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Background: Axial spondyloarthritis (axSpA) is associated with a high burden of disease, which may lead to inability to work and disability.
Objectives: This analysis aims to identify factors associated with inability to work and disability among European axSpA patients.
Methods: Data from 2,846 unselected patients participating in EMAS, a cross-sectional study (2017-2018) across 13 European countries were analysed. The sample was divided into those on permanent sick leave or with a recognised disability (Group 1) and those with neither permanent sick leave nor a recognized disability (Group 2). Mann-Whitney and Pearson’s χ 2 tests were used to analyse possible differences between groups regarding sociodemographic characteristics, patient-reported outcomes [BASDAI (0-10), GHQ-12 (0-12), functional limitation (0-54) and spinal stiffness (3-12)], lifestyle habits, working life, and comorbidities). Univariable and multivariable binary logistic regression were used to analyse variables possibly explaining being on permanent sick leave and disability, for which 1,657 patients were included.
Results: Mean age was 43.9 years, 61.3% were female, 48.1% had a university degree, and 67.9% were married. Patients in Group 1 (34.4%; n=978) were more likely to be women (54.3%), married (71.1%), with higher disease activity (BASDAI 5.9 vs. 5.3), functional limitation (25.1 vs. 18.0), spinal stiffness (8.6 vs. 7.3; all p<0.001), and longer diagnostic delay (8.1 vs 7.1 years; p = 0.01) than those in Group 2 (65.6%; n=1,868). In addition, 88.0% of Group 1 (n=728) had difficulties in finding a job due to axSpA throughout life; and more than 30.0% reported a diagnosis of anxiety, depression, or sleep disorders. Moreover, being in Group 1 was associated with higher functional limitation in all daily activities. In the multivariable binary logistic regression, the qualitative variables associated with permanent sick leave or disability were: difficulties finding work (OR= 2.52), belonging to a patient organisation (OR= 1.54) and work choice determined by axSpA (OR= 1.38). The quantitative variables associated with permanent sick leave or disability were: higher spinal stiffness (OR= 1.09), older age (OR= 1.03), longer disease duration (OR= 1.03), shorter diagnostic delay (OR= 0.98), and higher functional limitation (OR= 1.01) (
Regression analysis for variables explaining being on permanent sick leave or disability (n=1,657)
| Univariable logistic analysis | Multivariable logistic analysis | |||
| Qualitative variables | OR | 95% CI 3 | OR | 95% CI 3 |
| Gender 1 | 1.57 | 1.34, 1.83 | 1.24 | 0.97, 1.57 |
| Educational level 2 | 1.71 | 1.46, 2.00 | 1.08 | 0.86, 1.35 |
| Member of a patient organisation. Yes | 1.96 | 1.67, 2.29 | 1.54 | 1.23, 1.94 |
| Smoking. Yes | 1.28 | 1.08, 1.51 | 1.22 | 0.96, 1.55 |
| Difficulty finding job due to axSpA. Yes | 3.71 | 2.89, 4.77 | 2.52 | 1.83, 3.47 |
| Work choice determined by axSpA. Yes | 1.69 | 1.43, 1.99 | 1.38 | 1.09, 1.75 |
| Anxiety diagnosis. Yes | 1.27 | 1.07, 1.51 | 0.98 | 0.72, 1.34 |
| Depression diagnosis. Yes | 1.58 | 1.33, 1.89 | 1.25 | 0.92, 1.69 |
| Sleep disorder diagnosis. Yes | 1.33 | 1.13, 1.56 | 0.95 | 0.73, 1.23 |
| Quantitative variables | OR | 95% CI 3 | OR | 95% CI 3 |
| Age. Years | 1.04 | 1.03, 1.04 | 1.03 | 1.01, 1.04 |
| BASDAI (0-10) | 1.18 | 1.13, 1.24 | 1.06 | 0.98, 1.13 |
| Functional limitation (0-54) | 1.03 | 1.02, 1.03 | 1.01 | 1.00, 1.02 |
| Spinal stiffness (3-12) | 1.25 | 1.20, 1.29 | 1.09 | 1.03, 1.15 |
| Diagnostic delay | 1.01 | 1.01, 1.02 | 0.98 | 0.96, 0.99 |
| Disease duration | 1.04 | 1.03, 1.05 | 1.03 | 1.01, 1.04 |
1 Male vs Female; 2 No university studies vs university studies. 3 95% CI for test H 0 : OR=1
Conclusion: One third of patients reported being on permanent sick leave or having a recognised disability. They were more likely to have higher spinal stiffness scores, were older in age, experiencing difficulty finding a job, and belonged to a patient organisation. Increased efforts in relation to early access to effective treatments and the creation of flexible working environments are essential for axSpA patients to continue working and remain active, which benefits their quality of life.
Acknowledgements: This study was supported by Novartis Pharma AG.The authors would like to thank all patients who participated in this study.
Disclosure of Interests: Marco Garrido-Cumbrera: None declared, Christine Bundy Consultant of: Abbvie, Celgene, Janssen, Lilly, Novartis, and Pfizer, Victoria Navarro-Compán Grant/research support from: Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB, Laura Christen Employee of: Novartis Pharma AG, Raj Mahapatra: None declared, Souzi Makri: None declared, Carlos Jesús Delgado-Domínguez: None declared, David Gálvez-Ruiz: None declared, Pedro Plazuelo-Ramos: None declared, Denis Poddubnyy Consultant of: Abbvie, BMS, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, and UCB, Grant/research support from: Abbvie, MSD, Novartis, and Pfizer.