The challenges of living with Ankylosing Spondylitis/Axial SpA throughout the life course: A prospective longitudinal study of the first 3 years from diagnosis

Jane Martindale 1,3, Easwaradhas Gladston-Chelliah 2, Stephen Milan 1, Chibuzor Nnanatu 1 and John A. Goodacre1

1Medical School, Lancaster University, Lancaster, 2 Rheumatology Department, Wrightington Wigan and Leigh NHS Foundation Trust, Wigan
3Physiotherapy Department, Wrightington Wigan and Leigh NHS Foundation Trust, Wigan

Background and Aims
There is a paucity of knowledge regarding short-term progression once the diagnosis of AS/Axial SpA has been made. This study aims to explore how newly diagnosed patients progress during their initial 3 years after diagnosis investigating the stability of disease markers and associations between psychological and generic health status.


Methods
Physiotherapists from 13 secondary care sites identified participants who completed annual questionnaires and BASMI assessments. Ethical approval was obtained (MREC ref. 11/NW/0456). The questionnaire consisted of demographic data, BASDAI, BASFI, HADS, EASi-QoL, Arthritis Self Efficacy Scale and the Jenkins Sleep Evaluation Questionnaire. Data were stored and analysed in ‘R’ version 3.1.1 (2014-07-10).

Results
84 participants completed the first assessment, with 31 (16 women, 15 men, median age 36 (25 – 68), symptoms pre diagnosis 7 years (1 – 20) completing 3 assessments. The cohort at year 1 were similar to other cohorts mean (SD) BASMI 2.23 (1.37), BASFI 3.52 (2.89), BASDAI 4.04 (2.47), HADS A 7.72 (4.64), HADS D 5.59 (4.18), spinal pain 4.26 (3.17). Repeated measures ANOVA on disease status scores yielded a significant result for BASMI (p[HF]=0.00321**) and non-significant results for both BASFI (p[HF]=0.2258) and BASDAI (p[HF]=0.05). All measures of psychological status and quality of life (EASI –QoL) and self- efficacy correlated significantly with disease status scores throughout the study period and most strongly with Emotional Wellbeing. At year 1 (data shown) and throughout BASFI (-0.66***), BASDAI (-0.71***), but not BASMI are closely associated with self-efficacy.

Conclusions
There is improved and sustained disease status over the first 3 years of living with a diagnosis with significant correlation between disease, psychological status and quality of life in newly diagnosed patients. The strong association between self-efficacy and both disease and functional status is relevant and important for newly diagnosed patients as they learn to live with their condition.

Key Words
AS/ Axial SpA, newly diagnosed, self-efficacy