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POS0147 (2022)
DETERMINANTS OF GENERAL HEALTH AND HEALTH RELATED QUALITY OF LIFE IN AXIAL SPONDYLOARTHRITIS, PERIPHERAL SPONDYLOARTHRITIS AND PSORIATIC ARTHRITIS: RESULTS FROM THE ASAS-PerSpA STUDY
H. Santos1,2, A. R. Henriques2, M. Dougados3, C. López-Medina3, H. Canhão2,4, P. M. Machado5, F. Pimentel Santos6,7
1Portuguese Institute of Rheumatology, Rheumatology, Lisbon, Portugal
2Nova Medical School, EpiDoc Unit, Comprehensive Health Research Center, Lisbon, Portugal
3Cochin Hospital, Rheumatology, Paris, France
4Centro Hospitalar Lisboa Central, Rheumatology, Lisbon, Portugal
5University College of London, Centre for Rheumatology and Department of Neuromuscular Diseases, London, United Kingdom
6Nova Medical School, CEDOC, Rheumatic Diseases Lab, Lisbon, Portugal
7Centro Hospitalar Lisboa Ocidental, Hospital de Egas Moniz, Rheumatology, Lisbon, Portugal

Background: Axial Spondyloarthritis (axSpA), peripheral Spondyloarhritis (pSpA) and Psoriatic arthritis (PsA) are different types of SpA, with large heterogeneity in clinical manifestations. It is crucial to understand which are the determinants of health-related quality of life (HRQoL) and general health (GH, global functioning and health) in axSpA, pSpA and PsA, which can lead to differential approaches and interventions, to attain better outcomes.


Objectives: This study aims to identify and compare determinants of HRQoL and GH in axSpA, pSpA and PsA, using data from the PerSpA study.


Methods: Data from the ASAS-PerSpA study, a cross-sectional and multicenter study with 24 participating countries, was used. Patients with either axSpA, pSpA or PsA were enrolled. Sociodemographic, lifestyle, anthropometric, and clinical characteristics were collected. Univariable and multivariable regression models for the three groups were performed separately, to explore factors associated with HRQoL, assessed by EuroQoL-5 Dimensions 3 level (EQ-5D), and similar analysis was performed for GH, assessed by the Assessment of SpondyloArthritis international Society Health Index (ASAS-HI).


Results: 4185 patients were included in the analyses. For the final models, only patients with complete data were included (results summarized in Table 1 ). Regarding HRQoL, worse HRQoL in axSpA was associated with female gender, fibromyalgia (FM), peripheral disease (PD), worse function and higher disease activity (DA) and patient’s global assessment (PGA), in pSpA with worse function, higher DA and higher non-steroidal anti-inflammatory drugs intake score (NSAIDs-IS), and in PsA with female gender, axial involvement, worse function, higher DA and glucocorticoid therapy. On the contrary, better HRQoL was associated in axSpA with a history of uveitis, in pSpA with older age (with a trend in axSpA and PsA, but not statistically significant) and in PsA with biologic therapy. Regarding GH, in axSpA, worse GH was associated with female gender, FM, PD, worse function and higher DA and PGA, in pSpA, with female gender, inflammatory bowel disease, worse function, treatment with conventional synthetic disease-modifying anti-rheumatic drug and higher NSAIDs-IS, in PsA with female gender, alcohol intake, FM, axial involvement, worse function and higher DA. On the contrary, better GH was associated in axSpA with university education (UE), higher BMI and higher NSAIDs-IS, in pSpA with UE, and in PsA with older age and UE.

Factors associated with HRQoL and GH stratified by diagnostic category (summarized)

EQ-5D ASAS-HI
axSpAn= 2698 R 2 =0.548 pSpAn= 418R 2 =0.520 PsAn= 1017R 2 =0.551 axSpAn= 2700R 2 =0.539 pSpAn= 418R 2 =0.545 PsAn= 1016R 2 =0.560
p-value p-value p-value p-value p-value p-value
Female gender 0.146 0.017 <0.001 0.001 <0.001
Age 0.054 0.048 0.076 0.056 0.496 0.003
University education 0.060 NS 0.875 0.039 0.044 <0.001
BMI 0.428 0.116 0.207 0.004 0.646 0.309
Ever alcohol intake 0.072 NS 0.796 0.531 0.539 0.035
Fibromyalgia <0.001 0.473 0.052 <0.001 0.692 <0.001
Uveitis 0.028 NS 0.832 NS NS 0.225
IBD NS NS 0.341 NS 0.025 0.657
Axial disease NS 0.867 0.003 NS NS 0.006
Peripheral disease 0.039 NS NS <0.001 NS NS
PGA <0.001 * * <0.001 * *
BASFI <0.001 <0.001 <0.001 <0.001 <0.001 <0.001
ASDAS-CRP <0.001 NA NA <0.001 NA NA
DAS44-CRP NS <0.001 <0.001 NA 0.349 <0.001
csDMARD 0.156 0.796 NS 0.233 0.002 NS
bDMARD 0.491 0.896 0.021 0.901 NS NS
Glucocorticoids 0.295 0.988 0.035 0.692 0.803 0.814
NSAID intake score 0.998 <0.001 0.659 0.011 0.028 0.685

NS – not significant in univariable model; NA – not applicable; * - colinear with DAS44-


Conclusion: In all types of SpA, DA and function are major determinants of HRQoL, passible of tight monitoring and therapeutic intervention. In GH, besides DA and function, socio-demographic factors, like gender and education, also play an important role, in all forms of SpA, highlighting the importance of a holistic approach of the individual patient in order to achieve better outcomes.


Acknowledgements: The authors would like to thank all ASAS-PerSpA investigators and members of the scientific committee.


Disclosure of Interests: None declared

Citation: , volume 81, supplement 1, year 2022, page 300
Session: Clinical aspect of spondyloarthritis (Poster Tours)