Search

Objective: Patients with spondyloarthritis (SpA) may have a greater risk of falling due to poor postural balance and decreased mobility. To our best knowledge, there are no published reviews that study falls in patients with SpA. Therefore, we aim to systematically review the literature and identify the prevalence and risk factors of falls in patients with SpA. Methods: We conducted a systematic review using 5 electronic databases: PubMed, EMBASE, Scopus, Web of Science and Google Scholar using controlled vocabulary terms (eg MeSH terms) in the search strategy for the concepts: falls, fall risk, SpA and its subtypes. Results: We identified 7279 articles, of which 3 studies with a total of 441 patients were included. Prevalence of falls ranged from 13% to 25%. We identified 16 main factors across 5 categories. Under socio‐demographic factors, functional limitation, decreased quality of life, advanced age and job loss were associated with an increased risk of falls. Poor balance and mobility and fear of falling were associated with increased risk of falls. Active disease and symptoms of SpA were medical factors that were associated with increased risk of falls. Medication factors including polypharmacy, myorelaxants and antidepressants were not associated with increased fall risk. Conclusion: We identified potentially modifiable risk factors associated with increased risk of falls in patients with SpA, including functional limitation, poor balance and mobility, fear of falling and active disease. Clinicians should recognize these factors and address them in the holistic management of patients with SpA, thereby reducing falls and their complications. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the burden of residual disease in patients with axial spondyloarthritis (axSpA) or psoriatic arthritis (PsA) who achieved low disease activity (LDA) status.Methods: We used baseline data from a clinic registry of SpA in a tertiary hospital in Singapore. For axSpA, LDA was defined as Ankylosing Spondylitis (AS) Disease Activity Score based on erythrocyte sedimentation rate (ASDAS-ESR) < 2.1 or Bath AS Disease Activity Index (BASDAI) < 3/10. For PsA, LDA was defined by achieving 5/7 cutoffs in the minimal disease activity (MDA) or Clinical Disease Activity Index for Psoriatic Arthritis (cDAPSA) ≤ 13.Results: In 262 cases of axSpA (21% women; mean ± standard deviation (SD) age 42 ± 14 yrs), 33% and 43% of patients achieved ASDAS-ESR and BASDAI LDA states, respectively, while in 142 cases of PsA (49% women, mean age 51 ± SD 14 yrs), 35% and 63% achieved MDA and cDAPSA LDA, respectively. Both axSpA and PsA patients with LDA had pain scores ranging from 14.0 to 21.4/100 and fatigue scores ranging from 3.1 to 3.6/10. Substantial burden in physical disability and mental well-being were observed, with low physical and mental component summary scores on the 36-item Short Form Health Survey. AxSpa patients in BASDAI LDA had higher ESR and lower disability than those in ASDAS-ESR LDA. cDAPSA classified nearly twice as many PsA patients into LDA than MDA. Compared to PsA patients in MDA LDA, those in cDAPSA LDA had higher active joint counts, dactylitis, enthesitis, pain scores, and patient global assessment.Conclusion: Despite being in LDA, patients with axSpA and PsA experienced substantial residual burden in pain, poorer physical function, and mental well-being. [ABSTRACT FROM AUTHOR]

Objectives: To assess the validity and reliability of the Work Productivity and Activity Impairment (WPAI) questionnaire in patients with axSpA. Methods: English‐speaking patients seen at a dedicated axSpA clinic in a Singapore tertiary referral hospital were recruited from 2017 to 2019. Content validity of the WPAI was assessed through cognitive debriefing interviews (CDIs). Construct validity was assessed by a priori hypotheses regarding the correlations of the WPAI outcomes (absenteeism, presenteeism, overall work productivity loss, and activity impairment) with Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Patient Global Score (BAS‐G), patient global assessment (PGA) and pain scores. Known group validity was assessed relative to disease activity. Test‐retest reliability was assessed by intraclass correlation coefficients (ICC) in patients without treatment change 2 weeks apart. Results: Cognitive debriefing interviews conducted with 10 patients (22‐46 years old, 50% male) supported the content validity of the WPAI. We analyzed cross‐sectional data from 168 patients (mean [SD] age 41.0 [14.4], 79.8% male). Construct validity was established by meeting 100% of the hypotheses. Presenteeism, overall work productivity loss, and activity impairment demonstrated strong correlations with BASFI, BAS‐G, PGA, and pain (rs >.6). The WPAI was able to distinguish patients grouped by disease activity. Test‐retest reliability conducted with 50 patients ranged from moderate to good for all the four outcomes (absenteeism: ICC = 0.54; presenteeism: ICC = 0.76; activity impairment: ICC = 0.79; overall work productivity loss: ICC = 0.83; all P <.01). Conclusions: This study supports the content validity, construct validity, and test‐retest reliability of the WPAI in patients with axSpA. [ABSTRACT FROM AUTHOR]

