Assessment of difficulties, modifications and use of work adaptations in patients with axial spondyloarthritis: validation of the DificuLtAx and ModAL questionnaires

mariana benegas¹, Maria Victoria Martire², Leandro ferreryra³, Hernan Maldonado⁴, Carla Airoldi⁵, Luciana Casalla⁶, Joan Manuel Dapeña⁷, Etel Saturansky⁸, Eliana Serrano⁷, Julieta Morbiducci⁹, Aixa Lucia Merce¹⁰, Natalia Zamora¹¹, Javier Federico Flores Trejo¹², Fernando Sommerfleck¹³, Emilio Buschiazzo¹⁴, Hernan Molina¹⁵, Cecilia Castro¹⁶ and Romina Nieto¹⁷, ¹sanatorio Mendez, CABA, Ciudad Autonoma de Buenos Aires, Argentina, ²Hospital San Roque, La plata, Buenos Aires, Argentina, ³HIBA, CABA, Ciudad Autonoma de Buenos Aires, Argentina, ⁴, Hospital San Antonio de Padua, Rio cuarto, Cordoba, Argentina, ⁵Hospital Provincial de Rosario, Rosario, Santa Fe, Argentina, ⁶Centro medio GENEA, CABA, Ciudad Autonoma de Buenos Aires, Argentina, ⁷Sanatorio Dr Julio Méndez, CABA, Ciudad Autonoma de Buenos Aires, Argentina, ⁸Sanatorio Méndez, CABA, Ciudad Autonoma de Buenos Aires, Argentina, ⁹Hospital General de Agudos Bernardino Rivadavia, Capital Federal, Ciudad Autonoma de Buenos Aires, Argentina, ¹⁰Hospital General de Agudos Bernardino Rivadavia, Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina, ¹¹HIGA San José, pergamino, Buenos Aires, Argentina, ¹²Hospital General de Agudos Dr. Enrique Tornú, Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina, ¹³Sanatorio Julio Mendez, Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina, ¹⁴, Hospital Sr. del Milagro, CABA, Ciudad Autonoma de Buenos Aires, Argentina, ¹⁵Instituto CER, CABA, Ciudad Autonoma de Buenos Aires, Argentina, ¹⁶Hospital Z.G.A Dr. Isidoro Iriarte de Quilmes, Quilmes, Buenos Aires, Argentina, ¹⁷Centro Regional de Enfermedades Autoinmunes y Reumáticas, GO-CREAR, Rosario, Argentina, Rosario, Argentina

Meeting: ACR Convergence 2025

Keywords: Spondyloarthropathies, work

Session Information

Date: Monday, October 27, 2025

Title: (1405–1433) Spondyloarthritis Including Psoriatic Arthritis – Diagnosis, Manifestations, & Outcomes Poster II

Session Type: Poster Session B

Session Time: 10:30AM-12:30PM

Background/Purpose: DificuLtAR and ModAL, two spanish-language questionnaires that assess work difficulties and workplace adaptations, were originally developed and validated for rheumatoid arthritis (RA). Their performance in axial spondyloarthritis (axSpA) remains unknown. Objective: (1) to validate DificuLtAR and ModAL in axSpA (2) Identify factors associated with work difficulties and the use of workplace modifications and adaptations reported by employed patients with axSpA.

Methods: An adaptation of the DificuLtAR for EspAax (DificuLtAx) questionnaire was made, Both questionnaires were applied to patients ≥18 years old, both genders, with a diagnosis of axSpA (ASAS-2009) and actively working. Cronbach’s alpha (DifficuLtAx=0.92 and ModAL=0.83) and construct validity were explored through factor analysis. The Eigenvalue values for a single factor (DificuLtAx=0.89 and ModAL=0.81) and correlation coefficients greater than 0.40 for all questions of both questionnaires after varimax rotation were aceptable. Spearman correlation coefficients, Mann-Whitney or Kruskal-Wallis tests, were calculated. (p < 0.05).

Results: 72 patients were included, 72% men, median age 42 years (IQR 37-53), disease duration 97 months (IQR 40-156), 54% B27positive, and 67% radiographic. The median ASDAS-PCR 2 (IQR 1-3) and BASFI 3.5 (IQR 2-5). 58% were in formal salaried employment and the median WPAI (labor productivity) was 0 (IQR 0-44). The greatest difficulties were sitting or standing for prolonged periods of time (75%) and working crouched (84%) and the most frequent modifications were taking breaks (78%) and furniture changes (45%). The median DificuLtAx 5 (IQR 2-9) and ModAL 3.5 (IQR 2-6), with a correlation between both of rho: 0.67 (p 0.001). See correlations Table 1. Female gender 5.5 vs 3.5 (p 0.001) and boss’s knowledge of the disease 4 vs 3 (p 0.05), were associated with greater modifications.

Conclusion: DificuLtAx and ModAL showed good reliability and construct validity. The main work difficulties were to remain seated or standing and to work crouching/kneeling, and the most frequent modifications were to take breaks and modify the furniture; these were more common in women and in those in whom the boss was aware of the disease.

Disclosures: m. benegas: None; M. Martire: None; L. ferreryra: None; H. Maldonado: None; C. Airoldi: None; L. Casalla: None; J. Dapeña: None; E. Saturansky: None; E. Serrano: None; J. Morbiducci: None; A. Merce: None; N. Zamora: None; J. Flores Trejo: None; F. Sommerfleck: None; E. Buschiazzo: None; H. Molina: None; C. Castro: None; R. Nieto: None.

To cite this abstract in AMA style:

benegas m, Martire M, ferreryra L, Maldonado H, Airoldi C, Casalla L, Dapeña J, Saturansky E, Serrano E, Morbiducci J, Merce A, Zamora N, Flores Trejo J, Sommerfleck F, Buschiazzo E, Molina H, Castro C, Nieto R. Assessment of difficulties, modifications and use of work adaptations in patients with axial spondyloarthritis: validation of the DificuLtAx and ModAL questionnaires [abstract]. Arthritis Rheumatol. 2025; 77 (suppl 9). https://acrabstracts.org/abstract/assessment-of-difficulties-modifications-and-use-of-work-adaptations-in-patients-with-axial-spondyloarthritis-validation-of-the-dificultax-and-modal-questionnaires/. Accessed .

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