January 16, 2019
3 min read

Ankylosing spondylitis significantly reduces health-related quality of life

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Patients with ankylosing spondylitis experience significantly reduced health-related quality of life, defined by the Medical Outcome Survey Short Form-36, compared with healthy controls, although improvements may be possible by addressing disease activity score–C-reactive protein and fatigue, according to data published in Arthritis Research & Therapy.

“Studies of AS often describe functional disabilities and measures of disease activity, however, they less often report the quality of life experienced by patients with AS and how this is related to AS disease characteristics,” Helena Forsblad-d’Elia, MD, PhD, of Umeå University in Sweden, and colleagues wrote. “The Medical Outcome Survey Short Form-36 (SF-36) was designed for use in clinical practice and research, health policy evaluations, and general population surveys and is utilized in many different countries.”

To analyze health-related quality of life (HRQoL) using the SF-36 among patients with AS compared with healthy controls, and to evaluate the associations between SF-36 scores and spinal radiographic changes, physical function, disease activity and demographic data, Forsblad-d’Elia and colleagues studied a cohort of 210 participants recruited from three sites in western Sweden.

Figure 1. Patients with AS experience significantly reduced health-related quality of life, defined by the Medical Outcome Survey Short Form-36, compared with healthy controls, according to data.
Source: Shutterstock

All patients were assessed using the Modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) with spinal radiographs, clinical examination and questionnaires. These questionnaires included the Bath Ankylosing Spondylitis Metrology Index, Bath Ankylosing Spondylitis Functional Index (BASFI), Ankylosing Spondylitis Disease Activity Score-C-reactive protein (ASDAS-CRP), Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Patient Global (BASG) and the SF-36.

In addition, each patient’s SF-36 results were compared with five control participants, matched by age and sex, from the SF-36 Swedish normative population database. A total of 1,055 controls were included in the study. Lastly, Forsblad-d’Elia and colleagues determined associations between SF-36, physical component summary and mental component summary scores, as well as disease-related and demographic factors, using univariate and multivariable logistic regression analyses.

According to the researchers, patients with AS scored significantly lower (P<.001) compared with controls in all SF-36 domains and component summaries. This included a median physical component summary score of 42.4, and a median mental component summary score of 47.9, among patients with AS, compared with 52.4 and 54.1, respectively, among the control population.

After performing multivariable logistic regression analyses, the researchers found that living without a partner (OR = 2.38; 95% CI, 1-5.67), long symptom duration (year in decade OR = 1.66; 95% CI, 1.16-2.37), higher BASFI (OR = 1.98; 95% CI, 1.46-2.7) and an ASDAS score of 2.1 or greater (OR = 3.32; 95% CI, 1.45-7.62) were associated with worse physical component summary scores. Living without a partner (OR = 3.04; 95% CI, 1.34-6.91), fatigue (OR = 6.36; 95% CI, 3.06-13.19) and an ASDAS score of2.1 or greater (OR = 2.97; 95% CI, 1.41-6.25) were linked with worse mental component summary scores.


“The [physical component summary] score was more affected than the [mental component summary] score in both sexes,” Forsblad-d’Elia and colleagues wrote. “Both demographic and disease-related factors were associated with worse HRQoL, with partial overlap for the [physical component summary] and [mental component summary]. There were some differences between sexes in the factors associated with HRQoL. By modifying factors such as ASDAS-CRP and fatigue, HRQoL may potentially be improved.”

The researchers added that “there is a need for longitudinal studies investigating predictors related to the development of HRQoL in AS over time. We intend to investigate factors related to the change in HRQoL over a 5-year period in this same cohort of patients with AS in a future study.” – by Jason Laday

Disclosure: Forsblad-d’Elia reports advisory board fees from Sandoz, Novartis and Abbvie, as well as an unrestricted grant from Novartis. Please see the study for all other authors’ relevant financial disclosures.