Christopher Rein

Diagnostic delay in axial spondyloarthritis: A cross-sectional study of 432 patients

OBJECTIVESnThe diagnostic delay of axial spondyloarthritis (axSpA) is usually reported to be more than seven years but may have decreased recently. The objective was to quantify the diagnostic delay in patients with axSpA in France and to explore its associated factors.nnnMETHODSnTwo cross-sectional observational studies included consecutively patients with axSpA (according to both ASAS criteria and rheumatologist expert opinion). Diagnostic delay was defined as the time interval from the date of first symptoms to the date of diagnosis. Potential predictive factors of diagnostic delay analyzed by multiple linear regression were demographic factors, HLA B27 status, year of diagnosis, clinical presentation and sacroiliitis on MRI or radiography.nnnRESULTSnIn all, 432xa0patients were analyzed: the mean age at diagnosis was 34.2 (standard deviation, 12.5) years, the mean disease duration at the time of the assessment was 11.4 (10.4) years. In all, 66.7% were HLA B27 positive, and 70.2% had radiographic sacroiliitis. The mean diagnostic delay was 4.9 (6.3) years, with a median of 2.0xa0years (interquartile range, 1-7; range: 0-43). In multivariable analysis, factors independently associated with a longer diagnostic delay were: higher age at diagnosis (beta=0.13; P<0.001), less frequent peripheral arthritis or dactylitis (beta=-1.69; P=0.005), and more frequent entheseal pain (beta=1.46; P=0.015).nnnCONCLUSIONnThe median diagnostic delay was 2xa0years indicating diagnostic delay may be for most patients shorter than previously reported. A more typical SpA clinical presentation was associated with a shorter diagnostic delay, whereas sacroiliitis and HLA B27 positivity were not associated with this delay.

Physical activity in patients with axial spondyloarthritis: a cross-sectional study of 203 patients.

Physical activity is recommended in axial spondyloarthritis (axSpA) but may be insufficiently performed. The objective of this study was to assess physical activity in axial spondyloarthritis and to explore its explanatory factors. This was a cross-sectional study of patients with definite axSpA. The level of physical activity (International Physical Activity Questionnaire-Long form, IPAQ-L), type of aerobic exercise and the Exercise Benefits and Barriers Score were collected. Multivariate logistic regression analyses were performed to explain levels of exercise at least as recommended by the World Health Organization. In all, 203 patients were included: mean age 46.0xa0±xa011.6xa0years, 108 (53.2xa0%) males, mean Bath Ankylosing Spondylitis Activity Index (0–100) 37.8xa0±xa019.9; 137 (68.8xa0%) were treated with TNF-inhibitors. In all, 111 patients (54.7xa0%) were exercising at least as recommended; 96 (47.2xa0%) were in the ‘high physical activity’ category. Aerobic exercise >30xa0min was performed at least once a week by 61 (30.0xa0%) patients; the most frequent activities were energetic walking (31.0xa0%) and swimming (21.2xa0%). Main perceived benefits of exercising were improving physical fitness and functioning of the cardiovascular system, and the main barrier was physical exertion. Patients with paid employment had lower levels of physical activity whereas other demographic variables, disease activity/severity or TNF-inhibitor treatment were not predictive. One half of these patients performed enough physical activity according to the recommendations, similarly to the French population. Levels of physical activity did not appear to be explained by disease-related variables. Physical activity should be encouraged in axSpA.

SAT0267 Is the Widely-Used Score in Axial Spondyloarthritis, Basdai (Bath Ankylosing Spondylitis Diseases Activity Index), Influenced by Patients' Optimism? a Cross-Sectional Study of 206 Patients

Background The Bath Ankylosing Spondylitis Diseases Activity Index (BASDAI) is widely used to assess disease activity in axial spondyloarthritis (axSpA) and is a criterion for initiating anti-TNF therapy. Psychological distress (anxiety/depression) may be related to BASDAI scores (1), which may be an issue when using the BASDAI to decide on treatment strategies. Do stable personality traits like dispositional optimism-a general positive mood or attitude towards the future-also influence BASDAI results? Objectives To determine if BASDAI scores are influenced by optimism in axSpA. Methods A cross-sectional study was performed in two tertiary care hospitals and one office-based practice in France (2). Patients had definite axSpA according to the rheumatologist. Auto-questionnaires included the BASDAI and optimism, evaluated through the French version of the Life Orientation Test-Revised (LOT-R) (3). The LOT-R consists of 10 questions:the score ranges from 0 (low optimism) to 24 (high optimism). Analyses included Spearman correlation and multivariate regression analyses to explain BASDAI based on optimism, adjusted on demographic variables and anxiety/depression, evaluated through the Hospital Anxiety and depression scale (HADS). Results 206 patients were included: mean age, 46.3 years, 49.0% were men. Mean disease duration was 15.5±10.8 yrs, mean BASDAI (0-10) was 3.8±2.0. Optimism was low to moderate: mean LOT-R score was 13.7±4.3. Optimism was significantly though slightly correlated to BASDAI scores: R=-0.15, p=0.04. However, in the multivariate analysis, there was no significant relationship between BASDAI and optimism. Conclusions Optimism was not associated to BASDAI scores in multivariate analyses. This result confirms that BASDAI is a valid tool, which can be interpreted independently of patients personality traits like optimism. This result is reassuring in view of the reports of a relationship between anxiety/depression and BASDAI. However, optimism is a stable personality trait through life whereas anxiety and depression are variable psychological states. More work is needed on the best ways to analyse SpA activity; in particular ASDAS should be further evaluated. References Brionez TF, et al. Psychological Correlates of Self-Reported Disease Activity in Ankylosing Spondylitis. J Rheumatol 2010; 37:829-34. Fabre S, et al. Do Patients with Axial Spondyloarthritis (AxSpA) Perform Enough Physical Activity? a Cross-Sectional Study of 207 Patients. Arthritis Rheum 2014, 66(suppl):S1125. Scheier MF et al. Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): A re-evaluation of the Life Orientation Test. J Pers Soc Psychol 1994, 67:1063-78. Disclosure of Interest None declared