From the Department of Rheumatology, Leiden University Medical Center, Leiden; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam; Department of Rheumatology, Zuyderland Medical Center, Heerlen, the Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy; Department of Rheumatology, University of Gothenburg, Gothenburg, Sweden.
M. van Lunteren, MSc, Department of Rheumatology, Leiden University Medical Center; Z. Ez-Zaitouni, MD, Department of Rheumatology, Leiden University Medical Center; A. de Koning, MD, Department of Rheumatology, Leiden University Medical Center, H. Dagfinrud, PT, PhD, Department of Rheumatology, Diakonhjemmet Hospital; R. Ramonda, MD, PhD, Rheumatology Unit, Department of Medicine DIMED, University of Padua; L. Jacobsson, MD, PhD, Department of Rheumatology, University of Gothenburg; R. Landewé, MD, PhD, Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, and Department of Rheumatology, Zuyderland Medical Center; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center; F.A. van Gaalen, MD, PhD, Department of Rheumatology, Leiden University Medical Center.
J Rheumatol. 2018 Jun;45(6):779-784. doi: 10.3899/jrheum.170796. Epub 2018 Mar 15.
In early axial spondyloarthritis (axSpA), data are lacking about the relationship between disease activity and health-related quality of life (HRQOL). We assessed and quantified the association between change in Ankylosing Spondylitis Disease Activity Score (ASDAS) and HRQOL over time in early axSpA.
Baseline and 1-year data of patients with axSpA fulfilling the Assessment of Spondyloarthritis international Society (ASAS) classification criteria from the SPondyloArthritis Caught Early (SPACE) cohort were analyzed. Associations between change in ASDAS and in physical (PCS) or mental component summary (MCS) of the Medical Outcomes Study Short Form-36 were tested by linear regression models. Age, sex, ASAS criteria arm, and blue- versus white-collar work were tested for effect modification. Subsequently, these factors and medication were tested for confounding.
There were 161 patients with axSpA [53% male, mean (± SD) age 29.7 (± 7.5) yrs, symptom duration 13.6 (± 7.2) months, HLA-B27-positive 91%, radiographic sacroiliitis 22%] who had ASDAS of 2.5 (± 1.0) and 2.0 (± 0.8), PCS of 28.4 (± 14.3) and 36.9 (± 13.1), and MCS of 48.2 (± 13.8) and 49.3 (± 12.0) at baseline and 1 year, respectively. Per unit increase in ASDAS between baseline and 1 year, PCS worsened by 9.5 points. The same level of disease activity had fewer adverse effects on physical HRQOL in women and white-collar workers.
To our knowledge, our data are the first to show that in a broad group of patients with early axSpA, increasing ASDAS is associated with worsening of physical HRQOL, but not mental HRQOL, over time.
在早期中轴型脊柱关节炎（axSpA）中，关于疾病活动与健康相关生活质量（HRQOL）之间的关系的数据尚缺乏。我们评估和量化了早期 axSpA 中，ASDAS 变化与 HRQOL 随时间的变化之间的关联。
分析了满足 ASAS 分类标准的 axSpA 患者的基线和 1 年 SPACE 队列数据。通过线性回归模型检验了 ASDAS 变化与 Medical Outcomes Study Short Form-36 的物理（PCS）或心理成分综合评分（MCS）变化之间的关联。检验了年龄、性别、ASAS 标准臂、蓝领与白领工作对其的影响修饰作用。随后，检验了这些因素和药物对混杂因素的影响。
共有 161 例 axSpA 患者[53%为男性，平均（± SD）年龄 29.7（±7.5）岁，症状持续时间 13.6（±7.2）个月，91%HLA-B27 阳性，22%存在放射学骶髂关节炎]，他们的 ASDAS 基线和 1 年时分别为 2.5（±1.0）和 2.0（±0.8），PCS 分别为 28.4（±14.3）和 36.9（±13.1），MCS 分别为 48.2（±13.8）和 49.3（±12.0）。ASDAS 从基线到 1 年每增加 1 单位，PCS 恶化 9.5 分。相同疾病活动水平对女性和白领工人的物理 HRQOL 负面影响较小。
据我们所知，我们的数据首次表明，在一大组早期 axSpA 患者中，ASDAS 的增加与物理 HRQOL 的恶化有关，但与心理 HRQOL 无关。
