Abstract Background/Aims People with axial spondyloarthritis (axSpA) frequently experience increases in symptoms (flares) related to pain and stiffness, but no widely accepted patient-reported outcome measure (PROM) exists which can identify axSpA flares or quantify their severity. The Evaluation of Ankylosing Spondylitis Quality of Life (EASiQoL) is a patient-derived axSpA-specific PROM, with strong evidence of its ability to assess quality-of-life, including physical functioning, disease activity, emotional wellbeing & social participation domains. Our aim was to establish the feasibility of identifying and characterising flares in people with axSpA using an electronic (e) version of the EASiQoL. Methods Baseline analysis of a prospective cohort study. People with axSpA from UK Rheumatology departments and all members of the National Axial Spondyloarthritis Society were invited to complete a baseline questionnaire containing several ePROMs, including the EASiQoL (score range 0 (best health) to 100 (worst)) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) via a bespoke online study portal. Outcome scores were evaluated against self-reported flare status (yes/no) using crude and adjusted (age, gender, deprivation and Body Mass Index) Receiver Operating Characteristic (ROC) curve analysis. EASiQoL scores were then compared against self-reported flare severity (minor/moderate/major) through multinomial logistic regression. Results 728 people with axSpA completed baseline. Mean age was 54.2 (13.5) years, 51.4% were male and median (Interquartile Range) disease duration was 11 (5-23) years. At the time of completion, approximately half (46%) were experiencing a self-reported axSpA flare, of which 24.2%, 51.9% & 23.9% reported their flare as ‘minor’, ‘moderate’ or ‘major’ respectively. Mean (Standard Deviation (SD)) total EASiQoL score for people flaring was almost double that of people not flaring (42.9 (17.3) vs 23.1 (17.3)). Scores also reflected flare severity, with total mean scores of 30.1 (15.8), 44.2 (15.5) & 52.8 (14.4) found in those experiencing minor, moderate and major flares respectively. ROC analysis indicated a statistically significant 6% (crude & adjusted) increase in the odds of experiencing a flare with each 1-point increase in EASiQoL score (Odds Ratio 1.06 (95%CI 1.05, 1.07)). The adjusted area under the ROC curve for EASiQoL was 0.79 (95%CI 0.76, 0.82), very similar to 0.81 (95%CI 0.78, 0.84) of the BASDAI. Finally, for each 1-point increase in the total EASiQoL score, the adjusted relative risk of having a moderate or major flare saw a statistically significant increase of 7% and 12% respectively compared to those with a minor flare. Conclusion Baseline analysis of people with axSpA demonstrates that the EASiQoL can distinguish between those experiencing a self-reported flare or not. The ability of the EASiQoL to provide a more nuanced, patient-derived understanding of how flares impact an individual’s quality-of-life could be beneficial in supporting patient-initiated access to care in response to patient need. Disclosure J.A. Prior: None. H. Parsons: None. J. Grange: None. K.L. Haywood: None. I.C. Scott: None. A. Williams: None. J. Packham: None.
Prior et al. (Wed,) studied this question.