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Relationship Between Health-Related Quality of Life and Patient Acceptable Symptom State With Disease Activity and Functional Status in Patients With Ankylosing Spondylitis in Thailand

Chiowchanwisawakit, Praveena, MD*†; Thaweeratthakul, Phakhamon, RN*†; Wattanamongkolsil, Luksame, RN; Srinonprasert, Varalak, MD†‡; Koolvisoot, Ajchara, MD*†; Muangchan, Chayawee, MD*†; Nilganuwong, Surasak, MD*†; Arromdee, Emvalee, MD*†; Katchamart, Wanruchada, MD*†

JCR: Journal of Clinical Rheumatology: January 2019 - Volume 25 - Issue 1 - p 16–23
doi: 10.1097/RHU.0000000000000750
Original Articles

Objective This study aimed to identify factors associated with EuroQoL–5 Dimensions, 5 Levels and Patient Acceptable Symptom State (PASS) and health utility (HU) in Thai patients with ankylosing spondylitis (AS).

Methods This was a cross-sectional study of consecutive AS patients visiting Siriraj Hospital between May 31, 2012, and March 31, 2016. Demographic data and outcomes related to HU (Thai version of EuroQoL–5 Dimensions, 5 Levels), disease activity (Bath Ankylosing Spondylitis Disease Activity Index, Ankylosing Spondylitis Disease Activity Score–erythrocyte sedimentation rate or Ankylosing Spondylitis Disease Activity Score–C-reactive protein, number of tender and swollen joints, and enthesitis), and functional status (Bath Ankylosing Spondylitis Functional Index and Health Assessment Questionnaire) were collected. Regression analysis was used to explore factors associated with each EuroQOL–5 Dimensions (EQ-5D) domain, HU, and PASS.

Results Among 119 AS patients, the mean age was 40.4 years; 61.3% were male. The mean EQ-5D was 0.75. In univariate analysis, lower disease activity and less impaired function were significantly associated with higher HU and not to mild problems in each EQ-5D domain. In multivariate regression analysis, Bath Ankylosing Spondylitis Disease Activity Index, C-reactive protein, and Health Assessment Questionnaire adjusting for age explained 77.4% of the HU variance. Patients answering yes to PASS were significantly older, had higher HU, and lower disease activity compared with those answering no to PASS. Usual activity and pain problems were importantly related to PASS after adjusting for other domains and age.

Conclusions Disease activity and functional status in AS patients were significant factors related to HU and PASS. To improve quality of life, treatment goals should be achieving remission, improving function, and controlling pain.

From the *Division of Rheumatology,

Department of Medicine; and

Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.

This research project is supported by the Siriraj Research Fund, Faculty of Medicine Siriraj Hospital, Mahidol University (grant R015533011). The grant had no role in any parts of this work.

P.C. has received research grant from Siriraj Research Fund, Faculty of Medicine Siriraj Hospital, Mahidol University, and speaker honoraria from Pfizer, Janssen, and Novartis (<$10,000 each). W.K. has received speaker honoraria from Pfizer and Janssen (<$10,000 each). The other authors declare no conflict of interest.

P.C. contributed to conception of the work, data collection, data analysis, data interpretation, and drafting of the manuscript. P.T., L.W., A.K., C.M., S.N., and E.A. contributed to data collection and drafting of the manuscript. V.S. and W.K. contributed to conception of the work, data interpretation, and drafting of the manuscript. All authors read and approved the final manuscript.

Correspondence: Praveena Chiowchanwisawakit, MD, Division of Rheumatology, Siriraj Hospital, Mahidol University, 2 Wanglang Road, 8th Floor Asadang Building, Bangkoknoi, Bangkok, Thailand 10700. E-mail:

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