Objective: To estimate the economic annual direct and indirect costs of axial spondyloarthritis (axSpA) in Singapore, and to identify factors associated with these costs. Methods: A retrospective, cross‐sectional, Institutional Review Board‐approved study was conducted. A questionnaire was administered to the patients between 2013 and 2016 from the Singapore General Hospital (SGH) spondyloarthritis registry. Direct medical costs and indirect costs were estimated using the SGH database and the human capital approach respectively. Multivariate analyses using generalized linear model with gamma distribution and a log‐linked function was conducted to identify factors associated with these total, direct and indirect costs. All costs were adjusted to 2017 using the Singapore Consumer Price Index and converted to 2017 US dollars (USD) by purchasing power parity. Results: A total of 135 consecutive patients were included in the study, with a mean age of 40.4 ± 13.2 years. The overall annual total economic cost to society was around USD 74 790 820, with annual direct cost being the main component of total cost (90.8%). Annual direct cost was around USD 67 931 457, while annual indirect cost was around USD 6 855 951. Presence of extra‐spinal symptoms (ever) was associated with an increase in total and direct costs. Higher education level and Patient Global Assessment were associated with an increase in indirect costs. Lack of employment was associated with a decrease in indirect costs. Conclusion: The disease burden of axSpA in Singapore is not trivial given that the disease is relatively common. This highlights the need for measures to accommodate patients with axSpA economically in Singapore. [ABSTRACT FROM AUTHOR]

Introduction: The Ankylosing Spondylitis Disease Activity Score with C‐reactive protein (ASDAS‐CRP) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) are commonly used instruments for measuring disease activity. However, few studies have assessed their psychometric properties in patients with axial spondyloarthritis (axSpA). We aimed to assess the validity and reliability of ASDAS‐CRP and BASDAI in patients with axSpA in Singapore. Methods: Cross‐sectional data from 280 patients with axSpA from a dedicated axSpA clinic in a Singapore tertiary referral hospital from 2011 to 2019 were used. Internal consistency was assessed using Cronbach's alpha. Construct validity was assessed through 12 a priori hypotheses by correlation of overall ASDAS‐CRP and BASDAI score with other patient‐reported outcomes measures (PROMs). Structural validity was evaluated via confirmatory factor analysis using maximum‐likelihood method, where Comparative Fit Index (CFI) >0.95, Tucker‐Lewis Index (TLI) >0.95, Root Mean Square Error of Approximation (RMSEA) <0.06 and Standardized Root Mean Residuals (SRMR) <0.08 were indicative of good fit. Results: Among 280 patients (78.2% Male; 92.5% Chinese), ASDAS‐CRP showed poor internal consistency of 0.33, while BASDAI showed high internal consistency of 0.87. Convergent and divergent construct validity were demonstrated by fulfillment of 11 out of 12 a priori hypotheses when ASDAS‐CRP and BASDAI were compared with other PROMs. Our proposed ASDAS‐CRP and BASDAI model showed good fit for a 1‐factor structure respectively (CFI = 0.993, TLI = 0.984, RMSEA = 0.036, SRMR = 0.026 for ASDAS‐CRP; CFI = 0.993, TLI = 0.985, RMSEA = 0.057, SRMR = 0.022 for BASDAI), demonstrating structural validity. Conclusion: This study supports the use of both ASDAS‐CRP and BASDAI in measuring disease activity in patients with axSpA in Singapore. [ABSTRACT FROM AUTHOR]

