Gastrointestinal risk factors and patient-reported outcomes of ankylosing spondylitis in Korea

Int J Rheum Dis. 2020 Mar;23(3):342-349. doi: 10.1111/1756-185X.13758. Epub 2019 Dec 29.

Abstract

Aim: This study examined the degree of gastrointestinal (GI) risk and patient-reported outcomes including GI-related symptoms, adherence to non-steroidal anti-inflammatory drugs (NSAIDs), disease activity and quality of life (QoL) in patients with ankylosing spondylitis (AS).

Methods: Cross-sectional, observational study conducted at six nationwide, university-based hospitals of Korea. AS patients treated with NSAIDs for at least 2 weeks were included between March and September 2016. Demographic and clinical data were gathered through a medical chart review and patient survey. GI risk was estimated using Standardized Calculator of Risk for Events (SCORE). NSAIDs adherence was investigated with Morisky Medication Adherence Scale-8 (MMAS-8). Disease activity and QoL were examined with Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and EuroQol-3L (EQ-5D, EQ-visual analog scale [EQ-VAS]), respectively. Path analysis was implemented to estimate pathways of GI risk, GI symptoms and NSAIDs adherence to QoL.

Results: A total of 596 patients (age: 38.9 ± 12.6 years, male: 82.1%) participated in the study, of which 33.2% experienced GI symptoms during NSAID treatment, and 34.2% of them showed ongoing GI symptoms upon enrollment. According to SCORE, 37.1% of patients showed moderate to very high GI risk. No patient showed high adherence according to MMAS-8, so 55.3% of patients with moderate adherence were considered adherent. BASDAI and QoL of the total patients were 3.5 ± 2.0, 0.6 ± 0.3 (EQ-5D), and 67.4 ± 19.8 (EQ-VAS), respectively. From path analyses, higher GI risk significantly lowered QoL.

Conclusion: This study suggests timely therapeutic strategies should be implemented to manage GI risk during NSAID treatment in order to effectively manage AS.

Keywords: NSAID; ankylosing spondylitis; gastrointestinal risk; patient-reported outcomes; quality of life.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Adult
  • Anti-Inflammatory Agents, Non-Steroidal / adverse effects*
  • Cross-Sectional Studies
  • Female
  • Gastrointestinal Diseases / chemically induced*
  • Humans
  • Male
  • Medication Adherence
  • Middle Aged
  • Patient Reported Outcome Measures*
  • Quality of Life
  • Republic of Korea
  • Risk Assessment
  • Risk Factors
  • Spondylitis, Ankylosing / diagnosis
  • Spondylitis, Ankylosing / drug therapy*
  • Treatment Outcome

Substances

  • Anti-Inflammatory Agents, Non-Steroidal