Background The main symptom of patients with axial spondyloarthritis (axSpA), chronic inflammatory back pain, has been traditionally evaluated from a biomedical perspective but coping strategies may also have an important role in patients’ adjustment to back pain.
Objectives To examine differences in coping strategies in patients with axSpA in a 6-month longitudinal study.
Methods A total of 100 consecutive patients diagnosed with axSpA according to the ASAS classification criteria including patients with ankylosing spondylitis (AS, n=56) and non-radiographic axSpA (nr-axSpA, n=44) completed clinical and psychological assessments at baseline and after 6 months. At baseline, the patients were informed about their disease in a similar way by the same physician. The vast majority of patients (>90%) was treated with NSAIDs. Standardized clinical assessment tools evaluated pain (numerical rating scale), disease activity (BASDAI), physical functioning (BASFI), coping strategy (Trier scale for coping), quality of life (QoL) (ASQoL), health status (SF-36) and patient acceptable symptom state (PASS).
Results A total of 92 patients completed the follow-up examination. The majority of patients (55.6%) did not report to have a preferred coping strategy. The other patients indicated to prefer the following strategies at baseline: spiritual resources (12%), rumination (10.8%), information seeking (9.7%), withdrawal from society (3.3%), social embedding (2.2%) and fight back (2.2%). At baseline, only 38% of patients rated their disease status as acceptable (PASS+). Most patients who preferred rumination rated their disease status as not acceptable (PASS -) (88.9%). Almost no PASS+ patient reported to prefer rumination (2.9%). At follow-up, the proportion of PASS+ patients had not changed much, and most patients had not changed their coping strategy. However, PASS+ patients reported use of the strategy social embedding more often after 6 months (25.7%) as compared to baseline (11.4%), and this strategy was also more often used by the PASS+ as compared to PASS- patients: 25.7% vs 7%, respectively (p<0.001). However, a change in strategy was only reported by 7.6% of the patients with no preferred strategy at baseline (mostly to information seeking). Regarding coping no major differences between patients with AS and nr-axSpA were noted.
Conclusions Most patients with axSpA did not prefer one coping strategy. Our findings suggest that negative emotion focused coping styles (e.g. rumination) were associated with non-acceptance of the current health status. Whereas, active coping styles (e.g. social embedding) seem to have a rather positive influence on disease acceptance. However, the PASS concept and use of coping styles need to be further analysed and evaluated. Our findings suggest to study the potential benefit of standardized active interventions aimed at improvement and change of coping strategies.
Disclosure of Interest None Declared
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