Ankylosing Spondylitis Quality Of Life Questionnaire Research Articles

Spinal Mobility Limitation Can Be the Main Reason of Kinesiophobia in Ankylosing Spondylitis.

Objective The aim of this study is to determine the presence of kinesiophobia in patients with ankylosing spondylitis (AS) and to examine the factors affecting kinesiophobia. Materials and methods Sixty patients with AS participated in the study. Kinesiophobia was evaluated using the Tampa Scale for Kinesiophobia (TSK). Disease activity was assessed using the Bath AS Disease Activity Index (BASDAI) and AS Disease Activity Score with C-reactive protein (ASDAS-CRP), functional status using the Bath AS Functional Index (BASFI), spinal mobility using the Bath AS Metrology Index (BASMI), and quality of life using the AS Quality of Life Questionnaire (ASQoL). Those with a TSK score of >37 were classified as patients with high kinesiophobia, while those with a score of ≤37 as patients with low kinesiophobia. Results High kinesiophobia was detected in 29 (48.3%) patients. Age, disease duration, BASDAI, ASDAS-CRP, BASFI, ASQoL, and BASMI values were higher in these patients. The TSK scores correlated with age, duration of disease, ASDAS-CRP, BASFI, BASMI, and ASQoL (r = 0.697, r = 0.600, r = 0.410, r = 0.690, r = 0.889, and r = 0.576, respectively). As a result of the multivariate binary logistic regression analysis, BASMI was found to be the only statistically significant factor for high kinesiophobia (OR 5.338, 95% CI: 1.133-25.159, p = 0.034). Conclusion Kinesiophobia is seen at a high rate in patients with AS. In this study, the most important risk factor for kinesiophobia is found to be decreased spinal mobility. To prevent kinesiophobia - which prevents exercise, the cornerstone of AS treatment - patients should be encouraged to exercise and be active.

Validation of the Korean Ankylosing Spondylitis Quality of Life Questionnaire.

Measuring accurate and reliable scores of quality of life in patients with ankylosing spondylitis (AS) is important in both decision-making and treatment planning for the disease. Questionnaire, The ankylosing spondylitis quality of life (ASQoL), is one of the representative tools for assessing how seriously AS patients view their disease severity, activity, as well as their overall health. To make these types of questionnaires readable and understandable, local language translation of surveys should be required. A Korean version of the ASQoL questionnaire has accordingly been developed. This study assessed the Korean version of the ASQoL survey to evaluate the reliability and validity of it. Translation and reverse translation of the English ASQoL survey were conducted. A total of 120 consecutive AS patients received a mail including the Korean-translated 36-Item Short Form Survey (SF-36), the ASQoL survey, and the visual analog scale (pain). The coefficient of intraclass correlation and Cronbach's alpha were computed, and factor analysis, as well as reliability assessments utilizing the kappa agreement statistics for each item, was undertaken. By analyzing the responses to SF-36 and ASQoL questionnaire utilizing Pearson's correlation coefficient, construct validity was calculated. Factor analysis was performed regarding pain, physical function, and mental function. The kappa statistic of agreement was larger than 0.6 for all items. The ASQoL questionnaire had adequate test and re-test reliability (0.814). Furthermore, Cronbach'sα, the internal consistency, was very good (0.877). The Korean-translated ASQoL questionnaire demonstrated a significantly strong correlation between the single domain and total SF-36 scores. The Korean version of the ASQoL questionnaire showed acceptable properties of measurement and successful translation. Thus, it can be said that the questionnaire is appropriate for evaluating the outcomes of Korean patients with AS.

Association of Serum Interleukin-17 and Interleukin-23 Levels with Disease Activity, Function, Mobility, Enthesitis Index in Patients with Ankylosing Spondylitis

