SAT0375 DETERMINANTS OF PATIENT’S GLOBAL ASSESSMENT OF WELL-BEING IN EARLY AXIAL SPONDYLOARTHRITIS; 5-YEAR LONGITUDINAL DATA FROM THE DESIR COHORT.
Authors: F. Hirano, D. Van der Heijde, F. A. Van Gaalen, R. B. M. Landewé, C. Gaujoux-Viala, S. Ramiro
Journal: Annals of the Rheumatic Diseases (2020)

Background: A framework has been proposed to explain which disease outcomes impact quality of life or well-being in patients with axSpA; this was based on cross-sectional data and patients with radiographic axSpA. 1 Objectives: To investigate the determinants of patient’s well-being over time, and the influence of contextual factors on these relationships in patients with early axSpA. Methods: Five-year data from DESIR, a cohort of early axSpA, were analysed. Clinical data were collected every 6 months up to 2 years and annually thereafter. X-rays and MRI of the spine and SIJ were performed at baseline, 2, and 5 years. The outcome was BAS-G, the patient’s global assessment of the disease impact on well-being. Generalized estimating equations (GEE) were used to test the relationship between potential explanatory variables from 5 domains (disease activity, physical function, spinal mobility, structural damage, spinal and SIJ inflammation) and BAS-G over 5 years. Longitudinal relationships were analysed using an autoregressive GEE model. Contextual factors (patient’s educational level, gender and age) were tested as potential effect modifiers or confounders. Results: A total of 708 patients were included, mean age 33.7 (SD 8.6) years, 46% male, 41% lower educated. Higher scores of the individual questions of BASDAI on fatigue (Q1) (β [95% CI]: 0.17 [0.13-0.22]), back pain (Q2) (0.51 [0.46-0.56]), peripheral joint pain (Q3) (0.08 [0.04-0.12]) and severity of morning stiffness (Q5) (0.08 [0.03-0.13]), and BASFI (0.14 [0.08-0.19]) were independently associated with a higher BAS-G over time (Table 1). In the autoregressive GEE model, all variables except for the BASDAI Q5 showed true longitudinal associations with BAS-G. Age, gender and educational level were neither effect modifiers nor confounders. Table 1. Factors associated with BAS-G over time. Multivariable GEE model Multivariable autoregressive GEE model § Coefficient (95% CI) Coefficient (95% CI) BASDAI Q1 (fatigue, 0-10) 0.17 (0.13 to 0.22)* 0.15 (0.10 to 0.20)* BASDAI Q2 (back pain, 0-10) 0.51 (0.46 to 0.56)* 0.54 (0.47 to 0.60)* BASDAI Q3 (peripheral joint pain, 0-10) 0.08 (0.04 to 0.12)* 0.13 (0.08 to 0.19)* BASDAI Q4 (enthesitis, 0-10) 0.03 (-0.01 to 0.07) 0.02 (-0.04 to 0.08) BASDAI Q5 (severity of morning stiffness, 0-10) 0.08 (0.03 to 0.13)* 0.06 (-0.01 to 0.13) BASDAI Q6 (duration of morning stiffness, 0-10) 0.03 (-0.01 to 0.07) 0.05 (-0.01 to 0.11) SJC28 (0-28) 0.01 (-0.11 to 0.13) 0.10 (-0.11 to 0.31) TJC53 (0-159) ¶ -0.01 (-0.02 to 0.01) -0.01 (-0.03 to 0.01) MASES (0-39) 0.00 (-0.02 to 0.02) -0.00 (-0.03 to 0.02) CRP (mg/L) 0.01 (-0.00 to 0.01) 0.00 (-0.01 to 0.01) Any EAM (presence vs absence) -0.05 (-0.21 to 0.11) -0.09 (-0.28 to 0.10) BASFI (0-10) 0.14 (0.08 to 0.19)* 0.08 (0.00 to 0.16)* BASMI linear (0-10) -0.07 (-0.16 to 0.02) -0.10 (-0.22 to 0.02) mNY grading (0-8) 0.01 (-0.03 to 0.06) 0.06 (0.01 to 0.12)* mSASSS (0-72) -0.01 (-0.04 to 0.02) 0.00 (-0.03 to 0.04) * p-value &lt; 0.05 ¶ Each joint graded 0-3 § Adjusted for the outcome (i.e. BAS-G) one year before, in order to disentangle the cross-sectional and longitudinal relationships between outcomes and allow the interpretation of a longitudinal relationship Conclusion: A higher level of back pain was associated with a worsening of the patient’s well-being in early axSpA, as were, though to a lesser extent, higher levels of fatigue, morning stiffness, peripheral joint pain and physical disability. Contextual factors like age, gender and educational level did not have an impact on these relationships. Thus, the previously proposed framework of disease outcomes also applies to patients with early axSpA and to outcomes over time. References: [1]Machado, P. ARD 2011. Disclosure of Interests: Fumio Hirano Paid instructor for: Ono pharmaceuticals, Astellas Pharma Inc, Sumitomo Dainippon Pharma, Chugai Pharmaceutical Co., Ltd., Désirée van der Heijde Consultant of: AbbVie, Amgen, Astellas, AstraZeneca, BMS, Boehringer Ingelheim, Celgene, Cyxone, Daiichi, Eisai, Eli-Lilly, Galapagos, Gilead Sciences, Inc., Glaxo-Smith-Kline, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi, Takeda, UCB Pharma; Director of Imaging Rheumatology BV, Floris A. van Gaalen: None declared, Robert B.M. Landewé Consultant of: AbbVie; AstraZeneca; Bristol-Myers Squibb; Eli Lilly &amp; Co.; Galapagos NV; Novartis; Pfizer; UCB Pharma, Cecile Gaujoux-Viala: None declared, Sofia Ramiro Grant/research support from: MSD, Consultant of: Abbvie, Lilly, Novartis, Sanofi Genzyme, Speakers bureau: Lilly, MSD, Novartis