Department of Public Health and Clinical Medicine, Rheumatology, Umeå University, 901 87, Umeå, Sweden.
Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Box 480, 405 30, Gothenburg, Sweden.
Arthritis Res Ther. 2018 Dec 27;20(1):284. doi: 10.1186/s13075-018-1784-8.
Ankylosing spondylitis (AS) begins early in life and often leads to reduced physical function, but less is known about the impacts it has on health-related quality of life (HRQoL). The aims of this study were to assess HRQoL using the Short Form-36 (SF-36) in a cohort of patients with AS compared with controls and to examine associations between SF-36 scores and spinal radiographic changes, physical function, disease activity and demographic data overall and stratified by sex.
A cohort of patients with AS from Western Sweden were assessed using the Modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) with spinal radiographs, clinical examination and questionnaires, including the Bath Ankylosing Spondylitis Metrology Index, Bath Ankylosing Spondylitis Functional Index (BASFI), Ankylosing Spondylitis Disease Activity Score-C-reactive protein (ASDAS-CRP), Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Patient Global (BASG) and SF-36. Each patient's SF-36 results were compared with those of five age-matched and sex-matched persons (n = 1055) from the SF-36 Swedish normative population database. Associations between SF-36 physical component summary (PCS) and mental component summary (MCS) scores and disease-related and demographic factors were investigated using univariate and multivariable ogistic regression analyses with PCS and MCS below/above their respective median values as dependent variables.
A total of 210 patients, age (median, IQR) 49.0 (21.2) years, symptom duration 24.0 (21.0) years, men 57.6% and HLAB27 87.1% were included. Patients with AS scored significantly lower (p < 0.001) compared to controls in all SF-36 domains and component summaries; PCS 42.4 (14.5) in AS versus 52.4 (11.8) in controls and MCS 47.9 (20.0) in AS versus 54.1 (10.1) in controls. Both men and women scored significantly lower in PCS compared with MCS. Multivariable logistic regression analyses revealed that living without a partner (OR 2.38, 95% CI 1.00-5.67), long symptom duration (year in decade OR 1.66, 95% CI 1.16-2.37), higher BASFI (OR 1.98, 95% CI 1.46-2.70) and ASDAS ≥ 2.1 (OR 3.32, 95% CI 1.45-7.62) were associated with worse PCS, while living without a partner (OR 3.04, 95% CI 1.34-6.91), fatigue (visual analogue scale for global fatigue greater than the median (OR 6.36, 95% CI 3.06-13.19) and ASDAS ≥ 2.1 (OR 2.97, 95% CI 1.41-6.25) with worse MCS. Some differences between sexes were observed in the results.
The patients with AS had significantly lower HRQoL compared with controls. PCS was more affected compared to MCS in both sexes. Both disease-related and demographic factors were associated with HRQoL, partly overlapping for PCS and MCS. Factors associated with HRQoL showed some differences between sexes. By modifying factors, such as ASDAS-CRP and fatigue, HRQoL may potentially be improved.
ClinicalTrials.gov, NCT00858819 . Registered on 9 March 2009. Last updated on 28 May 2015.
强直性脊柱炎（AS）在生命早期开始，并常常导致身体功能下降，但人们对其对健康相关生活质量（HRQoL）的影响知之甚少。本研究的目的是使用简短形式 36 项健康调查（SF-36）评估 AS 患者队列与对照组相比的 HRQoL，并检查 SF-36 评分与脊柱放射学变化、身体功能、疾病活动度和人口统计学数据之间的关联，总体和按性别分层。
来自瑞典西部的 AS 患者队列使用改良 Stoke 强直性脊柱炎脊柱评分（mSASSS）进行评估，包括脊柱影像学检查、临床检查和问卷调查，包括巴斯强直性脊柱炎计量指数、巴斯强直性脊柱炎功能指数（BASFI）、强直性脊柱炎疾病活动评分-C 反应蛋白（ASDAS-CRP）、巴斯强直性脊柱炎疾病活动指数、巴斯强直性脊柱炎患者总体（BASG）和 SF-36。每位患者的 SF-36 结果与来自 SF-36 瑞典标准人群数据库的 5 名年龄匹配和性别匹配的人（n=1055）进行比较。使用单变量和多变量逻辑回归分析调查 SF-36 生理成分综合（PCS）和心理成分综合（MCS）评分与疾病相关和人口统计学因素之间的关系，PCS 和 MCS 低于/高于各自中位数作为因变量。
共纳入 210 名患者，年龄（中位数，IQR）为 49.0（21.2）岁，症状持续时间为 24.0（21.0）年，男性占 57.6%，HLAB27 占 87.1%。与对照组相比，AS 患者在所有 SF-36 领域和成分综合中得分明显较低（p<0.001）；AS 患者的 PCS 为 42.4（14.5），对照组为 52.4（11.8），MCS 为 47.9（20.0），对照组为 54.1（10.1）。男性和女性的 PCS 评分均明显低于 MCS。多变量逻辑回归分析显示，没有伴侣（OR 2.38，95%CI 1.00-5.67）、较长的症状持续时间（每十年 OR 1.66，95%CI 1.16-2.37）、较高的 BASFI（OR 1.98，95%CI 1.46-2.70）和 ASDAS≥2.1（OR 3.32，95%CI 1.45-7.62）与较差的 PCS 相关，而没有伴侣（OR 3.04，95%CI 1.34-6.91）、疲劳（视觉模拟量表总体疲劳大于中位数（OR 6.36，95%CI 3.06-13.19）和 ASDAS≥2.1（OR 2.97，95%CI 1.41-6.25）与较差的 MCS 相关。在结果中观察到一些性别差异。
与对照组相比，AS 患者的 HRQoL 明显较低。在两性中，PCS 比 MCS 受影响更大。疾病相关和人口统计学因素均与 HRQoL 相关，部分重叠 PCS 和 MCS。与 HRQoL 相关的因素在性别之间存在一些差异。通过改善 ASDAS-CRP 和疲劳等因素，可能会改善 HRQoL。
ClinicalTrials.gov，NCT00858819。于 2009 年 3 月 9 日注册。最新更新于 2015 年 5 月 28 日。
