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In Early Axial Spondyloarthritis, Increasing Disease Activity Is Associated with Worsening of Health-related Quality of Life over Time

Journal article
Authors M. van Lunteren
Z. Ez-Zaitouni
A. de Koning
H. Dagfinrud
R. Ramonda
Lennart T. H. Jacobsson
R. Landewe
D. van der Heijde
F. A. van Gaalen
Published in Journal of Rheumatology
Volume 45
Issue 6
Pages 779-784
ISSN 0315-162X
Publication year 2018
Published at Institute of Medicine, Department of Rheumatology and Inflammation Research
Pages 779-784
Language en
Keywords spondyloarthritis, quality of life, severity of illness index, longitudinal studies, activity score asdas, ankylosing-spondylitis, classification criteria, cohort, sf-36, validation, selection, outcomes, trial, Rheumatology
Subject categories Rheumatology and Autoimmunity


Objective. In early axial spondyloarthritis (axSpA), data are lacking about the relationship between disease activity and health-related quality of life (HRQOL). We assessed and quantified the association between change in Ankylosing Spondylitis Disease Activity Score (ASDAS) and HRQOL over time in early axSpA. Methods. Baseline and 1-year data of patients with axSpA fulfilling the Assessment of Spondyloarthritis international Society (ASAS) classification criteria from the SPondyloArthritis Caught Early (SPACE) cohort were analyzed. Associations between change in ASDAS and in physical (PCS) or mental component summary (MCS) of the Medical Outcomes Study Short Form-36 were tested by linear regression models. Age. sex. ASAS criteria arm, and blue- versus white-collar work were tested for effect modification. Subsequently, these factors and medication were tested for confounding. Results. There were 161 patients with axSpA [53% male, mean (+/- SD) age 29.7 (+/- 7.5) yrs, symptom duration 13.6 (+/- 7.2) months, HLA-B27-positive 91%, radiographic sacroiliitis 22%] who had ASDAS of 2.5 (+/- 1.0) and 2.0 (+/- 0.8), PCS of 28.4 (+/- 14.3) and 36.9 (+/- 13.1), and MCS of 48.2 (+/- 13.8) and 493 (+/- 12.0) at baseline and 1 year, respectively. Per unit increase in ASDAS between baseline and 1 year, PCS worsened by 93 points. The same level of disease activity had fewer adverse effects on physical HRQOL in women and white-collar workers. Conclusion. To our knowledge, our data are the first to show that in a broad group of patients with early axSpA, increasing ASDAS is associated with worsening of physical HRQOL, but not mental HRQOL, over time.

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