Pain and Fatigue Levels Remain High in Patients with Ankylosing Spondylitis Despite the Use of TNF Inhibitors

Pain and fatigue levels remain high among patients with ankylosing spondylitis (AS) despite apparent disease control with biologic therapies, such as tumor necrosis factor (TNF) inhibitors, according to the results of a recent study (Strand V, et al. J Clin Rheumatol. 2021;27:e446-e455).

“This real-world study agrees with previous reports that AS patients commonly report pain despite apparent control of disease with commonly available biologic therapies such as TNF [inhibitors],” wrote Vibeke Strand, MD, MACR, FACP, Adjunct Clinical Professor, Immunology/Rheumatology, Stanford University School of Medicine, CA, and colleagues.

To analyze the frequency and severity of persistent AS symptoms, as well as the impact of pain and fatigue on health-related quality of life, employment, and work activity, Strand and colleagues examined findings from the large, multinational Adelphi Spondyloarthritis AS Disease Specific Program, which collected data between 2015 and 2016 from 13 countries, including those in North America, Europe, Asia Pacific, Turkey, and the Middle East.

Physicians completed forms detailing patient demographics, clinical assessments, concomitant conditions, treatment history, disease status, disease activity, inflammation, and current medication usage. Patients were then invited to complete patient-reported forms, which included the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Medical Outcomes Study-Short Form (36-item) Health Survey version 2, and the Work Productivity and Activity Impairment General Health Questionnaire. Questions focused on symptoms, disease activity, employment status, current therapies, and health-related quality of life.

The study only analyzed patients who were receiving TNF inhibitors for ≥3 months and who had completed the BASDAI pain and fatigue domains. A total of 705 patients were ultimately chosen for the analysis.

Study Results

The investigators reported that 37.6% of patients reported high BASDAI pain scores, whereas 41.3% reported high BASDAI fatigue scores. The Medical Outcomes Study-Short Form (36-item) Health Survey version 2, the 5-dimensional EuroQoL Questionnaire, and the 5-dimensional EuroQoL visual analog scale scores were significantly lower (P <.0001), and work productivity and activity impairment scores were significantly higher (P <.0001), among those with high levels of pain or fatigue compared with those with low levels. Patients with severe disease status were more likely to have higher pain and/or fatigue compared with their low pain and/or fatigue counterparts (pain: 9.1% vs 2.3%, respectively; fatigue: 8.2% vs 2.4%, respectively). Flares were also higher in patients with higher BASDAI pain scores (11.4% vs 3.2%, respectively) and BASDAI fatigue levels (11% vs 2.9%, respectively).

In terms of mobility, a signficantly higher percentage of patients with high pain and/or fatigue reported either “some” or “extreme” mobility or self-care issues or anxiety and depression compared with those reporting low pain and fatigue (P <.0001).

Of those who provided employment information, 83.2% were employed. However, patients with higher pain and fatigue were less likely to be employed (pain: 71.6% vs 89.8%, respectively; fatigue: 74.3% vs 89.2%, respectively).

“Our observations indicate the importance of appropriately treating AS to minimize the impact on patients’ social lives, work participation, and economic and health burdens,” Dr Strand and colleagues concluded. “Lastly, our results highlight the need to explore other therapeutic approaches including nonpharmacologic interventions for the management of AS.”

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