Outcomes and treatment responses, including work productivity, among people with axial spondyloarthritis living in urban and rural areas: a mixed-methods study within a national register

Objectives: To examine differences in clinical and patient reported outcomes, including work, in individuals with axial spondyloarthritis (AxSpA) living in rural and urban settings.

Methods: Using a sequential, explanatory mixed-method design, data from The British Society for Rheumatology Biologics Register for Ankylosing Spondylitis (BSRBR-AS) was used to a) characterise axSpA participants living in rural and urban areas and b) to assess any differences in outcome after commencement of biologic therapy (phase 1). Semi-structured interviews further explored results from phase 1.

Results: axSpA patients living in rural areas were older and more likely to work in a physical job. Among patients prescribed biologics, there were no differences in response to biologics, but, after adjustment for age, sex and local-area deprivation, rural-dwellers reported more presenteeism and overall work impairment. Work effects could be explained by accounting for individual differences in: disease activity; fatigue; physical function and job type. Interviews highlighted complex relationship between clinical factors, contextual factors (work environment, job demands) and work disability. The ability to work and flexibility in terms of what, when and how tasks are undertaken was important. Support from employers was variable and healthcare professionals often perceived as unsupportive.

Conclusions: axSpA patients living in rural areas report a greater impact of their disease on work productivity. New measures are needed to capture important contextual factors and comprehensively determine the impact of long-term conditions on work. Future EULAR axSpA recommendations should include support to work as a target to optimise quality of life in patients with axSpA.