M. van Lunteren, MSc, PhD, D. van der Heijde, MD, PhD, F.A. van Gaalen, MD, PhD, Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands;
R. Landewé, MD, PhD, Department of Rheumatology, Amsterdam University Medical Center, Amsterdam, and Department of Rheumatology, Zuyderland Medical Center, Heerlen, the Netherlands.
J Rheumatol. 2020 Dec 1;47(12):1752-1759. doi: 10.3899/jrheum.191353. Epub 2020 May 15.
It is unknown if in axial spondyloarthritis (axSpA) patients' illness perceptions and coping strategies change when disease activity changes.
Patients diagnosed with axSpA and with 1 or more follow-up visits (1 and/or 2 yrs in the SPACE cohort) were included. Mixed linear models were used for illness perceptions (range 1-5), coping (range 1-4), back pain (numeric rating scale range 0-10), health-related quality of life (range 0-100), physical and mental component summary (PCS and MCS; range 0-100), work productivity loss (WPL; range 0-100), and activity impairment (AI; range 0-100%), separately, to test if they changed over time.
At baseline, 150 axSpA patients (mean age 30.4 yrs, 51% female, 65% HLA-B27+) had a mean (SD) numeric rating scale back pain of 4.0 (2.5), PCS of 28.8 (14.0), MCS of 47.8 (12.4), WPL of 34.1% (29.8), and AI of 38.7% (27.9). Over 2 years, clinically and statistically significant improvements were seen in the proportion of patients with an Ankylosing Spondylitis Disease Activity Score (ASDAS) of low disease activity (from 39% at baseline to 68% at 2 years), back pain (-1.5, SD 2.2), AI (-14.4%, SD 27.2), PCS (11.1, SD 13.3), and WPL (-15.3%, SD 28.7), but MCS did not change (0.7, SD 13.9; = 0.201). In contrast, illness perceptions and coping strategies did not change over a period of 2 years. For example, at 2 years patients believed that their illness had severe "consequences" (2.8, SD 0.9) and they had negative emotions (e.g., feeling upset or fear) towards their illness ["emotional representation", 2.5 (0.8)]. Patients most often coped with their pain by putting pain into perspective ["comforting cognitions", 2.8 (0.6)] and tended to cope with limitations by being optimistic ["optimism", 2.9 (0.7)].
While back pain, disease activity, and health outcomes clearly improved over 2 years, illness perceptions and coping strategies remained remarkably stable.
目前尚不清楚在轴性脊柱关节炎（axSpA）患者的疾病认知和应对策略是否会随着疾病活动度的变化而改变。
纳入了诊断为 axSpA 且有 1 次或多次随访（SPACE 队列中 1 年和/或 2 年）的患者。采用混合线性模型分别对疾病认知（范围 1-5）、应对方式（范围 1-4）、腰背疼痛（数字评分量表范围 0-10）、健康相关生活质量（范围 0-100）、生理和心理综合评分（PCS 和 MCS；范围 0-100）、工作生产力损失（WPL；范围 0-100）和活动受限（AI；范围 0-100%）进行评估，以检验其是否随时间变化。
在基线时，150 例 axSpA 患者（平均年龄 30.4 岁，51%为女性，65%为 HLA-B27+）的平均（标准差）腰背疼痛数字评分量表为 4.0（2.5），PCS 为 28.8（14.0），MCS 为 47.8（12.4），WPL 为 34.1%（29.8），AI 为 38.7%（27.9）。在 2 年期间，低疾病活动度（从基线时的 39%增加到 2 年时的 68%）、腰背疼痛（-1.5，标准差 2.2）、AI（-14.4%，标准差 27.2）、PCS（11.1，标准差 13.3）和 WPL（-15.3%，标准差 28.7）的患者比例有临床和统计学意义的显著改善，但 MCS 没有变化（0.7，标准差 13.9；=0.201）。相比之下，疾病认知和应对策略在 2 年期间没有改变。例如，在 2 年时，患者认为他们的疾病有严重的“后果”（2.8，标准差 0.9），并对疾病有负面情绪（例如感到不安或恐惧）[“情绪表达”，2.5（0.8）]。患者最常通过将疼痛放在适当的位置来应对疼痛[“安慰性认知”，2.8（0.6）]，并倾向于通过乐观的态度来应对限制[“乐观”，2.9（0.7）]。
尽管在 2 年内腰背疼痛、疾病活动度和健康结局明显改善，但疾病认知和应对策略仍然保持显著稳定。
