ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 2477

Impact Of Stressful Life Events On Disease Activity In Spondyloarthritis: Results Of The Coenv-2 Prospective Cohort Study

Guanguan Luo1, Pierre Yves Boelle1, Clément Turbelin1, Roula Said Nahal2, Nadine Zeboulon3, Maria-Antonietta d'Agostino4, Solen Kerneis1, Thomas Hanslik1,5 and Maxime A. Breban4,6, 1Epidemiology-UMR S 707, Faculté de Médecine Pierre et Marie Curie, Paris, France, 2Service de Rhumatologie, Hopital Ambroise Pare, Boulogne-Billancourt, France, 3Rheumatology, Ambroise Paré Hospital, Boulogne-Billancourt, France, 4Rheumatology, Ambroise Paré Hospital, and Versailles Saint Quentin en Yvelines University, Boulogne-Billancourt, France, 5Internal Medicine, Ambroise Paré Hospital, and Versailles Saint Quentin en Yvelines University, Boulogne-Billancourt, France, 6Immunology, NSERM U1016 - CNRS (UMR 8104), Montigny le Bretonneux, France

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: ,

Session Information

Title: Spondylarthropathies and Psoriatic Arthritis: Clinical Aspects and Treatment III

Session Type: Abstract Submissions (ACR)

Background/Purpose: The relative contribution of environmental factors to triggering and/or progression of spondyloarthritis (SpA) remains poorly characterized. A link between disease activity and stressful life events and vaccination has been shown previously (J Rheumatol 2013,40:469). The objective of this study was to specify the types of vaccine and life event related to disease activity.

Methods:  Adult spondyloarthritis patients were enrolled in the dedicated cohort, CoEnv-2, which was prospectively followed for 2 years. Patients logged on to a secured website every month to complete an auto-questionnaire. They reported whether they had been exposed to stressful life events, vaccinations or other environmental factors through a detailed standardized questionnaire. Patients were asked to rate the impact of a potential exposure to life events occurring since the previous connection, on a visual numeric scale (VNS) from 0 (no impact) to 10 (worst impact). The main outcome variable was the difference of Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) measured on two consecutive connections. Months with occurring event(s) were compared to those without such event.

Results: Three hundred and one patients participated and returned 3,896 monthly questionnaires. Months when an abrupt and unexpected traumatic event (such as natural disaster, robbery, physical abuse…) occurred were associated with an increase in BASDAI of 0.58 [95%CI: 0.50;0.66], as compared to months without such occurrence (p<0.001). The events with the highest rating on the VNS had the largest impact (0.66 [0.40;0.92] for a VNS ≥5, and 0.96 [0.33;1.59] for a VNS ≥9). Among non-abrupt stressful life events, only work-related events were followed by an increased BASDAI (0.40 [0.13;0.67]). Seasonal influenza vaccination was associated with a more moderate increase in BASDAI (0.35 [0.06;0.34], p<0.05).

Conclusion: Among stressful life events, abrupt and unexpected traumatic events had a clear-cut measurable impact on disease activity in patients with SpA. The link between vaccination and disease activity appeared as limited to influenza immunisation. Ongoing analyses will allow us to determine the duration of such effects.

Disclosure:

G. Luo,
None;

P. Y. Boelle,
None;

C. Turbelin,
None;

R. Said Nahal,
None;

N. Zeboulon,
None;

M. A. d’Agostino,
None;

S. Kerneis,
None;

T. Hanslik,
None;

M. A. Breban,
None.

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