Artikel
Disease severity, quality of life, and productivity loss among patients with Ankylosing Spondylitis (AS) In Germany
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Autoren
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Jürgen Braun
- Rheumazentrum Ruhrgebiet, St. Josefs-Krankenhaus, Herne
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Herbert Kellner
- Schwerpunktpraxis für Rheumatologie und Gastroenterologie, München
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Regina Max
- Universitätsklinikum Heidelberg, Medizinische Klinik V, Sektion Rheumatologie, Heidelberg
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Markus Rihl
- Rheumatologische Schwerpunktpraxis, Dr. H. Voit /PD Dr. M.Riehl, Traunstein
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Hendrik Schulze-Koops
- Klinikum der Universität München, Medizinische Klinik und Poliklinik IV, Rheumaeinheit, München
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Elmar Schmitz-Bortz
- Rheumatologische und Osteologische Schwerpunktpraxis Hattingen, Hattingen
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Silke Zinke
- Praxis Dr. Zinke, Berlin
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Tao Fan
- Merck, Kenilworth, NJ, USA
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Ramon Lyu
- Merck, Kenilworth, NJ, USA
| Veröffentlicht: | 12. September 2014 |
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Gliederung
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Background: AS affects the spine, causing significant pain and leading to ankylosis, spine deformities, and peripheral joint damage. Diminished QoL, reduced productivity, and unemployment present a significant burden to patients and society. The purpose of this study is to describe disease severity and morbidity in terms of patient-reported QoL and productivity loss.
Methods: A multi-center observational study using 12-month retrospective chart review, with prospective paper-based questionnaires at the index visit and 3 months thereafter was conducted. Patients completed SF-36, BASDAI, BASFI, and WPAI. Physicians completed the BASMI and current disease activity. Descriptive analyses of QoL, utility values derived from SF-36 domains, disease activity, and WPAI were performed. Adjusted multivariate regression was used to explore the variables associated with productivity loss.
Results: 106 patients in 15 AS care centers were recruited. The majority were men (75%), with a mean age of 46.5 ±13.2 years and disease duration of 14.6 ±10 years. Main disease manifestation was pain (37%), spinal deformities (27%) and hyperkyphosis (21%). The main treatment was biological drugs in 72 patients (68%), followed by NSAIDs (53%) and Immunosuppressants (21%).
Physician evaluated the disease activity with a mean of 2.8 ±2.1. The mean of BASMI was 3.9 ±1.8 at index visit, with limitations in lumbar flexion at mean of 5.5 ±2.7 and lateral spinal flexion at a mean of 4.5±2.6.
The SF-36 summary means were 43.8 ±8.9 and 46.9 ±11.7 with the lowest mean in general health (50.2 ±19), followed by vitality (52.7 ±20.7) and bodily pain (53.3 ±24.4). The mean of SF-36 utility values was 0.7 ±0.1.
Among 76 employed patients, 80% reported a mean of 2 ±4 hours/week missed work at the index visit. Two-thirds of patients reported means of 26% of impairment while working and 31% of activity impairment due to AS. Limitation in physical functioning and BASDAI can explain 68% of productivity loss (Adjusted R2=0.6765, P<0.0001).
Conclusion: German AS patients had lower QoL and experienced substantial sick leave or impairment while working due to AS. Productivity loss was significantly associated with limitation in physical functioning and BASDAI score.
