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Spondyloarthritis
Original article
Uncovering the heterogeneity of disease impact in axial spondyloarthritis: bivariate trajectories of disease activity and quality of life
  1. Maike Imkamp1,2,
  2. Valéria Lima Passos2,3,
  3. Annelies Boonen1,3,
  4. Suzanne Arends4,5,
  5. Maxime Dougados6,
  6. Robert Landewé7,8,
  7. Sofia Ramiro9,
  8. Filip Van den Bosch10,
  9. Desirée van der Heijde9,
  10. Freke R Wink5,
  11. Anneke Spoorenberg4,5 and
  12. Astrid van Tubergen1,3
  1. 1 Department of Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands
  2. 2 Department of Methodology and Statistics, Maastricht University, Maastricht, The Netherlands
  3. 3 Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
  4. 4 Department of Rheumatology & Clinical Immunology, University Medical Center Groningen, University Groningen, Groningen, The Netherlands
  5. 5 Rheumatology, Medical Center Leeuwarden, Leeuwarden, The Netherlands
  6. 6 Department of Rheumatology, Cochin Hospital, Paris Descartes University, Paris, France
  7. 7 Clinical Immunology and Rheumatology, Academic Medical Center, Amsterdam, The Netherlands
  8. 8 Department of Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands
  9. 9 Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
  10. 10 Department of Rheumatology, Ghent University and Ghent University Hospital, Ghent, Belgium
  1. Correspondence to Dr Astrid van Tubergen; a.van.tubergen{at}mumc.nl

Abstract

Objective The goal of managing axial spondyloarthritis (axSpA) is to improve and maintain patients’ health-related quality of life (HRQoL), mainly through targeting towards low disease activity. Here, we aim to gain insight into the joint evolution of HRQoL and disease activity by identifying and characterising latent subgroups of patients with longstanding disease displaying similar trajectories throughout 8  years of follow-up.

Methods Data from Outcome in Ankylosing Spondylitis (AS) International Study (n=161) and Groningen Leeuwarden AS cohort (n=264) were used. Biennially, HRQoL was assessed by AS Quality of Life (ASQoL) and disease activity by AS Disease Activity Score—C reactive protein (ASDAS-CRP). Bivariate trajectories of these outcomes were estimated by group-based trajectory modelling. Next, trajectories were profiled by comparing the latent groups with respect to baseline factors using analysis of variance and χ² test.

Results Five bivariate trajectories were distinguished, in which ASQoL and ASDAS-CRP were tightly linked: (t1) low impact of disease; (t2) moderate impact; (t3) high impact with major improvement; (t4) high impact with some improvement; (t5) very high impact. Profiling revealed, for example, that (t1) was characterised by male gender and Human Leucocyte Antigen B27 positivity; (t3) by younger age, shorter symptom duration and biological intake and (t5) by the highest proportion of females.

Conclusions We identified five bivariate trajectories of HRQoL and disease activity demonstrating a clear mutual relationship. The profiles revealed that both individual-related and disease-related features define the type of disease course in respect to HRQoL and disease activity in axSpA. This may provide clinicians insight into the differences among patients and help in the management of the disease.

  • group-based multi-trajectory modelling
  • health-related quality of life
  • disease activity
  • trajectories
  • axial spondyloarthritis

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/rmdopen-2018-000755

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    Footnotes

    • Contributors Conception and design: MI, VLP, AB, AvT. Data acquisition: SA, MD, RL, SR, FvdB, DvdH, FRW, AS, AB, AvT. Data analysis: MI, VLP, AB, AvT. Data interpretation: all authors. Drafting the work or revising it critically for important intellectual content: all authors. Final approval: all authors.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Ethics approval Approval was obtained from the medical ethics committee of every participating hospital.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.