Spondyloarthritis is associated with poor function and physical health-related quality of life

Abstract

Objective: To study physical function and health-related quality of life (HRQOL) in US veterans with spondyloarthritis (SpA).

Methods: In a postal survey of 70,334 eligible veterans, demographics, performance of activities of daily living (ADL), and HRQOL, by Veterans Short Form-36, were queried; 58% responded (n = 40,508). Databases provided International Classification of Diseases, 9th ed. codes for ankylosing spondylitis (AS), psoriatic (PsA) and reactive arthritis (ReA), comorbidities, and demographics. Multivariable linear/logistic regressions compared ADL limitations and HRQOL in SpA versus non-SpA, and predictors in SpA.

Results: Six hundred sixty-four veteran respondents had diagnoses of SpA: AS, n = 100; PsA, n = 551; ReA, n = 13. Veterans with AS, PsA, and ReA had significantly more limitations in dressing (44%, 23%, 24% vs 22%; p = 0.0002), transferring (57%, 42%, 64% vs 39%; p = 0.0006), walking (74%, 57%, 67% vs 54%; p = 0.0005), and overall mean ADL limitations (2.5, 1.7, 2.1 vs 1.6; p < 0.0001) compared to veterans without SpA, after multivariable adjustment. Limitations in each ADL in patients with SpA were 1.3-5.3 times that of an age-matched US cohort. Physical HRQOL was significantly lower compared with non-SpA veterans (p < 0.0001 for physical component summary, physical functioning, role physical, and bodily pain; p = 0.004 for general health) and age-sex-matched US norms; all differences exceeded clinically meaningful threshold of 5-10 units. More limitations in ADL were significantly associated with lower physical component summary scores in patients with AS and with lower physical and mental component summary scores in PsA.

Conclusion: After adjustment for differences in demographics and comorbidities, poorer physical function and HRQOL were observed in patients with SpA. Strategies focused to improve/maintain functional status are important for treatment of SpA.

Figure 1

Activities of daily living (ADL) limitations in patients with ankylosing spondylitis (AS), psoriatic arthritis (PsA), and reactive arthritis (ReA) age 60 years and older compared to a US cohort from San Luis Valley, CO, of similar age. Patients with AS, PsA, and ReA were 1.4–3 times as likely as the age-matched San Luis Valley cohort to have limitation of each ADL and 3.7–5.3 times as likely to have walking limitation. Overall ADL limitation was 1.3–2.3 times as likely as that of the US cohort. In general, differences were most marked for patients with AS and ReA.

Figure 2

Short Form-36 for Veterans (SF-36V) subscale scores in patients with ankylosing spondylitis (AS) and psoriatic arthritis (PsA) compared to age- and sex-matched US general population. SV-36V scores were lower on all domains in patients with AS and PsA as compared to age- and sex-matched US population norms. Deficits were greater in physical than psychosocial HRQOL domains. PF: physical functioning; RP: role physical; BP: bodily pain; GH: general health; VT: vitality; SF: social functioning; RE: role emotional; MH: mental health.