Individual-level and country-level socio-economic factors and health outcomes in spondyloarthritis: analysis of the ASAS-perSpA study

Capelusnik, Dafne; Zhao, Sizheng Steven; Boonen, Annelies; Ziadé, Nelly; López-Medina, Clementina; Dougados, Maxime; Nikiphorou, Elena; Ramiro, Sofía

doi:10.1093/rheumatology/keab638

Cited by 10 publications

(8 citation statements)

References 30 publications

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“…The median BASDAI score for our cohort was 2.2, which was slightly lower than that of other cohort studies and might limit the generalisability of the results, though other characteristics such as the proportion of males and HLA-B27 positivity were largely similar 80 81. Differences in the disease activity could be a reflection of country-level variation 82 83. Similarly, fewer patients in this study had possible anxiety as compared with other axSpA populations, which should be taken into consideration when interpreting results in other cohorts.…”

Section: Discussioncontrasting

confidence: 57%

Association of anxiety, depression and resilience with overall health and functioning in axial spondyloarthritis (axSpA): a cross-sectional study

et al. 2023

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ObjectivesTo evaluate the association between anxiety, depression and resilience with overall health and functioning in axial spondyloarthritis (axSpA).DesignCross-sectional evaluation of baseline data from a prospective cohort study, with recruitment from January 2018 to March 2021.SettingOutpatient clinic in a tertiary hospital in Singapore.ParticipantsPatients aged 21 years and above who were diagnosed with axSpA.Outcome measuresThe Hospital Anxiety and Depression Scale (HADS) was used for assessing anxiety and depression, 10-item Connor Davidson Resilience Scale (CD-RISC-10) for resilience, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) for disease activity, Bath Ankylosing Spondylitis Functional Index (BASFI) for functional limitation and Assessment of SpondyloArthritis International Society Health Index (ASAS HI) for overall health and functioning. Univariable and multivariable linear regression analyses were performed to assess the association between anxiety, depression and resilience with health and functioning.ResultsWe included 296 patients in this study. The median (IQR) score for HADS-Anxiety was 5.0 (2.0–8.0), with 13.5% and 13.9% having borderline abnormal and abnormal anxiety, respectively. The median (IQR) score for HADS-Depression was 3.0 (1.0–7.0), with 12.8% and 8.4% having borderline abnormal and abnormal depression, respectively. The median (IQR) CD-RISC-10 score was 29.0 (23.0–32.0) while the median (IQR) ASAS HI score was 4.0 (2.0–7.0). Apart from BASDAI, BASFI and disease duration, anxiety and depression were associated with overall health and functioning (β: 0.12, 95% CI 0.03, 0.20; β: 0.20, 95% CI 0.09, 0.31) in the multivariable linear regression. Level of resilience was not associated with health and functioning.ConclusionAnxiety and depression, but not resilience, were associated with poorer health and functioning. Clinicians could consider routinely screening for anxiety and depression in their patients, especially in patients with more severe symptoms.

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Section: Discussioncontrasting

confidence: 57%

Association of anxiety, depression and resilience with overall health and functioning in axial spondyloarthritis (axSpA): a cross-sectional study

et al. 2023

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“…Our study showed that disease activity scores were higher in women over time as reflected by both ASDAS and BASDAI. This finding is in line with previous cross-sectional and observational studies reporting that female sex was associated with higher disease activity, mainly observed on the BASDAI scores (5)(6)(7)(8)10,13,25,26), and a few recent studies also reported higher ASDAS in women (12,28). In this study, women had more peripheral arthritis and enthesitis than men.…”

Section: Discussionsupporting

confidence: 93%

“…This study has some strengths and limitations. This longitudinal analysis of the impact of sex on disease outcomes in axial SpA brings different and valuable information compared to published data, which are mainly cross-sectional (5)(6)(7)(8)10,12,13,15,25,26). A strength of our study is the validated methodologies used to analyze longitudinal data: mixed-effects models and trajectory analyses.…”

Section: Discussionmentioning

confidence: 99%

“…(4) Recent data suggest differences in disease phenotypes between men and women with axSpA, in terms of disease activity and disease progression. (5)(6)(7)(8)(9)(10)(11)(12) Women seem to have a higher disease burden, worse functional impairment but less structural damage. (13)(14)(15) However, data on sex differences in axSpA available today are mostly issued from cross-sectional, retrospective studies or long-standing disease cohorts.…”

Section: Key Pointsmentioning

confidence: 99%

“…ratio is 2-3:1 in radiographic axial spondyloarthritis (SpA), with an equal sex distribution in its nonradiographic form (4). Recent data suggest differences in disease phenotypes between men and women with axial SpA, in terms of disease activity and disease progression (5)(6)(7)(8)(9)(10)(11)(12). Women seem to have a higher disease burden and worse functional impairment but less structural damage (13)(14)(15).…”

