Disease activity and widespread pain are main contributors to patient-reported global health in axial spondyloarthritis: an analysis of 6064 patients

• Published in: Rheumatology international 2024-08, Vol.44 (8), p.1455-1468
• Main Authors: Drouet, Juliette, López-Medina, Clementina, Granger, Benjamin, Fautrel, Bruno, Landewe, Robert B. M., Molto, Anna, Gaujoux-Viala, Cécile, Kiltz, Uta, Dougados, Maxime, Gossec, Laure
• Format: Article
• Language: English
• Subjects: Adult; Axial Spondyloarthritis - epidemiology; Chronic Pain - epidemiology; Chronic Pain - etiology; Chronic Pain - physiopathology; Comorbidity; Cross-Sectional Studies; Female; Global Health; Health Status; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Observational Research; Pain; Pain Measurement; Patient Reported Outcome Measures; Patients; Quality of Life; Rheumatology; Severity of Illness Index; Sociodemographics
• ISSN: 1437-160X; 0172-8172; 1437-160X
• DOI: 10.1007/s00296-024-05576-7

Global health (GH) and health-related quality of life are patient priorities in axial spondyloarthritis (axSpA). Our objective was to assess the relative importance of disease-related factors including disease activity, and patient-related factors including comorbidities, to explain GH in axSpA. Post hoc cross-sectional analyses of 4 sets (COMOSPA, PERSPA, COMEDSPA, and DESIR) of patients fulfilling ASAS criteria for axSpA. GH was assessed through the ASAS Health Index (ASAS-HI) or the EuroQoL-5D-3L (EQ-5D). Disease-related factors included disease activity (ASDAS, psoriasis, arthritis, enthesitis, and CRP), disease duration, diagnostic delay, bamboo spine, and treatment. Non-disease-related factors included sociodemographic characteristics, comorbidities and chronic widespread pain. Multivariable logistic and linear regressions and partial variances (R 2 ) were applied to identify independent determinants of GH. In 6064 patients (range 284–2756 across datasets), mean age ranged 38.9–45.8 years, 51–68% were male. GH was generally moderate: median ASAS-HI ranged 5.0–7.0. GH was explained by ASDAS (range of odds ratios, OR, 2.60–4.48) and chronic widespread pain (range of OR 2.19–8.39); other determinants included comorbidities and sociodemographic characteristics. Only 47–57% of the total variance in GH could be explained by the models; disease activity (partial variance, 16–26%) and chronic widespread pain (partial variance 12–15%) were the key contributing variables. A wide range of disease and non-disease-related variables usually collected in studies could only explain 47–57% of the variability in GH. Among these, disease activity and chronic widespread pain were most relevant and of similar magnitude of importance. These findings will be helpful for shared decision-making.