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

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Abstract

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.

Original languageEnglish
Pages (from-to)62-69
Number of pages8
JournalJournal of Rheumatology
Volume45
Issue number1
Early online date1 Aug 2017
DOIs
Publication statusPublished - 1 Jan 2018

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Ankylosing Spondylitis
Scotland
Registries
Quality of Life
Baths
Fatigue
Odds Ratio
Chronic Pain
Demography
Exercise

Keywords

  • Ankylosing spondylitis
  • spondyloarthritis
  • Epidemiology
  • quality of life
  • ASQOL

Cite this

@article{cf815a14a4c94263835475690ec438fa,
title = "Five Potentially Modifiable Factors Predict Poor Quality of Life in Ankylosing Spondylitis: Results from the Scotland Registry for Ankylosing Spondylitis",
abstract = "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.",
keywords = "Ankylosing spondylitis, spondyloarthritis , Epidemiology, quality of life, ASQOL",
author = "Dean, {Linda E} and Macfarlane, {Gary J} and Jones, {Gareth T}",
note = "We thank all the clinicians and research nurses who facilitated recruitment and data collection. In particular, we thank the Scotland Registry for Ankylosing Spondylitis (SIRAS) steering committee, especially Professor Roger Sturrock (chair) and Dr. David Marshall (vice-chair). We also thank the SIRAS coordinating center study team, in particular Elizabeth Ferguson-Jones, Giles O’Donovan, Nabi Moaven-Hashemi, and Flora Joyce. GTJ has received research funding from AbbVie, Pfizer, and UCB. GJM has received research funding from AbbVie, Pfizer, and UCB in the form of unrestricted or investigator initiated grants. GJM also chairs a Pfizer research grant panel, for which he receives an honorarium. LED conducted the analysis while funded by an MRC PhD studentship.",
year = "2018",
month = "1",
day = "1",
doi = "10.3899/jrheum.160411",
language = "English",
volume = "45",
pages = "62--69",
journal = "Journal of Rheumatology",
issn = "0315-162X",
publisher = "Journal of Rheumatology",
number = "1",

}

TY - JOUR

T1 - Five Potentially Modifiable Factors Predict Poor Quality of Life in Ankylosing Spondylitis

T2 - Results from the Scotland Registry for Ankylosing Spondylitis

AU - Dean, Linda E

AU - Macfarlane, Gary J

AU - Jones, Gareth T

N1 - We thank all the clinicians and research nurses who facilitated recruitment and data collection. In particular, we thank the Scotland Registry for Ankylosing Spondylitis (SIRAS) steering committee, especially Professor Roger Sturrock (chair) and Dr. David Marshall (vice-chair). We also thank the SIRAS coordinating center study team, in particular Elizabeth Ferguson-Jones, Giles O’Donovan, Nabi Moaven-Hashemi, and Flora Joyce. GTJ has received research funding from AbbVie, Pfizer, and UCB. GJM has received research funding from AbbVie, Pfizer, and UCB in the form of unrestricted or investigator initiated grants. GJM also chairs a Pfizer research grant panel, for which he receives an honorarium. LED conducted the analysis while funded by an MRC PhD studentship.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - 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.

AB - 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.

KW - Ankylosing spondylitis

KW - spondyloarthritis

KW - Epidemiology

KW - quality of life

KW - ASQOL

U2 - 10.3899/jrheum.160411

DO - 10.3899/jrheum.160411

M3 - Article

VL - 45

SP - 62

EP - 69

JO - Journal of Rheumatology

JF - Journal of Rheumatology

SN - 0315-162X

IS - 1

ER -