Health-related quality of life in patients with ankylosing spondylitis under biologic therapy

Abstract

Background
Ankylosing spondylitis (AS) is a chronic inflammatory disorder that affects young adults of productive age, leading to impairment of health-related quality of life (HRQoL). This cross-sectional study aimed to assess HRQoL and work productivity in patients with AS on biologic therapy, to explore its relationship with clinical data and radiographic severity.


Methods
Eighty AS patients were included. Patients were evaluated using Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI), Short Form-36 (SF-36), Ankylosing Spondylitis Quality of Life (ASQoL), and Work Productivity and Activity Impairment Questionnaire (WPAI: AS). Spondyloarthritis Research Consortium of Canada MRI index (SPARCC) was used for radiological assessment of sacroilitis.


Results
Among the 80 AS patients included, 49 patients (61.3%) reported poor quality of life (QoL). Magnetic resonance imaging showed active inflammation in 36 patients (45%) and structural lesions in 80 patients (100%). There were positive correlations between the ASQoL and smoking (r = 0.238, p = 0.034), diagnostic delay (r = 0.298, p = 0.012), duration of current bDMARDs (r = 0.237, p = 0.035), peripheral joint involvement (r = 0.404, p < 0.001), BASDAI (r = 0.245, p = 0.028), BASFI (r = 0.349, p = 0.002), BASMI (r = 0.283, p = 0.011), role limitation due to physical health (r = 0.466, p = 0.029), presenteeism (r = 0.362, p = 0.011), activity impairment (r = 0.624, p < 0.001) and work impairment (r = 0.286, p = 0.047). while negative correlations were noted between ASQoL and employment status (r = -0.223, p = 0.047), vitality (r = -0.235, p = 0.036), and mental health (r = -0.227, p = 0.043). The current biologic therapy duration, BASDAI, BASMI, in addition to human leukocyte antigen B27 (HLA-B27) positivity, were significant predictors of QoL.


Conclusion
Health-related quality of life might be affected in patients with ankylosing spondylitis undergoing biologic therapy, emphasizing the importance of routinely incorporating HRQoL assessments into their clinical management.