Background/Purpose: Axial Spondyloarthritis (axSpA) is a chronic inflammatory disease that impairs quality of life. While pharmacological treatment is central to axSpA management, non-pharmacological strategies are increasingly recognized for their benefits on disease outcomes. This study evaluates the impact of physical activity, obesity, and mobility impairment on the quality of life in patients with axSpA.

Methods: This was a cross-sectional data analysis from the Brazilian Spondyloarthritis Registry, including 19 centers nationwide. All patients included were diagnosed with axSpA by a rheumatologist and met the ASAS classification criteria for axSpA. Physical activity was measured using the International Physical Activity Questionnaire (IPAQ), obesity was defined by body mass index (BMI), mobility impairment was evaluated using the Bath Ankylosing Spondylitis Metrology Index (BASMI), and quality of life was measured by the Ankylosing Spondylitis Quality of Life (ASQoL) questionnaire.

Results: A total of 965 patients with axSpA were included (70.7% male; mean age 47.8 ± 12.9 years). HLA-B27 was positive in 631 patients (65.4%), negative in 204 (21.1%), and unknown or untested in 130 (13.5%). Subsequent analysis focused on 833 patients with complete data on physical activity (11.9% active; 32.8% minimally active; 55.3% sedentary). ASQoL values progressively worsened with lower physical activity levels: active, minimally active, and sedentary (5.9 ± 5.2 vs. 6.8 ± 5.0 vs. 8.7 ± 5.4, p < 0.001) (Figure 1). Pairwise comparisons showed differences between active vs. sedentary (p < 0.001) and minimally active vs. sedentary (p < 0.001), but no significant difference between active and minimally active groups (p = 0.092). A positive correlation between BASMI and ASQoL was observed (Spearman r = 0.236, p < 0.001) (Figure 2), and patients classified as obese (BMI ≥30) exhibited significantly higher ASQoL compared to non-obese patients (9.3 ± 5.16 vs. 7.5 ± 5.07; p < 0.001) (Figure 3). Interestingly, no difference was observed between physical activity levels (active, minimally active, and sedentary) and BASMI (3.90 ± 2.09 vs. 3.94 ± 2.00 vs. 4.25 ± 2.11, p = 0.097) and frequency of obesity (28.4% vs. 22.9% vs. 23.8%, p = 0.523). Additionally, when comparing obese and non-obese axSpA patients, BASMI values were similar (4.25 ± 1.89 vs. 4.08 ± 2.13, p = 0.211).

Conclusion: Regular exercise was associated with a better quality of life, while obesity and mobility limitations independently had a negative impact. Remarkably, these variables did not influence each other, suggesting that additional factors may influence physical function, mobility, and body composition. These findings highlight the importance of incorporating non-pharmacological interventions, such as promoting physical activity, preventing disability, and managing weight, into the comprehensive care of axSpA patients to improve their quality of life.

Figure 1. Comparison of Ankylosing Spondylitis Quality of Life (ASQol) values among Physical Activity levels – International Physical Activity Questionnaire (IPAQ) in axSpA paients.

Figure 2. Comparison of Ankylosing Spondylitis Quality of Life (ASQol) values between Bath Ankylosing Spondylitis Metrology Index (BASMI) category in axSpA patients.

Figure 3. Comparison of Ankylosing Spondylitis Quality of Life (ASQol) values between Obesity status in axSpA patients. Obesity=Body Mass Index(BMI) ≥30.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/impact-of-regular-exercise-mobility-impairment-and-obesity-on-quality-of-life-in-patients-with-axial-spondyloarthritis-a-cross-sectional-analysis-from-the-brazilian-registry-of-spondyloarthritis/