Singh Jasvinder A, Strand Vibeke
heumatology Section, Medicine Service, Veterans Affairs Medical Center, Minneapolis 55417, USA.
J Rheumatol. 2009 May;36(5):1012-20. doi: 10.3899/jrheum.081015. Epub 2009 Apr 15.
To study physical function and health-related quality of life (HRQOL) in US veterans with spondyloarthritis (SpA).
In a postal survey of 70,334 eligible veterans, demographics, performance of activities of daily living (ADL), and HRQOL, by Veterans Short Form-36, were queried; 58% responded (n = 40,508). Databases provided International Classification of Diseases, 9th ed. codes for ankylosing spondylitis (AS), psoriatic (PsA) and reactive arthritis (ReA), comorbidities, and demographics. Multivariable linear/logistic regressions compared ADL limitations and HRQOL in SpA versus non-SpA, and predictors in SpA.
Six hundred sixty-four veteran respondents had diagnoses of SpA: AS, n = 100; PsA, n = 551; ReA, n = 13. Veterans with AS, PsA, and ReA had significantly more limitations in dressing (44%, 23%, 24% vs 22%; p = 0.0002), transferring (57%, 42%, 64% vs 39%; p = 0.0006), walking (74%, 57%, 67% vs 54%; p = 0.0005), and overall mean ADL limitations (2.5, 1.7, 2.1 vs 1.6; p < 0.0001) compared to veterans without SpA, after multivariable adjustment. Limitations in each ADL in patients with SpA were 1.3-5.3 times that of an age-matched US cohort. Physical HRQOL was significantly lower compared with non-SpA veterans (p < 0.0001 for physical component summary, physical functioning, role physical, and bodily pain; p = 0.004 for general health) and age-sex-matched US norms; all differences exceeded clinically meaningful threshold of 5-10 units. More limitations in ADL were significantly associated with lower physical component summary scores in patients with AS and with lower physical and mental component summary scores in PsA.
After adjustment for differences in demographics and comorbidities, poorer physical function and HRQOL were observed in patients with SpA. Strategies focused to improve/maintain functional status are important for treatment of SpA.
研究美国脊柱关节炎（SpA）退伍军人的身体功能和健康相关生活质量（HRQOL）。
在对70334名符合条件的退伍军人进行的邮政调查中，通过退伍军人简表-36询问了人口统计学信息、日常生活活动（ADL）表现和HRQOL；58%的人做出了回应（n = 40508）。数据库提供了国际疾病分类第9版中强直性脊柱炎（AS）、银屑病关节炎（PsA）和反应性关节炎（ReA）的编码、合并症和人口统计学信息。多变量线性/逻辑回归比较了SpA患者与非SpA患者的ADL限制和HRQOL，以及SpA患者的预测因素。
664名退伍军人受访者被诊断为SpA：AS患者100例；PsA患者551例；ReA患者13例。在多变量调整后，与没有SpA的退伍军人相比，AS、PsA和ReA患者在穿衣（分别为44%、23%、24%对22%；p = 0.0002）、转移（分别为57%、42%、64%对39%；p = 0.0006）、行走（分别为74%、57%、67%对54%；p = 0.0005）以及总体平均ADL限制（分别为2.5、1.７、2.1对1.6；p < 0.0001）方面存在显著更多的限制。SpA患者每项ADL的限制是年龄匹配的美国队列的1.3 - 5.3倍。与非SpA退伍军人相比，身体HRQOL显著更低（身体成分总结、身体功能、角色身体和身体疼痛方面p < 0.0001；总体健康方面p = 0.004），且低于年龄和性别匹配的美国标准；所有差异均超过了5 - 10分的临床有意义阈值。ADL更多的限制与AS患者较低的身体成分总结得分以及PsA患者较低的身体和心理成分总结得分显著相关。
在对人口统计学和合并症差异进行调整后，观察到SpA患者的身体功能和HRQOL较差。专注于改善/维持功能状态的策略对于SpA的治疗很重要。
