ABSTRACT
BACKGROUND: Ankylosing Spondylarthritis (AS) involves by its frequency and its repercussion on the functional capacity an important handicap and deterioration of the patients quality of life. AIMS: To evaluate the handicap and the quality of life during the AS and to seek the predictive factors of the deterioration of this quality of life. METHODS: A prospective study relating to 50 patients recruited in the Department of Rheumatology of F. B. Hospital of Monastir during 6 months period (Mars to September 2008). The studied parameters were the quality of life evaluated by a specific sore (ASQOL) and a generic score (SF-12). Also the physical, social and economic felt handicap was evaluated using a qualitative scale. Predictive factors (clinical, biological and radiological) of the quality of life were carried out. RESULTS: Our patients are divided in 42 men and 8 women with an average age of 38.9 ± 10.7 years. The average duration of AS is of 11.9 ± 7.6 years. The average of ASQOL is of 11.9 ± 4 (extremes: 0- 17). The average of physical SF12 is of 29.8 ± 6 (21.7-53.2) and of mental SF-12 of 35.3 ± 6.6 (22.5-55.8). The physical, social and economic felt handicap was considered to be average or important in respectively 88%, 72% and 86% of the cases. The predictive factors of a high ASQOL (faded quality of life) are absence of occupation, high BASMI, a high number of painful articulations and high BASFI, BASDAI, BASG, BASRI and EVA total pain. The factors associated to the alteration of the quality of life according to SF-12'S are male sex, professional statute, high number of painful articulations and high BASDAI, BASFI and BASRI. CONCLUSION: Our study shows the important deterioration of the quality of life in AS patients. The existence of the predictive factors of quality of life primarily related to the functional capacity of the patients and to the disease activity implicates an early and adequate disease management in order to decrease this repercussion.
Subject(s)
Quality of Life , Spondylitis, Ankylosing/physiopathology , Activities of Daily Living , Adult , Female , Humans , Male , Occupations , Pain/complications , Pain/etiology , Prognosis , Prospective Studies , Spondylitis, Ankylosing/complicationsABSTRACT
OBJECTIVE: Ankylosing spondylitis (AS) is the second most common chronic inflammatory joint disease after rheumatoid arthritis and causes substantial functional impairment, two features that generate a heavy socioeconomic burden. Here, our objective was to assess the socioeconomic impact of AS and to identify factors associated with higher costs. PATIENTS AND METHODS: We retrospectively reviewed the medical charts of 50 patients with AS seen at the Monastir Public Health Service Hospital over the 6-month period from March to September 2006. The following were evaluated: direct costs of medical care; indirect costs related to work incapacity; and impact on marital life, offspring, social activities, and activities of daily living. RESULTS: There were 42 men and eight women (male-to-female ratio, 5.25) with a mean age of 38.9+/-10.8 years (range, 19-60 years). The median mean direct cost of medical care for AS was 426.072 Tunisian Dinars (TND) (266.295 euro) per year, and the interquartile range (IQR) was 270.468 TND. Of the 34 patients who had paid employment, 12 (35%) were on sick leave. The mean indirect cost was 447.4+/-294.3 TND (279.625+/-183.937 euro) per patient per year. The median mean total cost was 873.472 TND (545,92 euro) per patient per year with an IQR of 292,324 TND. Factors associated with higher costs were the use of nonsteroidal anti-inflammatory drugs and higher values of the BASDAI and BASRI. Among married patients, 44.4% reported sexual problems, which correlated with the BASMI; and 37% reported a negative reaction on the part of the healthy spouse. Adverse effects on schooling and quality of life of the children were noted in 29.6% of cases. Among single patients, 30.4% felt their disease was responsible for their unmarried status. The disease adversely affected the ability to carry out many activities of daily living (grooming in 38% of cases, housework in 76%, shopping in 92%, sporting activities in 96%, socializing in 68%, and traveling in 80%). The patients usually reported receiving support from their family, which was physical in 74% of cases, financial in 52%, and psychological in 90%. CONCLUSION: Our data indicate that AS generates a major socioeconomic burden. Most of the factors associated with higher costs were related to greater disease activity. Therefore, early appropriate treatment is crucial. Despite the many socioeconomic problems generated by AS, the patients remained connected to their social network thanks to support from their family and friends.