AbstractAim: More and more studies have demonstrated that the interleukin (IL)-23/IL-17 axis is highly associated with immune dysfunction and activated autoimmune inflammation. The purposes of this study were to determine the serum levels of IL-17 and IL-23 in ankylosing spondylitis (AS) patients compared with healthy controls and evaluate these cytokine levels based on disease-related characteristics. Material and Methods: Eighty-six consecutive AS patients and 70 sex and age-matched healthy controls were included in the study. The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Ankylosing Spondylitis Disease Activity Score (ASDAS)-erythrocyte sedimentation rate (ESR), ASDAS-C reactive protein, the Bath Ankylosing Spondylitis Functional Index (BASFI), the Spondyloarthritis Research Consortium of Canada (SPARCC) enthesitis index, the Bath Ankylosing Spondylitis Metrology Index (BASMI), the Ankylosing Spondylitis Quality of Life Questionnaire (ASQoL) and Achilles pain VAS scores were recorded. Serum IL-17 and IL-23 levels were examined by enzyme-linked immunosorbent assay. Results: The serum levels of IL-17, IL-23 and CRP as well as ESR values were significantly increased in AS patients compared with controls (1.94 vs. 0.28 pg/mL p ˂ 0.001; 82.9 vs. 44.3 pg/mL p ˂ 0.001; 0.48 vs. 0.30 mg/dL, p=0.001; 12±13.9 vs. 8±6.8 mm/h, p=0.003, respectively). In AS patients, serum IL-17 levels were significantly correlated with the ASDAS-ESR and ASDAS-CRP (r=0.244, p=0.024; r=0.258, p=0.017), but not with ESR, CRP, BASDAI, function, mobility, quality of life, enthesitis index or Achilles pain scores (all p>0.05). Serum IL-23 levels demonstrated a significant correlation with Achilles pain VAS, but not with other disease-related parameters (all p>0.05). Conclusions: AS patients had increased serum IL-17 and IL-23 levels compared with healthy controls, and serum IL-17 levels were associated with disease activity. Our study results support the hypothesis that the IL17/23 pathway plays an important role in the pathogenesis of AS.

Residual Disease in Patients with Axial Spondyloarthritis: A Post-Hoc Analysis of the QUASAR Study.

In this study, we evaluated the presence of residual disease in patients with axial spondyloarthritis (axSpA) in remission/low disease activity (LDA) status. This cross-sectional post-hoc analysis of the QUASAR study involving 23 rheumatology centres across Italy included adults with axSpA classified according to the Assessment of SpondyloArthritis International Society criteria. Patients with inactive disease (score < 1.3) or at least LDA status (score < 2.1) at baseline visit according to Ankylosing Spondylitis Disease Activity Score were investigated to evaluate how residual disease activity impacts patients’ quality of life. They were assessed using the Ankylosing Spondylitis Quality of Life (ASQoL) and EuroQoL 5-Dimension 5-Level (EQ-5D-5L) questionnaires. This study included 480 patients with axSpA (mean age, 47.5 ± 12.9 years, 64% male). In total, 123 patients (25.6%) had inactive disease and 262 (54.6%) had at least LDA. Using the ASQoL, ranges of 10–25% and 20–40% of patients with inactive disease and with LDA status, respectively, experienced tiredness/fatigue. Despite being classified with inactive disease, 48.8% of patients reported light pain/discomfort according to the EQ-5D-5L, with 4.1% reporting moderate pain/discomfort, whereas 55.7% of patients with LDA reported light pain/discomfort and 13% had moderate pain/discomfort. Using the ASQoL questionnaire, in patients with at least LDA, a higher proportion of women compared with males and a higher proportion of patients > 48 years of age (vs. patients ≤ 48 years) experienced tiredness. In this post-hoc analysis, ≥25% of axSpA patients in remission/LDA status were still burdened by residual disease, mainly characterised by pain and fatigue.

Central Obesity in Axial Spondyloarthritis: The Missing Link to Understanding Worse Outcomes in Women?

