Results from a Multinational Real-World Sample

Background/Purpose: This study aimed to explore the relationship of self-reported happiness to disease activity and functional limitation in people with AS.

Methods: Data were from a cross-sectional sample of rheumatologists and their patients (pts) with AS in 15 countries. Physicians collected data on consecutively consulting AS pts including Physician Assessed Severity’ (PA severity) (choice of mild, moderate, severe), perceived change in control (choice of improving, stable, unstable, deteriorating) and general health (0 – 100 VAS). Pts completed forms on ratings of current activity and pain, assessments of health related quality of life (SF-36, EQ-5D) and disease activity (BASDAI). SF-36 question 9h (Q9h; mental health domain) asks “How much of the time during the past week have you been happy?”; responses of “All” or “Most” formed Happy (Group 1); responses of “A little” or “None” formed Not Happy (Group 2); “some” were excluded from the analysis. Groups 1 and 2 were compared using bivariate analysis.  SF-36 Question 3 (Q3; physical functioning domain) asks if the pts’ health limits them performing 10 daily activities. Results: 1,392 pts answered Q9h: 45.7% were assigned to Group 1 (Happy), 20.3% to Group 2 (Not Happy). Significantly more pts in Group 2 had moderate or severe disease, unstable or deteriorating AS, poorer general health status, worse pain, and more active AS (higher BASDAI) than Group 1 (Figure 1). 1,405 patients answered Q3, of whom 60%, 34% and 6% were considered by their physician to have mild, moderate and severe AS, respectively. The proportion of pts who reported “a lot” of limitation in each of the 10 activities increased with perceived severity (Figure 1). Of pts with severe AS, 47–73% were limited in undertaking normal physical activities, such as climbing several flights of stairs (moderate AS, 23–43%), and 22–43% could not perform activities requiring limited physical effort, such as carrying groceries or dressing themselves (moderate AS, 7–23%). It also shows that among the pts who are impaired ‘a lot’ for each activity, unhappiness increases with perceived disease severity.

Conclusion: Unhappiness in AS pts is associated with more severe or active disease, and many AS pts are limited in their ability to undertake everyday activities, with limitation and unhappiness  more common with more severe disease. Thus evaluating patient unhappiness via enquiry in routine consultation may help in assessing clinical severity, disease impact, and help inform treatment decisions.