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Background: Axial spondyloarthritis (axSpA) represents the whole clinical spectrum of ankylosing spondylitis (AS) including those at the non-radiographic (nr) stage of the disease. Although the disease burden associated with radiographic axSpA (classically known as AS) has been extensively studied, the burden associated with nr-axSpA is less well known.
Objectives: To assess and compare the burden of radiographic and nr-axSpA
Methods: This cross-sectional, observational study included consecutive AxSpA patients with varying disease severity, who attended our outpatient clinic between April 2014 and December 2014. During the visits, the following questionnaires were applied by trained health professionals:BASDAI, BASFI, HAQ-S, SF-36, ASQoL,Work Productivity and Activity Impairment (WPAI) and Work Productivity Survey (WPS).
Results: A total of 381 AxSpA patients (279 AS) were analyzed. Nr-axSpA group, were younger (39.4 vs 43.1, p=0.007), more likely to be female (54% vs 33%, p<0.001), had a shorter disease duration (10.1 vs 16.0 years, p<0.001) and lower CRP (5.9 vs 13.2, p<0.001) and less common use of biologics (41.2% vs 26.5, p=0.008) despite higher BASDAI scores (Table). Broadly similar results were found for the other clinical outcome measures. Of all the axSpA patients, 58% were employed, with non-manual (25%), mixed (19%) and manual works (14%). Only 1.1% of the patients could not work due to arthritis. Patients with nr-axSpA reported more work productivity loss at workplace and at home over the last month, but the difference was significant only for household activities. Subgroup analysis showed that this difference was only found in females.
Table 1. Clinical variables related to disease burden in study participants. Data are presented as mean ± SD, unless otherwise stated *Assessed in employed patients only.
Variable AS (n=279) nr-axSpA (n=102) P value BASDAI (0–100) 33.2±21.8 39.5±23.1 0.014 BASFI (0–100) 30.5±24.1 29.4±24.6 0.711 HAQ-S 0.7±0.6 0.8±0.6 0.606 SF36 PCS 41.3±9.3 39.2±10 0.111 SF36 MCS 46.1±10.5 43.3±11.4 0.060 ASqoL 5.6±5.4 6.2±5.6 0.331 Work productivity and impairment index (refers to the last week) Absenteeism (%)* 8.7±25.5 12.3±30.3 0.374 Presenteeism (%)* 33.8±25.0 37.1±25.9 0.401 Overall work impairment (%)* 33.4±29.7 36.6±32.9 0.476 Daily activity impairment, (%) 33.5±22.9 34.6±23.6 0.672 Work productivity survey (refers to the last month) Days of work missed* 1.4±4.6 3.0±6.6 0.090 Days with productivity at work reduced by ≥50%* 2.6±6.3 4.6±8.2 0.090 Rate of SpA interference on work productivity* 3.2±2.3 3.8±2.6 0.109 Days of household work missed 2.5±5.6 4.8±7.6 0.010 Days with household productivity reduced by ≥50% 3.1±2.1 3.6±2.3 0.048 Days with outside help 2.7±6.5 2.8±5.9 0.815 Rate of SpA interference with household work productivity (0-10 ) 3.1±2.1 3.7±2.3 0.052
Conclusions: Patients with AS and nr-AxSpA demonstrate similar degree of disease burden and prodcutivity, with a greater impairment of household work in females. Low rate of inability to work due to arthritis in this population with a relatively high prevalence of anti-TNF use may be a reflection of the effectiveness of such therapies.
Disclosure of Interest: None declared
DOI: 10.1136/annrheumdis-2015-eular.5452