Background: Severe pain in patients with axial spondyloarthritis (axSpA) can cause deterioration in their physical and mental health. Pain is usually the most relevant domain reported by patients. However, the characteristics and factors associated with pain need further research. Objectives: To investigate factors associated with pain intensity in a large sample of patients from the International Map of Axial Spondyloarthritis (IMAS) study from around the globe. Methods: IMAS is a cross-sectional online survey (2017-2022) including 5,557 unselected axSpA patients worldwide from Europe, North America, Latin America, Asia, and South Africa. Of the total sample, data from 5,357 participants who reported pain were analysed. Pain was assessed using the average of the following BASDAI items employing a numeric rating scale from 0 (no pain) to 10 (most severe pain): "How would you describe the overall level of AS neck, back or hip pain you have had?" and "How would you describe the overall level of pain/swelling in joints other than neck, back, hips you have had?". The independent factors evaluated were sociodemographic characteristics (age, gender and educational level), disease characteristics (diagnostic delay and symptom duration), life style (physical activity and body mass index), patient-reported outcomes (spinal stiffness, functional limitation and mental health using GHQ-12 scale), employment (work related-issues, difficulty finding a job due to axSpa and work choice due to axSpA), mental comorbidities (anxiety, depression and sleep disorders) and treatments (nonsteroidal anti-inflammatory drugs - NSAIDs, disease-modifying antirheumatic drugs - csDMARDs and biological disease-modifying antirheumatic drugs - bDMARDs). Univariable and multivariable linear regression analysis was applied to evaluate factors associated with pain (N = 2,095). Results: Of 5,347 patients, average of axial pain was 5.7 (±2.5), average of peripheral pain was 4.6 (±2.7), average overall pain was 5.2 (±2.4) and 72.4% reported a high pain intensity (≥4). The average overall pain was 5.8 in Latin America, 5.4 in North America, 5.1 in Europe, 4.7 in Asia and 4.5 in South Africa (Map 1). Patients with higher pain intensity were more frequently younger, female, not university educated, longer diagnostic delay, HLA-B27 negative, not physically active, overweight/obese, with greater spinal stiffness, higher functional limitation, poorer mental health, with presence of work-related issues, experienced difficulties finding work due to axSpA, employment choice was determined by axSpA, with presence of anxiety, depression and sleep disorders, and use of DMARDs. The multivariable linear regression model showed that higher pain intensity was associated with no university education (b= 0.36, 95%CI= 0.13, 0.59), shorter diagnostic delay (b= -0.02, 95%CI= -0.03, -0.01), greater spinal stiffness (b= 0.22, 95%CI= 0.17, 0.27), higher functional limitation (b= 0.03, 95%CI=0.02, 0.04), poorer mental health (b= 0.13, 95%CI= 0.09, 0.16), with difficulty finding a job due to axSpA (b= 0.89, 95%CI= 0.60, 1.18), and with presence of sleep disorders (b= 0.77, 95%CI= 0.49, 1.05; Table 1). Conclusion: Globally, seven in ten patients with axSpA had high pain intensity, with higher proportion of patients with a significant pain intensity in the Americas and lower proportion in South Africa. Pain in patients with axSpA was most strongly associated with the absence of university degree, presence of work impairment as job search, as well as poor patient-reported outcomes. Pain is a critical symptom in axSpA, as it is negatively associated with work impairment and disease outcomes so, if patients' quality of life is to be improved, pain reduction should be a priority in treatment and management. REFERENCES: NIL. Table 1. Univariable and multivariable linear regression analysis of the factors associated with pain* (N = 1,254) *Average pain in all body joints including neck, back and hips. Acknowledgements: This study was supported by Novartis Pharma AG. The authors would like to thank all patients who participated in the study. Disclosure of Interests: Marco Garrido-Cumbrera Novartis, Victoria Navarro-Compán AbbVie, Eli Lilly, Janssen, MSD, Novartis, Pfizer, UCB Pharma, AbbVie, Eli Lilly, Galapagos, MoonLake, MSD, Novartis, Pfizer, UCB Pharma, AbbVie, Novartis, Fernando Sommerfleck Abbvie, Eli Lilly, Janssen, Novartis, Abbvie, Novartis, Janssen, Christine Bundy AbbVie, Celgene, Janssen, Lilly, Novartis, Pfizer, Souzi Makri Novartis, GSK, Bayer, José Correa-Fernández: None declared, Shashank Murlidhar Akerkar Pfizer, Novartis, Eli Lilly, Jansen, Jo Lowe No personal funding, but ASIF has received funding from Novartis, UCB, Lilly, Abbvie, Boehringer Ingleheim, Pfizer, Janssen, Elie Karam: None declared, Denis Poddubnyy AbbVie, BMS, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, UCB, AbbVie, MSD, Novartis, Pfizer.
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Garrido-Cumbrera et al. (2024) studied this question.