To determine (1) the prevalence of central obesity in axial spondyloarthritis (axSpA) and its effect on disease-related outcomes and (2) how this differs between sexes. Data were extracted from the Ankylosing Spondylitis Registry of Ireland. Patients with physical measurements for the calculation of anthropometric measures were included. BMI and waist-to-hip ratio (WHR) were used to compare classifications of obesity. Comparison analyses based on sex and central obesity were carried out. Multivariate analysis examined the effects of these factors on the following patient-reported outcomes: the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Functional Index (BASFI), the Ankylosing Spondylitis Quality of Life (ASQoL) questionnaire, and the Health Assessment Questionnaire (HAQ). In total, 753 patients were included in the analysis. Of these patients, 29.6% (n = 223) were classified as obese based on their BMI, and 41.3% (n = 311) were classified as centrally obese according to the WHR. The prevalence of central obesity was significantly higher among women with axSpA compared to men (71.6% vs 29.9%, P < 0.01). Central obesity had a clear effect on patient outcomes, regardless of sex. Presence of central obesity was associated with significantly worse BASFI scores (P < 0.01), HAQ scores (P < 0.01), and ASQoL questionnaire scores (P = 0.01), with a nonsignificant trend toward worse BASDAI scores (P = 0.07). There was a high prevalence of central obesity as assessed by the WHR in axSpA, most notably among women with axSpA. This modifiable comorbidity was significantly associated with worse quality of life, greater impairment of functional ability, and a trend toward worse disease activity. Regular use of the WHR to screen for central obesity as part of an axSpA assessment would provide an opportunity for prompt identification and intervention for at-risk patients.

Sleep quality and depression in patients with ankylosing spondylitis and their associations with clinical parameters: A cross-sectional, case-control study.

This study aimed to explore sleep quality in patients with ankylosing spondylitis (AS) and to reveal the clinical parameters that predict sleep quality and depression in AS. This study included 100 AS patients and 100 age/sex-matched healthy individuals. The AS activity was assessed by Bath AS Disease Activity Index (BASDAI), AS Disease Activity Score (ASDAS-ESR, ASDAS-CRP), and Visual Analog Scale (VAS). The functional status was assessed by the Bath AS Functional Index (BASFI). AS Quality of Life Questionnaire was administered for the assessment of the disease-related quality of life. Pittsburgh Sleep Quality Index for sleep assessment and Beck Depression Inventory for psychological assessment were administered to all participants. Sleep problems and depressive symptoms were significantly higher in AS patients compared to healthy individuals. All of the AS clinical parameters were significantly higher in AS patients with poor sleep quality than in AS patients with good sleep quality. In the correlation analysis, it was determined that poor sleep quality, depressive symptoms and low quality of life were strongly correlated with each other and AS clinical parameters. The most effective predictor for sleep problems was higher BASDAI scores, followed by higher BASFI, VAS, ASDAS-ESH scores, and younger age. Higher BASFI and VAS scores were predictors for depressive symptoms. The findings indicate that poor sleep, depressive symptoms and low quality of life may negatively affect the AS clinic, and therefore sleep quality and depression should not be ignored in the examinations of AS patients.

Plasma let-7i, miR-16, and miR-221 levels as candidate biomarkers for the assessment of ankylosing spondylitis in Mexican patients naïve to anti-TNF therapy.

Novel biomarkers are needed for the diagnosis and clinical assessment of ankylosing spondylitis (AS). Our objective was to investigate plasma microRNAs differentially expressed between AS patients and controls and to evaluate their potential as biomarkers in Mexican subjects. A cross-sectional study including 15 AS patients naïve to anti-TNF therapy and 13 controls was performed. Disease activity, physical function, and global well-being were evaluated by the AS Disease Activity Score (ASDAS-CRP), the Bath AS Disease Activity Index (BASDAI), the Bath AS Functional Index (BASFI), and the AS Quality of Life Questionnaire (ASQoL), respectively. Total RNA was isolated from plasma of participants and relative expression of let-7i, miR-16, and miR-221 was evaluated. Serum levels of C-reactive protein (CRP), matrix metalloproteinase-1 (MMP-1), MMP-9, and intercellular adhesion molecule-1 (ICAM-1) were also measured. Expression of let-7i was higher in patients than in controls (1.8, 0.9 to 3.4 versus 0.6, 0.4 to 1.2; P = 0.033) with an AUC/ROC of 0.74 (0.54 to 0.93; P = 0.032). Levels of miR-16 and miR-221 were unable to discriminate between patients and controls. Notably, plasma miR-16 levels were inversely correlated with the ASDAS-CRP score (rho - 64, - 0.87 to - 0.18; P = 0.011), the BASFI score (rho - 0.78, - 0.93 to - 0.43; P = 0.001), and serum MMP-1 levels (rho - 0.59, - 0.85 to - 0.09; P = 0.022). No other associations were found. Plasma let-7i levels may serve as a biomarker for the diagnosis of AS in Mexican individuals. Additionally, plasma miR-16 levels are associated with disease activity and physical functionality in patients naïve to anti-TNF therapy.

