POS0962 PATIENT-REPORTED IMPACT OF AXIAL SPONDYLOARTHRITIS ON WORKING LIFE. RESULTS FROM THE SPANISH ATLAS
Authors: M. Garrido-Cumbrera, E. Collantes-Estévez, V. Navarro-Compán, P. Zarco Montejo, C. Sastré, S. Sanz-Gómez, J. Correa-Fernández, J. Gratacos-Masmitja
Journal: Annals of the Rheumatic Diseases (2021)

Background: Axial spondyloarthritis (axSpA) impacts negatively on multiple dimensions of patient’s life, including their working life. Objectives: The present study aims to evaluate burden of disease ox axSpA patients by working status, work-related issues and their associations and determinants in a Spanish sample. Methods: The Atlas 2017 is an extensive cross-sectional patient survey conducted in Spain (2016), validated by a multidisciplinary group of experts on spondyloarthritis. Participants were recruited through an on-line panel and patient organizations. Participants were classified as active (employed, unemployed between 15-64 years) and inactive (retirees, on sick leave, students and homemakers). Those employed were asked to report work-related issues (WRIs) due to axSpA (sick-leave, difficulty fulfilling work hours, missing work for doctors’ appointments, reducing working hours or taking days off) in the past 12 months. Diagnostic delay, disease activity (BASDAI), spinal stiffness (3-12), functional limitation (0-54) and psychological distress (General Health Questionnaire, GHQ-12 [0-12]) were compared between employed patients with or without WRIs using a Mann-Whitney and Kruskal-Wallis test. Results: Data from 680 patients were collected: mean age was 47±11 years, 52.5% were female and 36.9% were university educated. Mean disease duration and diagnostic delay were 20.9±12.2 and 8.5±7.7 years, respectively, and mean BASDAI was 5.5±2.2. A total of 63.6% (n=415) were considered active population, of which 49.8% (n=325) were employed. Of those employed, 54.3% reported a WRI, specifically 37.1% took sick leave, 44.1% had difficulties in fulfilling the working hours, 42.9% missed work due to doctor’s appointments 37.1% took sick leave, 18.2% reported that their professional life had suffered, 12.3% asked for some days off, 12.3% changed shift sometimes and 7.6% had to give up their previous job. Among all patients, 95.5% faced (or believed they would) difficulties finding a job due to axSpA. Experiencing WRIs due to axSpA was significantly associated in the univariable analysis with higher disease activity, self-reported spinal stiffness, longer diagnostic delay, higher functional limitation and higher level of psychological distress (p&lt;0.001). However, the highest levels of disease burden were reported by unemployed participants (see Table 1). Table 1. Differences between employees with/without work-related issues and between employed/unemployed participants in relation to sociodemographic and patient-reported outcomes Reference group Employed Active Population Subgroup Any WRI With no WRIs Employed Unemployed N size n: 170 n: 143 n: 325 n: 90 Sociodemographic characteristics Age (years) 41.9 ± 7.9 44.2 ± 9.4 42.9 ± 8.6* 42.0 ± 9.1* Gender (Male) 79 (46.5) 75 (52.4) 159 (48.9) 36 (40.0) Education level (University) 80 (47.1)* 68 (47.6)* 153 (47.1) 21 (23.3) Marital status (Married) 110 (64.7) 109 (76.2) 231 (71.1) 54 (60.0) Patient-reported outcomes BASDAI (0-10) 5.7 ± 1.8** 4.5 ± 1.9** 5.2 ± 1.9** 6.3 ±1.9** Spinal Stiffness (3-12) 6.7 ± 2.7** 6.1 ± 2.4** 6.5 ± 2.6** 7.8 ± 2.3** Functional Limitation (0-54) 43.9 ± 8.8** 36.9 ± 10.3** 40.6 ± 10.1** 45.0 ± 8.4** GHQ-12 (0-12) 6.6 ± 4.2** 3.0 ± 3.5** 4.9 ± 4.3** 7.6 ± 4.2** Anxiety 35 (20.6)* 16 (11.2)* 52 (16.0)* 25 (27.8)* Depression 29 (17.1)* 4 (2.8)* 33 (10.2)** 21 (23.3)** Note: WRI: Work-related issue ** p-value &lt;0.001; * p-value &lt;0.05 Conclusion: Results reveal a relevant impact of axSpA in patient working life. Approximately two out of three patients employed experienced WRIs due to axSpA, being associated to worse disease outcomes and poorer psychological health. However, those who were unemployed faced a harsher situation reporting even poorer disease-related and psychological health outcomes. As psychological health appears impaired severely in axSpA patients regardless of their employment status it should be key for a holistic approach to patient care. Acknowledgements: This study was supported by Novartis Spain. The authors would like to thanks all patients who participated in the Atlas study. Disclosure of Interests: Marco Garrido-Cumbrera: None declared, Eduardo Collantes-Estévez Grant/research support from: Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB, Victoria Navarro-Compán Grant/research support from: Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB., Pedro Zarco Montejo: None declared, Carlos Sastré Employee of: Novartis Farmacéutica Spain, Sergio Sanz-Gómez: None declared, José Correa-Fernández: None declared, Jordi Gratacos-Masmitja Grant/research support from: Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB.