Increased proportion of comorbidities but no deterioration of sexual quality of life during a 5-year follow-up in patients with axial spondyloarthritis in the biologic treatment era.

OBJECTIVE: To explore patient perception of sexual quality of life (SQOL), an important category of QOL, in male and female patients with axial SpA (axSpA) after a 5 year follow-up. METHODS: A broad spectrum of demographic, disease-related, treatment and SQOL data was collected at baseline and at the 5 year follow-up. SQOL was assessed by the SQOL-Female (SQOL-F) questionnaire. For statistical analysis, McNemar's tests, paired t-tests and multiple regression analyses were applied. RESULTS: A total of 245 axSpA patients (168 men and 77 women) from outpatient clinics were examined (mean age 46 years, mean disease duration 11.9 years at baseline). Compared with baseline, the patients had lower CRP, lower Maastricht Ankylosing Spondylitis Enthesitis Scores, lower BASFI scores, less use of smoking and significantly more patients were treated with biologic DMARDs at the 5 year follow-up. Patient perception of SQOL was basically unchanged at the 5 year follow-up despite a significantly increased proportion of comorbidities, including cardiovascular, endocrine and gastrointestinal disease. A decrease in SQOL after 5 years was observed only in patients exercising <1 h/week at baseline (P = 0.048) and in patients >65 years old. CONCLUSION: In our axSpA patients, no statistically significant changes in SQOL were observed over 5 years, despite a significant increase in comorbidities. Overall disease symptoms decreased, indicating better disease control. Increased use of biologic drugs at the 5 year follow-up may have contributed to this favourable outcome.

No deterioration in health-related quality of life in patients with axial spondyloarthritis followed for 5 years in ordinary outpatient clinics in the biological treatment era.

BACKGROUND: Axial spondyloarthritis (ax-SpA) causes pain, fatigue, stiffness, loss of physical function and impaired health-related quality of life (HRQOL). AIMS: The study aimed to explore the changes in HRQOL over 5 years in patients with ax-SpA and to identify baseline predictors associated with changes in HRQOL assessed using three HRQOL measures. METHODS: Demographic, disease, medication and HRQOL data were collected at baseline and at 5-year follow-up. HRQOL was assessed using SF-6D, 15D and SF-36. Analyses involved McNemar, independent paired t tests and multiple regression. RESULTS: In the 240 (women 31%, men 69%) ax-SpA patients assessed (mean age 46 years), measures reflecting disease activity decreased and co-morbidities increased, and more patients were treated with biologic drugs during follow-up. No deterioration in HRQOL was observed between baseline and 5-year follow-up; indeed, there was a significant increase in SF-6D and SF-36 PCS scores. Improvement in HRQOL measured by SF-6D was associated with younger age, higher education, low Bath Ankylosing Spondylitis (BAS) Activity Index (BASDAI), high BAS Patient Global Score and high C-reactive protein; improvement in SF-36 PCS was associated with younger age, higher education, low BASDAI and no use of biological treatment at baseline. CONCLUSION: Our ax-SpA outpatient clinic patients, with more patients treated with biologic drugs during the 5-year follow-up, did not deteriorate in HRQOL. In fact, the physical dimension in HRQOL improved over the years, as did measures reflecting disease activity. Our study adds evidence to the importance of suppressing inflammation to maintain and improve HRQOL in ax-SpA patients.

Sexual Quality of Life in Patients with Axial Spondyloarthritis in the Biologic Treatment Era.

OBJECTIVE: To examine the relationship between demographics, disease-related variables, treatment, and sexual quality of life (SQOL) in men and women with axial spondyloarthritis (axSpA). METHODS: AxSpA patients were consecutively recruited from 2 rheumatology outpatient clinics in southern Norway. A broad spectrum of demographics, disease, treatment, and QOL data were systematically collected. SQOL was assessed using the SQOL-Female (SQOL-F) questionnaire (score range 18-108). Appropriate statistical tests were applied for group comparison, and the association between independent variables and SQOL-F was examined using multiple linear regression analysis. RESULTS: A total of 360 (240 men, 120 women) axSpA patients with mean age 45.5 years and disease duration 13.9 years were included. Seventy-eight percent were married/cohabiting, 26.7% were current smokers, 71.0% were employed, 86.0% performed > 1-h exercise per week, and 88.0% were HLA-B27-positive. Mean (SD) values for disease measures were C-reactive protein (CRP) 8.5 (12.1) mg/l, Bath Ankylosing Spondylitis Disease Activity Index 3.1 (2.1), Bath Ankylosing Spondylitis Global Score (BAS-G) 3.8 (2.5), Bath Ankylosing Spondylitis Functional Index 2.7 (2.2), and Health Assessment Questionnaire 0.6 (0.5). The proportion of patients using nonsteroidal antiinflammatory drugs was 44.0%, synthetic disease-modifying antirheumatic drugs (DMARD) 5.0%, and biologic DMARD 24.0%. Mean (SD) total sum score for SQOL was 76.6 (11.3). In multivariate analysis, female sex, increased body mass index, measures reflecting disease activity (BAS-G and CRP), and current biologic treatment were independently associated with a lower SQOL. CONCLUSION: Our data suggest that inflammation in patients with axSpA even in the biologic treatment era reduces SQOL.

