Does the Inclusion of Extra-Articular Manifestations Improve Validity of the Self-Administered Comorbidity Questionnaire Modified for Spondyloarthritis (SpA-SCQ)? Results from ASAS-Comospa

Ivette Essers^1,2, Carmen Stolwijk^1,2, Adrien Etcheto³, Anna Molto⁴, Filip van Den Bosch⁵, Désirée van der Heijde⁶, Robert B.M. Landewé^7,8, Astrid van Tubergen^1,2, Maxime Dougados^4,9 and Annelies Boonen^1,10, ¹School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, Netherlands, ²Rheumatology, Maastricht University Medical Center, Maastricht, Netherlands, ³Cochin Hospital, Paris Descartes University, Paris, France, ⁴Hopital Cochin, Paris Descartes University, Paris, France, ⁵Department of Rheumatology, Ghent University Hospital, Ghent, Belgium, ⁶Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands, Leiden, Netherlands, ⁷Rheumatology, Atrium Medical Center, Heerlen, Netherlands, ⁸Department of Rheumatology, Amsterdam Rheumatology Center, Amsterdam, Netherlands, ⁹Rheumatology Department, Hôpital Cochin, Paris, France, ¹⁰Maastricht University Medical Center, Maastricht, Netherlands

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: Co-morbidities, extraarticular manifestations, Questionnaires and spondylarthropathy

Session Information

Date: Sunday, November 8, 2015

Title: Spondylarthropathies and Psoriatic Arthritis - Clinical Aspects and Treatment Poster I: Clinical Aspects and Assessments

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: The
self-administered comorbidity questionnaire (SCQ) was developed to understand
the impact of 13 common comorbidities on functioning and resource utilisation.
In patients with ankylosing spondylitis, we recently showed that criterion- and
construct validity of the SCQ was good, and improved after removing rheumatic items from the questionnaire
(SpA-SCQ) (1). However, this modification (SpA-SCQ)
does not address uveitis, psoriasis and inflammatory bowel disease,
which are frequently occurring extra-articular manifestations (EAMs) in
spondyloarthritis (SpA), and might have a relevant impact on disease specific
and generic outcomes. The aim of the present study was to assess and compare criterion and construct validity
of the SpA-SCQ and the SpA-SCQ with 3 items representing the EAMs
(“SpA-SCQ-EAM”).

Methods: Data from the CO-MOrbidities in SPA (COMOSPA) study, conducted in 22 countries, were
used. We hypothesised that the criterion validity of the added EAM, assessed by agreement (kappa) between patients’
self-reported and physicians’ confirmed diagnoses of each of the three EAM, was good. For construct validity, we hypothesised that the
SpA-SCQ-EAM would correlate moderate (r>0.30) and somewhat better (r-difference
>0.05) than SpA-SCQ with demographics, physical function (BASFI), work-ability
(WPAI) and health utility (EQ-5D),and that both would have low correlation with
disease activity (ASDAS-CRP). We further hypothesized that the SpA-SCQ(-EAM)
correlated better with these outcomes (but not disease activity) than the rheumatic disease comorbidity index (RDCI).

Results: 3,984 patients
(age 43.6 (SD 13.9) years, 2,588 (65.0%) male, disease duration 8.2 (SD 9.3)
years, of which 2,217/3,067 (72.4%) HLA-B27 positive) contributed to the analyses.
The mean SpA-SCQ was 2.0 (SD 2.8) and the SpA-SCQ-EAM 2.8 (SD 3.3). The
agreement between patient and physician diagnosed EAMs was substantial to
almost perfect (uveitis ĸ=0.81, IBD ĸ=0.74, psoriasis ĸ=0.78),
and was not systematically different across countries. Table 1 shows the
correlations between the SpA-SCQ-(EAM) and outcomes, and makes clear that the
hypothesis of a better correlation of the SpA-SCQ-EAM than SpA-SCQ with
outcomes could not be confirmed. On the other hand, both
the SpA-SCQ and the SpA-SCQ-EAM performed better with respect to the correlations
with outcomes than the RDCI (Table 1). Similar results were found for patients
with axial and ‘pure’ peripheral SpA.

Conclusion:
EAMs can be reliably assessed through
self-report by patients with SpA. Notwithstanding, adding the EAMs to the
SpA-SCQ can improve the face validity of this questionnaire. Both the SpA-SCQ
and SpA-SCQ-EAM correlated better with health outcomes than the RDCI in
patients with (axial and peripheral) SpA.

Disclosure: I. Essers, None; C. Stolwijk, None; A. Etcheto, None; A. Molto, None; F. van Den Bosch, AbbVie, Celgene, Janssen, Novartis, Pfizer and UCB, 5,AbbVie, Celgene, Janssen, Novartis, Pfizer and UCB, 8; D. van der Heijde, AbbVie, 5,Amgen, 5,Astellas, 5,AstraZeneca, 5,Bristol-Myers Squibb, 5,Celgene, 5,Daiichi Pharmaceutical Corporation, 5,Eli Lilly and Company, 5,Galapagos, 5,Merck Pharmaceuticals, 5,Novartis Pharmaceutical Corporation, 5,Pfizer Inc, 5,Roche Pharmaceuticals, 5,UCB Pharma, 5; R. B. M. Landewé, None; A. van Tubergen, None; M. Dougados, Pfizer Inc, 5,UCB, 5,AbbVie, 5,Merck Pharmaceuticals, 5; A. Boonen, None.

To cite this abstract in AMA style:

Essers I, Stolwijk C, Etcheto A, Molto A, van Den Bosch F, van der Heijde D, Landewé RBM, van Tubergen A, Dougados M, Boonen A. Does the Inclusion of Extra-Articular Manifestations Improve Validity of the Self-Administered Comorbidity Questionnaire Modified for Spondyloarthritis (SpA-SCQ)? Results from ASAS-Comospa [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/does-the-inclusion-of-extra-articular-manifestations-improve-validity-of-the-self-administered-comorbidity-questionnaire-modified-for-spondyloarthritis-spa-scq-results-from-asas-comospa/. Accessed .

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