Disease Severity in Never Smokers, Ex-Smokers, and Current Smokers With Axial Spondyloarthritis: Results From the Scotland Registry for Ankylosing Spondylitis.

To examine the relationship between smoking, smoking cessation, and disease characteristics and quality of life (QoL) in spondyloarthritis. The Scotland Registry for Ankylosing Spondylitis collects data from clinically diagnosed patients with spondyloarthritis. Clinical data, including Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Bath Ankylosing Spondylitis Functional Index (BASFI) scores, were obtained from medical records. Mailed questionnaires contained information on smoking status and QoL (Ankylosing Spondylitis QoL questionnaire [ASQoL]). Linear and logistic regression were used to quantify the effect of smoking, and smoking cessation, on various disease-specific and QoL outcomes, with adjustments for age, sex, deprivation, education level, and alcohol use. Results are presented as regression coefficients (β) or odds ratios (ORs) with 95% confidence intervals (95% CIs). Data were obtained from 946 participants (73.5% male, mean age 52 years). Current smoking was reported by 22%, and 38% were ex-smokers. Ever smokers had poorer BASDAI (β = 0.5 [95% CI 0.2, 0.9]) and BASFI scores (β = 0.8 [95% CI 0.4, 1.2]), and reported worse QoL (ASQoL β = 1.5 [95% CI 0.7, 2.3]). Compared to current smokers, ex-smokers reported less disease activity (BASDAI β = -0.5 [95% CI -1.0, -0.04]) and significantly better QoL (ASQoL β = -1.2 [95% CI -2.3, -0.2]). They also were more likely to have a history of uveitis (OR 2.4 [95% CI 1.5, 3.8]). Smokers with spondyloarthritis experience worse disease than those who are never smokers. However, this study provides new evidence that, among smokers, smoking cessation is associated with lower disease activity and better physical function and QoL. Clinicians should specifically promote smoking cessation as an adjunct to usual therapy in patients with spondyloarthritis.

Relationship between kinesiophobia and pain, quality of life, functional status, disease activity, mobility, and depression in patients with ankylosing spondylitis

Background/aim: Our aim was to investigate the association of kinesiophobia with pain, quality of life, clinical measures, and depression in patients with ankylosing spondylitis (AS). Materials and methods: Patients with AS (n: 163) were enrolled in the study. Kinesiophobia was evaluated with the Tampa Scale of Kinesiophobia (TSK), pain with a visual analog scale (VAS), mobility with Bath Ankylosing Spondylitis Metrology Index (BASMI), disease activity with the Bath AS Disease Activity Index (BASDAI), functional status with the Bath AS Functional Index (BASFI), depression level with Beck's Depression Inventory (BDI), and quality of life with the AS Quality of Life Questionnaire (ASQoL). Besides correlation analysis, outcome measures were compared between patients with (TSK ? 37) and without (TSK < 37) kinesiophobia. Results: Kinesiophobia was found to be common with a percentage of 66.6%. TSK scores were correlated with VAS, BASFI, ASQoL, and BDI scores (r = 0.259, r = 0.294, r = 0.392, and r = 0.398, respectively; P < 0.05 for each). There were no correlations between TSK and the BASDAI and BASMI scores (r = 0.142, r = 0.198, respectively; P > 0.05). Patients with kinesiophobia had more pain and poorer BASFI, ASQoL, and BDI scores than patients without kinesiophobia (P < 0.05).Conclusion: Our study is the first study that investigated the relationship between kinesiophobia and other clinical measures in AS patients. Pain and psychological status have an impact on fear of movement and thus functional status and quality of life.

Evaluation of the effectiveness of home based or hospital based calisthenic exercises in patients with ankylosing spondylitis.

