How biological treatment affects the ability to work in patients with axial spondyloarthritis - results from ATTRA, the Czech national registry
Abstract
A number of studies háve shown that the ability to work in patients with ankylosing spondylitis (AS) is reduced compared to the generál population. Furthermore, it has atso been shown that reducing disease activity by biological disease-modifying antirheumatic drugs (bDMARDs) improves the patienťs ability to work, both in paid and unpaid work.
The Work Productivity and Activity Impairment Questionnaire (WPAI) is a validated indicator of work ability that has also proven itselfin AS. Methods.
The aim ofthe study was to compare the effectiveness of biological treatment in patients with radiographic and non-radiographic axial spondyloarthritis (nr-axSpA) and also to evaluate the effect on work ability in both subsets ofthe disease. The study included 2599 patients with a diagnosis ofAS and 333 patients with a diagnosis of nr-axSpA.
Results. Biological treatment was significantly effective.
Treatment retention was 42% better in patients with ankylosing spondylitis than with non-radiographic axial spondyloarthritis. After six months of treatment, the non-radiographic subset had a lower Health Assessment Questionnaire (HAQ) and a lower Ankylosing Spondylitis Disease Activity Score (ASDAS), which were already balanced at later intervals.
Some differences werefound in the overalt health assessment by the SF-36 (Short Form 36 Health Survey). Furthermore, the effect of disease activity and its possible reduction ofthe individual components ofWPAl was eval- uated.
The mean percentage of missed working hours decreased from an initial 12.3 +- 0.8 to 3.5 +- 0.5 after 24 months of treatment in AS. Presenteeism improved by 34.5% (p < 0.001), overalt reduction ofactivities by 36.4% (decrease from 61.5% to 25.1%, p < 0.001).
A correlation of disease activity assessed by ASDAS prior to initiation ofthe first biologie ther- apy with WPAI components was also performed. ASDAS correlated highly with all components ofWPAl, i.e. absenteeism, presenteeism, overalt timitation ofwork capacity and limitation ofactivities.
The decrease in ASDAS correlated with the decrease in all WPAI components in all evaluated intervals