未确诊的非放射学轴性脊柱关节炎和强直性脊柱炎患者的工作成果；慢性下腰痛患者横断面研究结果
Work outcome in yet undiagnosed patients with non-radiographic axial spondyloarthritis and ankylosing spondylitis; results of a cross-sectional study among patients with chronic low back pain.
作者信息
van Hoeven Lonneke, Boonen Annelies E R C H, Hazes Johanna M W, Weel Angelique E A M
机构信息
Department of Rheumatology, Erasmus MC, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands.
Department of Rheumatology, Maasstad Hospital, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands.
出版信息
Arthritis Res Ther. 2017 Jun 17;19(1):143. doi: 10.1186/s13075-017-1333-x.
BACKGROUND
To understand the impact of yet undiagnosed non-radiographic axial spondyloarthritis (nr-axSpA) and ankylosing spondylitis (AS) on work outcomes in a cohort of patients with long-lasting chronic low back pain (CLBP).
METHODS
Data were used from a primary care CLBP cohort that was established to understand the prevalence of nr-axSpA and AS. Clinical characteristics comprised measures of back pain (visual analogue scale), inflammation (C-reactive protein) and physical functioning (Roland Morris Disability Questionnaire (RMDQ)). Worker outcomes comprised a question on employment and the Work Productivity and Activity Impairment (WPAI) questionnaire, distinguishing absenteeism, presenteeism, and overall work impairment in those employed and activity impairment in all patients. For each disease subgroup, employment ratio compared to the general population was assessed by indirect standardization. Factors associated with work productivity were explored by zero inflated negative binomial (ZINB) regression models.
RESULTS
Patients with CLBP (n = 579) were included (41% male, mean age 36 years), of whom 71 (12%) were identified as having nr-axSpA and 24 (4%) as having AS. The standardized employment ratios were 0.89 (95% CI 0.84-0.94), 0.97 (95% CI 0.85-1.09) and 0.81 (95% CI 0.56-1.06) for patients with CLBP, nr-axSpA and AS, respectively. Scores for the WPAI subdomains were not significantly different between patients with CLBP, nr-axSpA or AS. The ZINB models showed significant associations between visual analog scale (VAS) score for pain and RMDQ and work productivity.
CONCLUSION
The impact of yet undiagnosed nr-axSpA and AS on patients' work outcomes was substantial but was not significantly different from those of patients with long-standing CLBP. Variables significantly associated with reduced work productivity were VAS for pain and RMDQ score.
背景
为了解未确诊的非放射性轴性脊柱关节炎（nr-axSpA）和强直性脊柱炎（AS）对一组长期慢性下腰痛（CLBP）患者工作结局的影响。
方法
使用来自一个初级保健CLBP队列的数据，该队列旨在了解nr-axSpA和AS的患病率。临床特征包括背痛测量（视觉模拟量表）、炎症（C反应蛋白）和身体功能（罗兰·莫里斯残疾问卷（RMDQ））。工作结局包括一个关于就业的问题和工作效率与活动障碍（WPAI）问卷，区分缺勤、出勤时工作效率低下，以及就业者的总体工作障碍和所有患者的活动障碍。对于每个疾病亚组，通过间接标准化评估与一般人群相比的就业比例。通过零膨胀负二项式（ZINB）回归模型探索与工作效率相关的因素。
结果
纳入了CLBP患者（n = 579）（41%为男性，平均年龄36岁），其中71例（12%）被确定患有nr-axSpA，24例（4%）患有AS。CLBP、nr-axSpA和AS患者的标准化就业比例分别为0.89（95%CI 0.84 - 0.94）、0.97（95%CI 0.85 - 1.09）和0.81（95%CI 0.56 - 1.06）。CLBP、nr-axSpA或AS患者的WPAI子域得分无显著差异。ZINB模型显示疼痛的视觉模拟量表（VAS）评分和RMDQ与工作效率之间存在显著关联。
结论
未确诊的nr-axSpA和AS对患者工作结局的影响很大，但与长期CLBP患者的影响无显著差异。与工作效率降低显著相关的变量是疼痛的VAS评分和RMDQ评分。
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