthritis patients. Findings on compliance with BAs were heterogeneous. However, persistence rates exceeded 50% irrespective of the BA administered. Results on preferences indicated that most SpA patients prefer being involved in decisions regarding their treatment and that besides efficacy and safety, frequency and route of administration may influence patients' preferences for BAs.

CONCLUSION

Implementing management programs for SpA patients focuses on the physical, emotional, and social consequences of the disease, in addition to assessing and including patient preferences in the treatment decision-making process, could be crucial to improve patients' HRQoL and ensure their satisfaction and compliance with treatment.

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

Background

Previously, many studies have evaluated quality of life (QoL) in patients with ankylosing spondylitis (AS), however, none of them specifically investigated the correlation between pain-related disability measured by Oswestry Disability Index (ODI) and QoL in AS patients. In addition, the correlation between global kyphosis (GK) in lateral plain radiographs and QoL in AS patients remains unclear up to now. Therefore, this study aimed to evaluate QoL and correlation with clinical and radiographic variables in AS patients, especially to figure out the relationship about the pain-specific disability measured by ODI, GK and QoL.

Methods

From January 2008 to November 2015, two hundred and forty-five consecutive patients with an average age of 36.2 ± 10.9 years (range, 17–66 years) satisfying the Modified New York Criteria for AS from a single institution were enrolled. Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI) and Bath Ankylosing Spondylitis Global score (BAS-G) were applied to assess the disease activity, functional status, spinal mobility and overall feeling of AS patients, respectively. ODI was recorded to evaluate low back pain-related disability. QoL was evaluated by the Short Form-36 (SF-36). According to global kyphosis (GK) measured on standing lateral full-spine radiographs, the patients were divided into two groups: mild kyphotic group (GK < 70°,n = 176) and severe kyphotic group (GK ≥ 70°,n = 69).

Results

The scores of BASDAI, BASFI, BASMI and ODI had significant negative correlations with all SF-36 subscale scores (P < 0.01). BASFI and BASMI scores of severe kyphotic group were much higher than those of mild kyphotic group, respectively (P = 0.005 and P = 0.001, respectively) and the score of physical function (PF) subscale in severe kyphotic group was significantly higher than that in mild kyphotic group (P = 0.046) as well. Notably, the scores of ODI, BASFI and BASMI were the major predictors of PF subscale score of SF-36.

Conclusions

Poor QoL is significantly correlated with high disease activity, poor functional status and decreased spinal mobility in AS. GK is significantly associated with functional status, spinal mobility and QoL in AS patients. ODI, BASFI and BASMI are the major predictors of PF subscale of SF-36.

Anxiety and depression correlate with disease and quality-of-life parameters in Chinese patients with ankylosing spondylitis

AIM

To evaluate the relationship between mental and physical health in Chinese patients with ankylosing spondylitis (AS) and to identify the predictors of psychological status.

METHODS

Patients with AS (n=103) and healthy controls (n=121) were surveyed between 2010 and 2011 (cross-sectional study). The Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Functional Index, Bath Ankylosing Spondylitis Metrology Index, pain visual analog scale, Health Assessment Questionnaire, revised Self-Rating Anxiety Scale, revised Self-Rating Depression Scale, and Short-Form 36 questionnaire were administered.

RESULTS

The frequency of anxiety and depression in patients with AS was higher than that in healthy controls (P<0.001). Severe disease status and reduced quality of life (QoL) were associated with anxiety and depression. Disease activity and somatic pain were more severe in the anxious and depressed subgroups. Impaired physical functioning (assessed by Bath Ankylosing Spondylitis Functional Index) was higher in the anxious and depressed subgroups, while measures of spinal mobility (assessed by Bath Ankylosing Spondylitis Metrology Index) were not associated with depression. Lower QoL was observed in the depressed subgroup.

CONCLUSION

Low socioeconomic status, lack of health insurance, and fatigue contributed to depression in Chinese patients with AS. These patients may require a psychological care approach that is different from those of other countries.

Relationship of back and neck pain with quality of life in the Croatian general population

OBJECTIVE

The purpose of this study was to determine the prevalence of back pain and neck pain and their relationship with the quality of life in the Croatian general population.

METHODS

This was a cross-sectional study using home-based face-to-face interviews of 1030 participants (51.6% females) 15 years or older. Back and neck pain frequencies were assessed using single items and quality of life using the Short Form Survey and Satisfaction with Life Scale. Analysis of covariance was conducted, where back pain or neck pain frequency was used as the categorical predictor; physical component summary or mental component summary, as the dependent variable; and age, body mass index, and physical activity level, as covariates.

RESULTS

The prevalence of back pain was 66.3% (95% confidence interval [CI], 62.3%-70.3%) and 62.9% (95% CI, 58.7%-67.2%) in females and males, respectively. The prevalence of neck pain was 58.0% (95% CI, 53.8%-62.2%) for females and 53.6 (95% CI, 49.2%-58.0%) for males. Differences between men and women were not significant (P>.05). Adjusted mean values for physical component summary and mental component summary were substantially lower in participants who reported back or neck pain often/almost always compared with those without pain. Differences ranged from 8.11 to 11.86 points (95% CI, 5.54-13.99) and from 9.61 to 10.99 points (95% CI, 7.35-13.45) in females and males, respectively.

CONCLUSIONS

The findings of this study showed that back and neck pain are highly prevalent and negatively related to quality of life in the Croatian general population. These data might raise the awareness of local government health authorities and lead to improvements in health care service for people with back and neck pain.