Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose: Ankylosing spondylitis (AS) causes pain, joint damage and reduced function, which contribute to a substantial burden on affected patients and their families. A feeling of helplessness (self-perceived lack of control over the disease) can have an impact on coping1,2. We aimed to understand associations between helplessness in coping with AS and patient-reported outcomes, including depression, work productivity, disease activity, functional impairment and health-related quality of life (HRQoL).
Methods: A prospective Patient Reported Outcomes Survey of Employment in Patients with AS (PROSE-AS) was conducted at rheumatologists’ clinical practice sites in Canada (n=234), the Netherlands (n=131), the United Kingdom (n=144) and the United States (n=46). Patients ≥18 years of age completed surveys at baseline, 3, 6, 9 and 12 months. Helplessness was assessed using the helplessness subscale of the Rheumatology Attitudes Index (RAI; scale 5–25), and patients were stratified according to low (RAI <11), moderate (RAI 11–19) or high (RAI ≥20) helplessness for analysis3. Depression was assessed using the Center for Epidemiological Studies Depression (CES-D) scale. Work outcomes were assessed using the Work Productivity and Activity Impairment (WPAI) questionnaire. Disease activity and functional impairment were assessed using the Bath AS Disease Activity Index (BASDAI) and Bath AS Functional Index (BASFI) scales, respectively. HRQoL was assessed using the Physical Component Summary (PCS) and Mental Component Summary (MCS) of the Short Form 36 Health Survey (SF-36) and the AS Quality of Life (ASQoL) questionnaires. Associations between helplessness and outcome variables over time were analyzed using multivariable generalized estimating equations (GEE), with adjustment for baseline patient socio-demographics, disease characteristics, medication use and country.
Results: Mean AS duration among 553 patients was 13.9 years; 194 (35.1%), 317 (57.3%) and 42 (7.6%) were classified with low, moderate and high helplessness, respectively. Patients with moderate and high helplessness were significantly more likely than patients with low helplessness to be depressed, unemployed and exhibit overall work and activity impairment (Table). High helplessness was also significantly associated with greater clinical severity as measured by BASDAI and BASFI, and with greater HRQoL impairment as measured by ASQoL, SF-36 PCS and MCS scores, compared with low helplessness.
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Association Between RAI Helplessness Category and Outcome Variables Over Timea
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Outcome Variables (Categorical)
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Moderate vs Low Helplessness (OR, 95% CI)
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High vs Low Helplessness (OR, 95% CI)
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CES-D (scale 0–60) (a) Depressed (≥16, n=182) vs Not Depressed (<16, n=371) |
3.56 (2.72 to 4.64) |
12.91 (8.20 to 20.32) |
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Work Status (a) Unemployed (n=177) vs Employed (n=376) |
1.14 (0.99 to 1.33) |
1.69 (1.30 to 2.21)
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WPAI (a) Absenteeism (n=60) vs no absenteeism (n=312) (b) Presenteeism (n=287) vs no presenteeism (n=86) (c) Overall work impairment (n=286) vs no overall work impairment (n=83) (d) Activity impairment (n=317) vs no activity impairment (n=59) |
3.41 (2.07 to 5.62) 2.49 (1.86 to 3.34) 2.54 (1.89 to 3.41) 2.93 (2.06 to 4.17) |
5.16 (2.35 to 11.33) 4.57 (1.76 to 11.86) 4.65 (1.75 to 12.35) 4.46 (1.33 to 14.91) |
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Outcome Variables (Continuous)
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Moderate vs Low Helplessness (β, 95% CI)
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High vs Low Helplessness (β, 95% CI)
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BASDAI Score (n=553, scale 0–10) |
1.01 (0.85 to 1.16) |
2.28 (1.98 to 2.58) |
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BASFI Score (n=552, scale 0–10) |
0.88 (0.73 to 1.02) |
2.01 (1.74 to 2.28) |
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SF-36 PCS Score (n=553, scale 0–100) SF-36 MCS Score (n=553, scale 0–100) |
-4.40 (-5.04 to -3.75) -4.03 (-4.88 to -3.17) |
-8.31 (-9.56 to -7.07) -9.92 (-11.57 to -8.28) |
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ASQoL Score (n=552, scale 0–18) |
2.77 (2.47 to 3.07) |
5.34 (4.76 to 5.92) |
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aAdjusted for age, sex, race, country, education, comorbidities, NSAIDs, DMARDs, anti-TNF, and AS duration. CI, confidence interval; DMARD, disease-modifying antirheumatic drug; MCS, Mental Component Summary; OR, odds ratio; PCS, Physical Component Summary; β, regression coefficient |
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Conclusion: High helplessness in coping with AS was associated with depression, poor work productivity and employment outcomes, greater disease activity and functional impairment, and worse HRQoL. Helplessness should receive more attention in clinical care.
References:
- Pearlin LI, Schooler C. J Health Soc Behav. 1978;19:2–21.
- Smith CA, Wallston KA. Health Psychol. 1992;11:151–62.
- Brady TJ. Arthritis & Rheumatism. 2003;49(5s):S147–S164.
Disclosure:
W. P. Maksymowych,
AbbVie,
5,
AbbVie,
2,
AbbVie,
8;
A. Boonen,
Amgen, AbbVie, Merck and Pfizer,
2,
UCB and Pfizer,
8;
H. Marzo-Ortega,
AbbVie, MSD, UCB, Pfizer, Janssen,
5,
AbbVie, MSD, UCB, Pfizer, Janssen,
8,
AbbVie, MSD, UCB, Pfizer, Janssen,
2;
M. N. Magrey,
MetroHeath,
3,
Abbvie,
5,
AbbVie,
9;
M. Mittal,
AbbVie,
1,
AbbVie,
3;
M. Halpern,
AbbVie,
2;
J. Renaud,
AbbVie,
2;
Y. Bao,
AbbVie,
1,
AbbVie,
3;
A. D. Joshi,
AbbVie,
1,
AbbVie,
3.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/helplessness-in-coping-is-associated-with-worse-patient-reported-outcomes-among-patients-with-ankylosing-spondylitis-a-longitudinal-multi-country-cohort-study/