Data from the British Society for Rheumatology Biologics Register in Ankylosing Spondylitis (BSRBR-AS) suggest a number of important factors are omitted as treatment targets in current European League Against Rheumatism (EULAR) guidelines for managing axial spondyloarthritis (axSpA).
A study published in the Annals of the Rheumatic Diseases confirms that poor quality of life (QoL) in patients with axSpA is independently influenced by sleep disturbance, mood and widespread pain.
The study analyses BSRBR-AS data from 1810 patients with axSpA recruited during 2012-2017. Data collected included clinical and patient-reported measures. QoL was assessed using the Ankylosing Spondylitis Quality of Life (ASQoL) measure.
The results showed that four out of five factors included in a previous model of poor QoL in patients with axSpA were confirmed: Bath Ankylosing Spondylitis Disease Activity Index and Bath Ankylosing Spondylitis Functional Index, fatigue and widespread pain. The performance of the model was improved by the addition of measures of mood and sleep disturbance.
In a de novo model which included these factors, there were six elements (other than disease activity and function) that predicted ASQoL: depression (β=0.16), sleep disturbance (β=0.08), activity impairment (β=0.04), fibromyalgia (Symptom Severity Scale [β=0.24] and Widespread Pain Index [β=0.10]) and smoking (β=0.66).
The authors concluded that poor mental health, sleep problems and widespread pain independently contribute to poor QoL in patients with axSpA. These factors are not currently included as targets for treatment in current EULAR guidelines. However, the authors of this study say the management of axSpA needs to focus on a wider set of targets than just disease activity and function.