Aim: Axial spondyloarthritis (axSpA) affects patients in the prime of their economic productivity. We aim to identify factors associated with poor work productivity in patients with axSpA in Singapore. Methods: A cross‐sectional study was performed in two tertiary centers in Singapore. Consecutive adult patients ≥21 years fulfilling Assessment in Spondyloarthritis International Society (ASAS) 2009 criteria for axSpA were recruited. Data on social demographics, clinical, treatment modalities and patient‐reported outcome measures (PROMs) were collected. Work productivity was assessed by the Work Productivity and Activity Impairment scale (WPAI:SpA). Factors associated with presenteeism, absenteeism, work productivity loss and activity impairment were evaluated. Results: A total of 156 patients with axSpA were included: 72.4% employed, 80.1% male, 86.5% Chinese, median (Q1:Q3) age and duration of illness 36.7 (28.7:47.9) years, and 6.3 (1.6:12.2) years respectively. The mean (SD) activity impairment was 28.2% (24.3%). Among employed patients, mean (SD) absenteeism, presenteeism and work productivity loss was 4.5% (13.7%), 24.9% (19.9%) and 27.6% (23.2%), respectively. In multivariable analysis, absenteeism was associated with disease duration (P = .02) and EuroQol‐5D (EQ‐5D) (P = .04). Presenteeism was associated with Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) ≥4 (P = .04), Bath Ankylosing Spondylitis Functional Index (BASFI) (P < .01) and EQ‐5D (P = .02). Work productivity loss was associated with BASFI (P = .02) and EQ‐5D (P < .01). Activity impairment was associated with age (P = .04), BASDAI ≥ 4 (P < .01), BASFI (P < .01), EQ‐5D (P < .01). Conclusion: Active disease, reduced physical function and poorer quality of life are associated with reduced work productivity in patients with axSpA in Singapore. Addressing these factors can potentially improve work productivity in patients with axSpA. [ABSTRACT FROM AUTHOR]

Objective: To cross‐culturally adapt the Hamilton axial spondyloarthritis (axial SpA) screening questionnaire and develop a Chinese version for use in a multi‐ethnic Asian population in Singapore. Methods: Consenting participants newly referred from primary care to a rheumatology specialist outpatient clinic for evaluation of possible axial SpA were studied. The original axial SpA questionnaire was revised based on inputs from cognitive debriefing interviews (CDIs) and discussions with an expert panel of rheumatologists and the developer. Forward and back translations of the adapted English version were also reviewed by the expert panel and the developer. The common translation produced was tested in CDIs with Chinese‐speaking participants. Adapted English and Chinese versions were pilot‐tested in a separate group of similar participants. Results: Participants were recruited for English (n = 25) and Chinese CDIs (n = 15, relatively older and less frequently presented with axial SpA symptoms), respectively. Alternative terms and explanatory notes were added to difficult medical terms to improve the understandability of the adapted English version. English medical terms were retained in the Chinese version. Pilot‐testing of the adapted axial SpA questionnaire was performed on 116 participants, all of whom reported ease of comprehension with both adapted versions. Only one participant was diagnosed with axial SpA, who also scored positive on the adapted axial SpA questionnaire. Conclusion: The adapted axial SpA questionnaire demonstrated good sensitivity in the pilot‐testing and appears to be a promising tool for facilitating early identification of axial SpA cases in the multi‐ethnic Asian population. [ABSTRACT FROM AUTHOR]