The relationship between demographic- and disease-related variables and health-related quality of life in patients with axial spondyloarthritis.

BACKGROUND: Axial spondyloarthritis (ax-SpA) is a chronic inflammatory disease of the spine causing pain, stiffness, loss in physical function, and fatigue. Therefore, the physical and psychological burden of having this chronic disease can reduce the quality of life. We aimed to explore the relationship between demographic- and disease-related variables and health-related quality of life (HRQoL) in patients with ax-SpA. METHODS: Demographic- and disease-related, HRQoL-related and treatment data were collected. Disease measures included the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the BAS Functional Index (BASFI), the BAS Global (BAS-G) score, the Maastricht Ankylosing Spondylitis Enthesitis Score (MASES), the Health Assessment Questionnaire (HAQ) and co-morbidity. HRQoL was assessed using the SF-36 and the utility measures SF-6D and 15D. Variables associated with HRQoL were identified in unadjusted and adjusted analyses. RESULTS: We examined 380 patients with ax-SpA (67% men) with a mean age of 46 years. Among them, 86% reported exercising >1 h per week. Mean values were as follows: BASDAI, 3.17; MASES, 3.19; BASFI, 2.71; BAS-G. 3.88; and HAQ, 0.56. The percentage of current users of NSAIDs was 44%, and of DMARDs 23%. In multivariate analyses, exercising 1-3 h per week (B = 2.73, p = 0.022) and exercising >3 h per week (B = 2.71, p = 0.020), lower HAQ scores (B = -4.61, p = 0.001), lower BASFI scores (B = -1.05, p = 0.010) and lower BAS-G scores (B = -0.91, p = 0.001) were independently associated with higher SF-36-PCS scores, whereas modest alcohol consumption (B = 4.63, p = 0.018) and a lower BAS-G score (B = -1.73, p < 0.001) were independently associated with higher SF-36-MCS scores. Exercising 1-3 h per week (B = 0.032, p = 0.004) and exercising >3 h per week (B = 0.036, p = 0.001), lower HAQ scores (B = -0.051, p < 0.001), lower BAS-G scores (B = -0.010, p < 0.001) and co-morbidity (B = -0.014, p = 0.004) were independently associated with higher 15D scores. Finally, exercising 1-3 h per week (B = 0.045, p = 0.001) and exercising > 3 h per week (B = 0.053, p < 0.001), lower HAQ scores (B = -0.054, p = 0.001) and lower BAS-G scores (B = -0.020, p < 0.001) were associated with higher SF-6D scores. CONCLUSIONS: In patients with ax-SpA, a low level of physical activity, impaired physical function and impaired general well-being were independently and consistently associated with a decreased HRQoL across all applied measures.

Perceived effects of health status on sexual activity in women and men older than 50 years.

BACKGROUND: Sexual activity and enjoyment are considered to be important components of quality of life (QOL) for adults of all ages. However, limited data are available on the effects of health status on sexual activity in women and men older than 50 years. Thus, our aim was to explore the perceived effects of health status on sexual activity in women and men older than 50 years. METHODS: For this purpose we used data from an age and gender matched control study initially designed to study QOL in patients with low-energy wrist fracture. We investigated patients with wrist fractures older than 50 years (n = 181), as well as age- and gender-matched controls (n = 226), who participated in the QOL study. There were minimal differences between patients and controls, thus the groups were pooled (mean age 67 years (8 SD)). Health-related quality of life (HRQOL) was assessed using SF-36 and 15D, and the global quality of life using the Quality of Life Scale (QOLS). To assess perceived effects of health status on sexual activity we used the question on sexuality from the 15D questionnaires. Group comparisons and logistic regression analyses were conducted. RESULTS: The 15D question on sexuality was not answered by 25% of the participants. Health status having a large negative effect on sexual activity was reported by only 13% of the participants. In the multivariate analyses a large negative effect of health status on sexual activity was associated with higher age (60-69 years: OR = 5.7, 95% CI = 1.62-29.2; 70-79 years: OR = 3.60, 95% CI = 0.94-13.9; ≥80 years: OR = 9.04, 95% CI = 1.29-63.4), male gender (OR = 10.8, 95% CI = 3.01-38.9), weight (OR = 1.03, 95% CI = 1.00-1.07), low SF-36 PCS score (OR = 0.88, 95% CI = 0.37-0.93) and a low SF-36 MCS score (OR = 0.92, 95% CI = 0.88-0.96). CONCLUSION: Only a small proportion of the participants reported their health status to have a large negative effect on sexual activity. Furthermore, health status having a negative effect on sexual activity was associated with decreased HRQOL. Insights into this important topic may increase our awareness as health care workers and help us to address this aspect of QOL in this age group.