The aim of this study is to evaluate the effects of calisthenic exercises on functionality, mobility, disaese activity, quality of life, and psychological status in patients with Ankylosing spondylitis (AS). Prospective analysis of forty patients diagnosed with AS were randomized into two exercise groups. AS patients having diagnosis based on 1984-modified New York criteria were involved. Patients were given 8 weeks calisthenic exercise program. Outcome measures including the Bath AS Functional Index (BASFI), Bath AS Disease Activity Index (BASDAI), Bath AS Metrology Index (BASMI), AS Quality of Life Questionnaire (ASQoL), Bath AS Patient Global Score (BAS-G) Hospital Anxiety Depression Score (HADS), erythrocyte sedimentation rate (ESR) and the serum C-reactive protein (CRP) levels were assessed at the baseline and at 8 weeks. Thirty-seven participants completed the exercise programme. After the 8-week exercise programme, the home-based exercise group showed significant improvement in ESR levels and hospital-based exercise group showed significant improvements in terms of the BASMI and HADS-A scores. Calisthenic exercises can be easily performed both at home and in hospital setting. In patients with AS, calisthenic exercises performed at the hospital may improve the mobility, and psychological status (anxiety).

Restless legs syndrome is associated with poor sleep quality and quality of life in patients with ankylosing spondylitis: a questionnaire-based study.

We aimed to investigate the frequency of restless legs syndrome (RLS) and the associations between RLS and quality of sleep and life in patients with ankylosing spondylitis (AS). One hundred and eight AS patients and 64 controls were included in this study. Demographics, clinical, and laboratory data were recorded. The presence of RLS was determined with face-to-face interview by an experienced neurologist based on the International RLS Study Group criteria. RLS severity was evaluated using International RLS Study Group rating scale. Sleep quality and insomnia severity were assessed by Pittsburgh sleep quality index (PSQI) and insomnia severity index (ISI), respectively. Disease-related quality of life was evaluated by AS quality of life questionnaire (ASQoL). The frequency of RLS was significantly higher in AS patients than in controls (36.4 vs. 14.0%, p=0.004). RLS severity score for AS patients was significantly higher than that for controls (p=0.03). The AS patients had higher scores in the subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleep medication domains of PSQI, and also total PSQI and ISI than controls (p<0.05, for all). ASQoL scores were higher in AS patients with RLS compared to those without RLS (p<0.001). RLS severity was observed to be independently associated with total PSQI, ISI and ASQoL (p<0.05, for all). As RLS may adversely affect the sleep and quality of life in AS patients, clinicians should be aware of RLS for early diagnosis and management in AS patients.

Elevated Serum Levels of Calprotectin (Myeloid-Related Protein 8/14) in Patients With Ankylosing Spondylitis and Its Association With Disease Activity and Quality of Life

BackgroundCalprotectin is one of the major leukocyte S100 proteins showing both calcium binding and antimicrobial characteristics. The serum level of calprotectin is markedly elevated in patients with inflammatory bowel disease,...

Evaluating the reliability of Persian version of ankylosing spondylitis quality of life (ASQoL) questionnaire and related clinical and demographic parameters in patients with ankylosing spondylitis

Ankylosing spondylitis quality of life (ASQoL) is an instrument for assessing quality of life (QoL). The aims of this study were to assess the reliability of Persian version of ASQoL questionnaire and evaluation of QoL status and related factors in ankylosing spondylitis (AS). One hundred and sixty-three Iranian patients with AS who fulfilled modified New York criteria were enrolled. Patients were evaluated using questionnaires including demographic and clinical variables, Bath AS Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI), fatigue, Bath AS Metrology Index, pain and ASQoL. Reliability and validity of Persian version of ASQoL were evaluated by test-re-test agreement, internal consistency and correlation with specific scales. Relationship of parameters with ASQoL was analyzed by multiple regression. Age, disease duration and ASQoL score (mean ± SD) were 37.74 ± 9.88, 14.49 ± 8.47 and 8.02 ± 5.28 years, respectively. Test-re-test reproducibility for ASQoL was good as assessed by intra-class correlation coefficient (ICC: 0.97, P < 0.001). Internal consistency was high (Cronbach's alpha: 0.91). Convergent validity was confirmed by correlation of ASQoL score with specific scales (BASFI, r = 0.74, BASDAI, r = 0.6, fatigue, r = 0.56, depression, r = 0.24, intermalleolar distance, r = -0.44 and educational level, r = -0.37). Persian version of ASQoL is a valid and reliable scale to assess QoL in AS. Function, fatigue, mood, hip mobility and education are the factors which should be noted to achieve the best QoL.