Objectives: To compare clinical characteristics, disease activity, patient‐reported outcomes and associated comorbidities between patients with ankylosing spondylitis (AS) and non‐radiographic axial spondyloarthitis (nr‐axSpA) in a multi‐ethnic Asian population of Singapore. Methods: We used data from the PREcision medicine in SPONdyloarthritis for Better Outcomes and Disease Remission (PRESPOND) registry in Singapore General Hospital. All patients fulfilled 2009 Assessment in AS International Working Group classification criteria for axial SpA (axSpA). Of these, all AS patients fulfilled the 1984 modified New York criteria. Baseline characteristics, medications, disease activity, patient‐reported outcomes and inflammatory markers were recorded using standardized questionnaires. Results: Two hundred and sixty‐two axSpA patients (82% Chinese, 79% male) were included. Mean age (SD) at diagnosis was 32.4 (13.1) years, which was similar between AS and nr‐axSpA patients. AS patients were older (mean age 42.7 [13.5] vs 37.4 [13.8] years, P = 0.02), had longer disease duration (mean disease duration 10.9 [8.7] vs 6.4 [4.8] years, P < 0.01), higher Bath Ankylosing Spondylitis Metrology Index (BASMI) (mean BASMI 3.1 [2.3] vs 1.5 [1.5], P < 0.01), more frequently human leukocyte antigen (HLA)‐B27 positive (82% vs 68%, P = 0.03), associated with uveitis (33% vs 17%, P = 0.03), and hypertensive (17% vs 0%, P < 0.01) compared to nr‐axSpA, respectively. Nr‐axSpA patients had higher Bath Ankylosing Spondylitis Global Score (BAS‐G) (mean BAS‐G 46.9 [16.8] vs 38.6 [20.6], P < 0.01), Bath Ankylosing Spondylitis Disease Activity Index (mean [SD] 4.2 [1.6] vs 3.5 [1.9], P = 0.02) and AS quality of life (ASQoL) (mean ASQoL 4.9 [4.8] vs 3.5 [4.1], P = 0.04) scores compared to AS patients respectively at baseline. Patient global assessment, Bath Ankylosing Spondylitis Functional Index, AS Disease Activity Score – C‐reactive protein (CRP), Health Assessment Questionnaire, Short‐Form 36 physical component summary and mental component summary were similar in both groups at baseline, as were medications used and mean erythrocyte sedimentation rate and CRP. Conclusions: In our multi‐ethnic Asian cohort, patients with AS are more likely to be HLA‐B27 positive, have uveitis, hypertensive, and have poorer spinal mobility, while nr‐axSpA patients tend to experience poorer well‐being and quality of life. [ABSTRACT FROM AUTHOR]

To assess the extent to which a history of extra-spinal symptoms (including peripheral arthritis, heel enthesitis, or dactylitis) (HPED) is associated with quality of life (QoL) in patients with axial spondyloarthritis (axSpA) at baseline and 1-year follow-up. We analyzed data from 138 patients with axSpA from a tertiary referral center in Singapore, seen between 2011 and 2015. Demographic, clinical variables, and patient-reported outcomes [Ankylosing Spondylitis Quality of Life (ASQoL) and SF-36] at baseline and 1-year follow-up were collected. We used linear mixed models to assess the association of HPED with QoL at baseline and 1 year post-baseline. Among 138 patients (mean age 39.3 years, 74.6% males, 87.6% Chinese, disease duration 7.4 years), at baseline, HPED was associated with poorer QoL for 3 of 8 SF-36 domains [role physical (RP) scores β − 8.38, p < 0.05; social functioning (SF) scores β − 6.74, p < 0.05; role emotional (RE) scores β − 9.37, p < 0.01] and SF-36 Physical Component Summary (PCS) (β − 4.52, p < 0.01) scores, but not ASQoL scores. At 1 year post-baseline, HPED was associated with poorer ASQoL (β 1.61, p < 0.05) scores, SF-36 PCS (β − 5.61, p < 0.01) scores, and three out of eight SF-36 domains (physical functioning (PF) β − 9.60, p < 0.01; RP β − 12.17, p < 0.01; RE β − 7.87, p < 0.05) scores. HPED was associated with QoL in patients with axSpA. After 1-year, patients with HPED have poorer QoL especially for physical health domains than patients without HPED. [ABSTRACT FROM AUTHOR]

Introduction: C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) which are used for assessment of axial spondyloarthritis (AxSpA) related disease activity have poor specificity and sensitivity. Neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and mean platelet volume (MPV) have not been investigated as disease activity markers among Asian AxSpA patients. Methodology: A retrospective, cross-sectional study was conducted in Singapore General Hospital from January 2013 to December 2015 to investigate the role of NLR, PLR and MPV as disease activity markers in AxSpA patients. Results: The mean age of patients (n = 122) was 37.0 ± 12.5 years old and majority of them were male (n = 93, 76.2%). No significant differences were found between patients with disease with regards to age, gender, ethnicity, HLAB-27 status, age at onset of diagnosis of AxSpA, duration of disease and comorbidities such as cardiac disease (p > 0.05). There were no significant differences in the ESR, NLR, PLR and MPV between the four disease activity groups (p > 0.05). However, patients with very high disease activity had higher ESR and CRP compared to patients with inactive disease and moderate disease activity (p < 0.05). Conclusion: NLR, PLR and MPV were not associated with disease activity in Asian AxSpA patients. [ABSTRACT FROM AUTHOR]