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Background: As spinal mobility becomes progressively impaired and pain levels escalate, difficulty in performing simple physical routines places a huge burden on axial spondyloarthritis (axSpA).
Objectives: The aim is to evaluate the impact of axSpA on patients’ social life and to identify the factors associated with this.
Methods: Data from 2,846 unselected patients participating in EMAS, an online survey (2017-2018) across 13 European countries, were analysed. Impact of axSpA on social life was assessed by: “Score your relationships since you have been affected by Spondylitis / Spondyloarthritis” [Much worse to much better relationships with spouse, family, friend, and neighbours], and “Please indicate the frequency with which you do the following activities since you became affected by Spondylitis/ Spondyloarthritis?” [Much less frequent to much more frequent engagement in restaurants, cultural outings, travel, and sports]. Patients who rated at least one relationship as “worse/much worse” and at least one of social activity as “less/much less frequent” were considered to have a negatively impacted social life. BASDAI (0-10), spinal stiffness (3-12), functional limitation (0-54), and mental health via the General Health Questionnaire GHQ-12 (0-12) were assessed. Univariable and multivariable binary logistic regression were used to identify variables possibly explaining negative impact on social life (n= 2,120).
Results: Mean age was 43.8±12.3 years, 61.5% female, 49.2% had a university degree, and 68.2% married. 44.9% (n= 1,205) patients had their social life negatively impacted since the onset of axSpA.
Those experiencing a negative impact on their social life were more frequently females (49.5% vs. 37.5% males, p<0.001), divorced/separated (59.5% vs. 34.4% widowed, p<0.001), and on sick leave (temporary and permanent) or unemployed (63.9%, 60.9% and 57.0% vs. 36.8% employed, p<0.001). Furthermore, those whose social life was negatively impacted reported greater BASDAI (6.2 vs. 5.0), functional limitation (24.4 vs. 17.4), spinal stiffness (8.4 vs. 7.3), longer diagnostic delay (9.7 vs. 7.4), poorer mental health (6.7 vs. 3.6), anxiety (62.6% vs. 37.1% no anxiety), depression (61.9% vs. 38.5% no depression), or sleep disorders (55.7% vs. 37.5% no sleep disorders), all p<0.001.
The variables associated with negative impact on social life in the multivariable logistic regression were higher disease activity (OR=1.15), poor mental health (OR=1.14), being on a sick leave/unemployed (OR=1.49), divorced/separated (OR=1.46), anxiety (OR= 1.41) and female gender (OR= 1.30;
Factors associated with a worsening social life (n= 2,120)
| Univariable logistic analysis | Multivariable logistic analysis | |||
|---|---|---|---|---|
| OR | CI 95% | OR | CI 95% | |
| Age | 0.99 | 0.98, 0.99 | 1.00 | 0.99, 1.01 |
| Gender. Female 1 | 1.63 | 1.39, 1.91 | 1.30 | 1.06, 1.60 |
| Marital status. Divorced/separated 2 | 1.93 | 1.48, 2.50 | 1.46 | 1.05, 2.04 |
| Employment status. Sick Leave/Unemployed 3 | 2.66 | 2.24, 3.17 | 1.49 | 1.20, 1.85 |
| BASDAI (0-10) | 1.41 | 1.35, 1.48 | 1.15 | 1.08, 1.22 |
| Functional Limitation (0-54) | 1.03 | 1.02, 1.03 | 1.02 | 1.09, 1.02 |
| Spinal Stiffness (3-12) | 1.20 | 1.16, 1.24 | 1.06 | 1.01, 1.11 |
| Diagnostic delay | 1.02 | 1.01, 1.03 | 1.01 | 0.99, 1.02 |
| GHQ-12 (0-12) | 1.22 | 1.19, 1.24 | 1.14 | 1.11, 1.17 |
| Anxiety | 2.84 | 2.39, 3.37 | 1.41 | 1.08, 1.83 |
| Depression | 2.59 | 2.17, 3.10 | 1.14 | 0.87, 1.49 |
| Sleep disorders | 2.10 | 1.79, 2.46 | 1.02 | 0.81, 1.27 |
1 Female vs. male; 2 Divorced/separated vs. single/married/widow; 3 Sick leave/unemployed vs. other employment status.
Conclusion: Almost half of the axSpA patients reported to have negatively impacted their social life. Being female, divorced/separated, on sick leave/unemployed, with higher disease activity, poor mental health, and anxiety increase the likelihood of worsening social life. As relationships with others and engagement in social or community activities influence quality of life, greater attention to enabling individuals to participate socially through controlling disease activity and addressing mental health comorbidity in the management of axSpA.
Acknowledgements: This study was supported by Novartis Pharma AG. The authors would like to thank all patients who participated in the study.
Disclosure of Interests: Marco Garrido-Cumbrera Grant/research support from: has a research collaboration with and provides services to Novartis Pharma AG, Victoria Navarro-Compán Grant/research support from: Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche and UCB, Christine Bundy Speakers bureau: AbbVie, Celgene, Janssen, Lilly, Novartis and Pfizer, Raj Mahapatra: None declared, Souzi Makri Grant/research support from: Novartis, GSK and Bayer, José Correa-Fernández: None declared, Laura Christen Employee of: Novartis Pharma AG, Carlos Jesús Delgado-Domínguez: None declared, Denis Poddubnyy Speakers bureau: AbbVie, BMS, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, Roche and UCB, Grant/research support from: AbbVie, MSD, Novartis and Pfizer