Elevated serum levels of high mobility group box protein 1 (HMGB1) in patients with ankylosing spondylitis and its association with disease activity and quality of life

This study was carried out to determine the serum levels of high mobility group box protein 1 (HMGB1) in patients with ankylosing spondylitis (AS) and to evaluate its correlation with disease activity and quality of life. According to our knowledge, it is the first trial evaluating HMGB1 levels in AS. Serum samples of 30 patients (18 males and 12 females) with AS and 29 healthy controls (HC) (15 females and 14 males) were collected. HMGB1 levels were measured by enzyme-linked immunosorbent assay, activity of disease was assessed according to the Bath AS Disease Activity Index (BASDAI), and functional status of patients was evaluated with Bath AS Functional Index (BASFI). Modified Schober, chest expansion values and AS Quality of Life Questionnaire (ASQoL) scores were noted. The serum levels of HMGB1 were obtained significantly increased in AS patients compared to HC (p < 0.05). There was no significant correlation between HMGB1 levels and ESR (p > 0.05), and CRP (p > 0.05) values. BASDAI, BASFI and ASQoL scores were also not correlated with serum levels of HMGB1 (p > 0.05). Our results suggest that HMGB1 might play an important role in the pathogenesis of AS; however, it seems not to be a good candidate for reflecting disease activity, functional abilities and the quality of life in patients with AS; on the other hand, the increased levels of HMGB1 in patients may open a new dimension for targeting this cytokine as a new therapy option in AS.

Relationship Between Smoking and Patient-reported Measures of Disease Outcome in Ankylosing Spondylitis

To investigate the relationship between smoking and disease activity, pain, function, and quality of life in patients with ankylosing spondylitis (AS). Patients with AS (n = 612) from areas across the United Kingdom took part in a cross-sectional postal survey. Patient-reported outcome measures including the Bath AS Disease Activity Index, the Bath AS Functional Index (BASFI), a numerical rating scale (NRS) of pain, the AS quality of life questionnaire (ASQoL), and the evaluation of AS quality of life measures (EASi-QoL) were analyzed in terms of smoking status and relationship with pack-year history. The influence of potential confounding factors [age, sex, disease duration, and social deprivation (Townsend Index)] were tested in multivariate logistic regression analyses. Median scores of BASFI, pain NRS, ASQoL, and the 4 EASi-QoL domains were all higher in the group that had ever smoked compared to those who had never smoked (p < 0.0001, p = 0.04, p = 0.003, p < 0.02, respectively). In stepwise multivariate logistic regression analyses, high disease activity and more severe pain were associated primarily with current smoking, disease duration, and Townsend Index score, while decreased function and poor quality of life measures were associated more closely with increasing pack-year history, disease duration, and Townsend Index score. These associations were independent of age and sex. Smoking has a dose-dependent relationship with measures of disease severity in AS. The association with increased disease activity, decreased function, and poor quality of life in smokers was independent of age, sex, deprivation level, and disease duration.

Evaluation of Ankylosing Spondylitis Quality of Life (EASi-QoL): Reliability and Validity of a New Patient-reported Outcome Measure

There is currently no universally accepted measure of quality of life in ankylosing spondylitis (AS). Our objective was to develop and evaluate a patient-reported outcome measure of quality of life in AS, EASi-QoL. We used patient interviews, a literature review, and completion of an individualized measure of AS quality of life during clinic-based and pilot surveys to derive questionnaire content. Classical and modern psychometrics were then used to evaluate the questionnaire using data from a large UK-based postal survey of 1000 patients with AS. Data analysis from the interviews and clinic-based and postal surveys produced a 57-item self-completed questionnaire. Fifteen items were removed as a result of patient interviews and the pilot survey. In total, 612 (64.0%) patients responded to the main postal survey. After assessment of data quality, confirmatory factor analysis, and Rasch analysis, 20 items were found to contribute to 4 domains of AS-related quality of life: physical function, disease activity, emotional well-being, and social participation. Item-total correlations ranged from 0.66 to 0.84. Cronbach's alpha and test-retest reliability estimates were 0.88-0.92 and 0.88-0.93, respectively. Confirmed hypothesized correlations with the AS Quality of Life questionnaire, the Bath AS Disease Activity Index, Bath AS Functional Index, SF-36, EQ-5D, and the Hospital Anxiety and Depression Scale were evidence for the construct validity of the EASi-QoL. The EASi-QoL has good evidence of data quality, internal reliability, test-retest reliability, and content and construct validity, and should be considered for use with patients in routine practice settings and in evaluative studies including clinical trials. Measurement responsiveness and minimal important change are currently being assessed.