Section: Introductionmentioning

confidence: 99%

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Influence of Sex on Early Axial Spondyloarthritis: ASix‐YearLongitudinal Analysis From a Large National Cohort

Aouad

Tournadre

Lucasson

et al. 2023

Arthritis Care & Research

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ObjectiveThe objective was to determine sex differences in disease outcomes in recent axial spondyloarthritis (SpA) over time.MethodsWe analyzed the first 6 years of follow‐up of the prospective French multicenter DESIR cohort. Patients analyzed had <3 years of disease, were naive to disease‐modifying antirheumatic drugs, and fulfilled the Assessment of SpondyloArthritis international Society classification criteria for axial SpA. Disease activity (Ankylosing Spondylitis Disease Activity Score [ASDAS] using the C‐reactive protein [CRP] level), patient global assessment (PtGA), CRP level, and radiographic sacroiliitis were compared between men and women (self‐reported sex) by linear and logistic mixed‐effects models. Models were created for trajectories of disease activity over 6 years in men and women, using k‐means.ResultsOf 494 patients analyzed (mean ± SD age 31.9 ± 7.5 years, symptoms duration 20.7 ± 11.7 months), 50.4% were men. Over 6 years of follow‐up, both men and women showed clear improvements in ASDAS‐CRP, PtGA, and CRP level. Women had higher ASDAS‐CRP and PtGA over time compared to men (both P < 0.0001) with overall similar CRP levels (P = 0.089), whereas structural damage increased more in men (P < 0.0001). One‐third of both men (33%) and women (34%) belonged to persistent high/very high disease activity trajectories, but ASDAS‐CRP was globally higher in women in these trajectories.ConclusionIn early axial SpA, clinical outcomes (disease activity and symptoms) were worse in women than men over 6 years of follow‐up, whereas CRP was similar and structural damage was more frequent in men. Although similarly distributed, disease activity scores were higher in women in high/very high disease activity trajectories. Sex appears to be an important contextual factor in axial SpA.image

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Low Socioeconomic Status and Female Sex are Associated With Worse Functional Status in Axial Spondyloarthritis

Stovall,

Li,

Fitzpatrick

et al. 2024

Arthritis Care & Research

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ObjectiveWe determined whether socioeconomic status (SES) and sex are associated with functional status (FS) in axial spondyloarthritis (axSpA).MethodsWe conducted a cohort study of patients with axSpA in the Rheumatology Informatics System for Effectiveness (RISE) registry. We performed cross‐sectional and longitudinal analyses of FS through the Multi‐Dimensional Health Assessment Questionnaire (MDHAQ) using GEE models. Area Deprivation Index (ADI) was used as an SES proxy. The cross‐sectional analysis tested for a linear trend across ADI quintiles for MDHAQ. The longitudinal analysis’ outcome was functional decline. We reported predictive margins and assessed for interaction with sex. In the longitudinal analysis, we reported odds of functional decline.ResultsIn the cross‐sectional analysis (N=5,658) mean (SD) age was 53.8 years (15.2), 55.8% were female, and 71.4% were non‐Hispanic White. Average (SD) MDHAQ was 1.6 (2.0) in men vs. 2.1 (2.2) in women. Predicted mean MDHAQ score was 2.2 (95%CI 1.8‐2.7) for the lowest ADI quintile and 1.8 (95%CI 1.4‐2.1) for the highest. Women had lower FS compared to men across quintiles. In the longitudinal analysis (N= 2,341) the proportion with FS decline was 14.3% (95% CI 7.6%‐25.5%) for the lowest SES quintile compared to 9.6% (95% CI 5.2%‐17.1%) for the highest. Women had 1.7 (95%CI 1.3‐2.2) times higher odds of functional decline compared to men. There was no interaction with sex.ConclusionsIn this large sample of axSpA patients, those with lower SES had worse FS and functional decline. Women had worse FS than men, initially and over time.

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Individual-level and country-level socio-economic factors and health outcomes in spondyloarthritis: analysis of the ASAS-perSpA study

Cited by 10 publications

References 30 publications

Association of anxiety, depression and resilience with overall health and functioning in axial spondyloarthritis (axSpA): a cross-sectional study

Association of anxiety, depression and resilience with overall health and functioning in axial spondyloarthritis (axSpA): a cross-sectional study

Influence of Sex on Early Axial Spondyloarthritis: ASix‐YearLongitudinal Analysis From a Large National Cohort

Low Socioeconomic Status and Female Sex are Associated With Worse Functional Status in Axial Spondyloarthritis

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