Abstract
The Assessment of Spondyloarthritis International Society (ASAS) health index (HI) is a novel tool for approaching disability, health, and functioning in spondyloarthritis (SpA). In the present study we compared ASAS HI between patients with ankylosing spondylitis (AS) and those with nonradiographic axial SpA (nr-axSpA). In addition, we identified predictors of ASAS HI. We designed this cross-sectional study using data from the Catholic Axial Spondyloarthritis COhort (CASCO), a prospective cohort from a single tertiary hospital. We compared baseline characteristics, including ASAS HI, between AS and nr-axSpA, and determined the frequency of each item constituting the ASAS HI. We used linear regression analysis to identify factors associated with ASAS HI. Total of 357 patients with axSpA—261 with AS and 96 with nr-axSpA—were included in analysis. AS patients were older and had higher ASAS HI than nr-axSpA. Among ASAS HI items, pain (item No. 1) and energy/drive (item No. 5) were the most common areas for which axSpA patients experienced discomfort. ASAS HI correlated with other SpA-related parameters such as BASDAI, ASDAS, and BASFI. Multivariable regression analysis of the axSpA group showed that high NSAID intake and mSASSS were positively associated with ASAS HI, whereas higher economic status and alcohol consumption were negatively associated with ASAS HI. Results were consistent in the AS group on subgroup analysis, whereas alcohol consumption was the only factor significantly associated with ASAS HI in the nr-axSpA group. In the present cohort study, patients with AS had poorer health status (higher ASAS HI) than those with nr-axSpA. Items proposed by AS patients (items No. 1 and 5) were the most frequently checked areas as axSpA patients feel discomfort, and this support that ASAS HI could practically assess actual discomfort of axSpA patient. ASAS HI was well correlated with known disease parameters, including activity, function, and quality of life; therefore, ASAS HI could be used in the future to represent the health status of SpA in a systematic way. Spinal structural damage (higher mSASSS), high NSAID intake, alcohol consumption, and economic status were predictors of ASAS HI in patients with axSpA, especially those with AS.
Highlights
The Assessment of Spondyloarthritis International Society (ASAS) health index (HI) was recently developed as a means of assessing the health, functioning, and disability of patients with spondyloarthritis (SpA) in an inclusive way [1]
Rheumatologists, patients with ankylosing spondylitis (AS), and other healthcare professionals participated in selecting the items comprising the ASAS HI, which were chosen from a core set of the International Classification of Functioning, Disability and Health (ICF) [1,2]
The ASAS HI items were selected from a core set of ICF variables, and rheumatologists, health care experts, and even patients with AS were involved in the process of item selection
Summary
The Assessment of Spondyloarthritis International Society (ASAS) health index (HI) was recently developed as a means of assessing the health, functioning, and disability of patients with spondyloarthritis (SpA) in an inclusive way [1]. Rheumatologists, patients with ankylosing spondylitis (AS), and other healthcare professionals participated in selecting the items comprising the ASAS HI, which were chosen from a core set of the International Classification of Functioning, Disability and Health (ICF) [1,2]. Items suitable for AS and representative of a wide spectrum of health and functioning indices related to AS were selected from the ICF core set to comprise the ASAS HI [1,2]. The ASAS HI questionnaire is easy to complete by choosing either “I agree” or “I do not agree”, and it has high internal consistency [4]
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