Impact of Age, Sex, Physical Function, Health-related Quality of Life, and Treatment with Adalimumab on Work Status and Work Productivity of Patients with Ankylosing Spondylitis

To determine factors associated with work in patients with ankylosing spondylitis (AS). Three hundred fifteen patients with AS were enrolled in a 24-week, randomized controlled study of adalimumab with a longterm, open-label, adalimumab extension phase. Patient-reported outcome (PRO) measures included the Medical Outcome Study Short Form 36 Health Survey (SF-36), AS Quality of Life Questionnaire (ASQOL), Health Utilities Index Mark 3 (HUI-3), and Work Productivity and Activity Impairment-Specific Health Problem Questionnaire (WPAI-SHP). Multivariate logistic regression was used to analyze differences between working and nonworking patients. The relationships between PRO and WPAI-SHP scores were assessed using Pearson correlation coefficients. Multivariate modeling was applied to determine factors associated with productivity while at work. WPAI-SHP was assessed through 3 years of adalimumab exposure. Younger age (p = 0.002) and male sex (p < 0.001) were significantly and independently associated with working patients with AS. The SF-36 Physical Component Summary score (p < 0.001), ASQOL score (p < 0.001), HUI-3 scores (p < 0.001), and both patient's global assessment of disease activity (p < 0.001) and nocturnal pain (p < 0.001) scores were independently associated with working status. Work absenteeism due to AS was weakly correlated with all PRO scores. WPAI-SHP components of work presenteeism (lack of productivity at work), activity impairment, and overall work productivity loss due to AS were moderately correlated with quality of life as measured by the ASQOL, the SF-36 Physical Component Summary score, and the SF-36 Bodily Pain domain. Linear multivariate analyses indicated that work presenteeism was significantly associated with pain, functioning, and disease activity. Longterm adalimumab treatment was associated with sustained improvements in WPAI-SHP scores. Quality of life and the physical consequences associated with AS have a direct relationship with a patient's ability to work. Adalimumab sustains improvements in work outcomes in patients with AS.

Disease-specific, patient-assessed measures of health outcome in ankylosing spondylitis: reliability, validity and responsiveness.

To assess the acceptability and measurement properties of four ankylosing spondylitis (AS)-specific, patient-assessed measures of health outcome: AS Quality of Life Questionnaire (ASQoL), Bath AS Disease Activity Index (BASDAI), the Body Chart and the Revised Leeds Disability Questionnaire (RLDQ). Instruments were administered by means of a self-completed questionnaire to patients recruited from across the United Kingdom (UK). Instruments were assessed for data quality and scaling assumptions. Where appropriate, dimensionality was assessed using principle component analysis (PCA). Internal consistency reliability was tested using Cronbach's alpha. Test-retest reliability was assessed in those patients reporting no change in AS-specific health at 2 weeks. The convergent validity of the instruments was assessed and scores were correlated with responses to the health transition questions. Responsiveness was assessed for patients reporting change in health at 6 months. The BASDAI and Body Chart have low self-completion rates. Item responses for the RLDQ were skewed towards higher levels of functional ability. PCA supported instrument unidimensionality. Cronbach's alpha ranged from 0.87 (BASDAI) to 0.93 (RLDQ). Test-retest reliability estimates support the use of the ASQoL and RLDQ in individual evaluation (>0.90). Correlations between instruments were in the hypothesized direction; the largest was between the ASQoL and BASDAI (0.79). The BASDAI had the strongest linear relationship, with responses to both specific and general health transition questions (P<0.01). With the exception of the Body Chart, instruments had a stronger relationship with general health transition. The BASDAI was the most responsive instrument. The Body Chart and RLDQ had low levels of responsiveness. The instruments have undergone a comprehensive comparative evaluation to assess the measurement properties required for patient-assessed measures of health outcome. Adequate levels of reliability and validity were found for all instruments. The BASDAI and the ASQoL were the most responsive to self-perceived change in health, but the BASDAI had low levels of self-completion.