Non-Radiographic Spondyloarthritis Has Greater Work Instability Than Other Spondyloarthritis Subtypes in a National Database

Sherry Rohekar¹, Robert D. Inman², Renise Ayearst³, Proton Rahman⁴, Walter P. Maksymowych⁵ and Dafna D. Gladman⁶, ¹Rheumatology, St. Joseph's Hospital, London, ON, Canada, ²Dept of Medicine/Rheumatology, Toronto Western Research Institute, University Health Network and University of Toronto, Toronto, ON, Canada, ³Rheumatology, University of Toronto, Toronto Western Hospital, Toronto, ON, Canada, ⁴Faculty of Medicine, Memorial University of Newfoundland, St. John's, NF, Canada, ⁵Department of Medicine, University of Alberta, Edmonton, AB, Canada, ⁶Centre for Prognosis Studies in The Rheumatic Diseases, Toronto Western Research Institute, University of Toronto, University Health Network, Toronto, ON, Canada

Meeting: 2012 ACR/ARHP Annual Meeting

Keywords: Ankylosing spondylitis (AS), Employment, psoriatic arthritis and spondylarthropathy

Session Information

Title: Spondylarthropathies and Psoriatic Arthritis: Clinical Aspects and Treatment

Session Type: Abstract Submissions (ACR)

Background/Purpose: Clinical subsets of spondyloarthritis (SpA), such as ankylosing spondylitis (AS) and psoriatic arthritis (PsA) can be associated with significant impact on work performance and attendance. Prior to becoming completely work disabled, patients’ functional abilities do not match their work demands. This period of time is one of work instability (WI). The aim of this study was to determine the characteristics of WI in a large population of patients with SpA.

Methods: Patients were recruited from two large, well established cohorts of AS and PsA. WI was evaluated using a validated questionnaire, the AS-WIS, in which higher scores denote more WI, which may be stratified into low, medium and high risk of future job loss. Standard protocols were completed at the time of completion of the AS-WIS which included a detailed history, physical examination, physician -reported outcome measures and patient-reported outcome measures.

Results: 414 patients responded (222 PsA, 160 AS, 18 undifferentiated SpA [uSpa], 12 non-radiographic SpA [nr-axSpA] and 2 reactive arthritis [ReA]). Mean age was 47.2 (SD 14.4), 66.9% male. Mean duration of PsA was 17.4 years; AS was 11.9 years. Mean WIS scores were low in AS (8.0, SD 6.1), PsA (6.7, SD 6.0), ReA (7.5, SD 9.2) and uSpA (8.0, SD 6.9). However, those with nr-axSpA had significantly greater WIS scores than the other groups, placing them in the moderate risk category (mean 12.6, SD 6.6). Higher WIS scores were significantly correlated with female gender, lower education, lung disease, gastrointestinal (GI) disease, diabetes, peripheral joint involvement, NSAID use, tender joint count, fibromyalgia tender point count (FMTP), MD global assessment of disease activity, EQ5D, Dermatology Life Quality Index, pain, stiffness, Health Assessment Questionnaire, Fatigue Severity Score, Bath AS-Global, Bath AS Disease Activity Index, Bath AS Functional Index, AS Quality of Life, Functional Assessment of Chronic Illness Therapy, SF-Physical Component Scale, SF-Mental Component Scale, and patient global assessment of disease activity. Linear regression revealed that sex, lower education level, history of GI disease, diabetes, NSAID use and FMTP were significantly associated with higher WIS scores. Multinomial logistic regression was carried out on WIS risk level (low, medium or high) with low risk as the reference category. Medium WIS risk scores were significantly associated with education level, history of GI disease, diabetes, NSAID use and FMTP. High WIS risk scores were significantly associated with education level and history of GI disease.

Conclusion: WI was significantly higher in those with nr-axSpA than other types of SpA, suggesting that these patients have a greater mismatch between their functional abilities and job demands. Education level, history of GI disease, NSAID use and higher FMTP were associated with higher levels of WI. The highest risk of WI was associated with education level and history of GI disease.

Disclosure:

S. Rohekar,
None;

R. D. Inman,
None;

R. Ayearst,
None;

P. Rahman,

Janssen Research and Development, LLC,

;

W. P. Maksymowych,
None;

D. D. Gladman,
None.

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