Determining factors related to poor quality of life in patients with axial spondyloarthritis: results from the British Society for Rheumatology Biologics Register (BSRBR-AS)

Ann Rheum Dis. 2020 Feb;79(2):202-208. doi: 10.1136/annrheumdis-2019-216143. Epub 2019 Oct 29.


Objective: To determine modifiable factors associated with poor quality of life (QoL) in patients with axial spondyloarthritis (axSpA).

Methods: Analysis of data from the British Society for Rheumatology Biologics Register in Ankylosing Spondylitis (BSRBR-AS) and validation of a previous model using data from 1810 patients with axSpA recruited during 2012-2017. Data collected included clinical and patient-reported measures. QoL was assessed using the Ankylosing Spondylitis Quality of Life (ASQoL) measure. Linear regression models predicting ASQoL scores were used first to validate a previous model from a national study, to extend this with additional information available in BSRBR-AS and finally to identify a 'de novo' model from BSRBR-AS of which factors impact on poor QoL.

Results: Four out of five factors included in a previous model of poor QoL in patients with axSpA were confirmed: Bath Ankylosing Spondylitis Disease Activity Index and Bath Ankylosing Spondylitis Functional Index, fatigue and widespread pain, although the performance of the model was improved by the addition of measures of mood and sleep disturbance. In a de novo model in BSRBR-AS, there were six factors (other than disease activity and function) that predicted ASQoL: depression (β=0.16), sleep disturbance (β=0.08), activity impairment (β=0.04), fibromyalgia (Symptom Severity Scale (β=0.24) and Widespread Pain Index (β=0.10)) and tobacco smoking (β=0.66).

Conclusion: This study confirms that poor QoL in patients with axSpA, in addition to high disease activity and poor function, is independently influenced by sleep disturbance, mood and widespread pain. These additional factors are not considered targets for treatment in current European League Against Rheumatism (EULAR) guidelines for managing the condition.

Keywords: disease register; fatigue; mood; quality of life, axial spondyloarthritis; sleep.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Affect
  • Depression / etiology
  • Depression / psychology
  • Fatigue / etiology
  • Fatigue / psychology
  • Female
  • Fibromyalgia / etiology
  • Fibromyalgia / psychology
  • Humans
  • Linear Models
  • Male
  • Middle Aged
  • Pain / etiology
  • Pain / psychology
  • Physical Functional Performance*
  • Prospective Studies
  • Quality of Life*
  • Registries
  • Rheumatology / statistics & numerical data*
  • Severity of Illness Index*
  • Sleep Wake Disorders / etiology
  • Sleep Wake Disorders / psychology
  • Spondylarthritis / complications
  • Spondylarthritis / psychology*
  • Tobacco Smoking / psychology