Background Studies in patients with rheumatic diseases report that negative views of illness are associated with poorer disease outcomes, such as more disability and pain. Little is known about illness perceptions in patients with early axial Spondyloarthritis (axSpA).
Objectives To describe illness perceptions and to explore the association between illness perceptions and disease activity in patients with early axSpA at baseline.
Methods The Spondyloarthritis Caught Early (SPACE) cohort includes patients (chronic back pain ≥3 months, ≤2 years, onset <45 years) recruited from 5 participating centres in Europe. Patients completed the Revised Illness Perception Questionnaire (IPQ-R). The illness identity dimension asked patients if they have experienced a certain symptom (15 in total) and if they believed these symptoms are related to axSpA. The other illness perception dimensions and causal attributions (15 causes) used 5-point Likert scales to score all items ranging from 1 (strongly disagree) to 5 (strongly agree). For the IPQ-R dimensions, see Figure 1. Disease activity was assessed by ASDAS (Ankylosing Spondylitis Disease Activity Score, CRP based). Univariable linear regression models were built for each IPQ-R dimension as dependent and ASDAS as independent variable adjusted for age and gender. Results were stratified when gender was an effect modifier (p<0.10). P-values <0.05 were considered to be statistically significant.
Results Only patients fulfilling the ASAS classification for axSpA (n=119) were included. These patients had a mean age of 29.7 (SD 7.9) years and 50.4% was male. The mean disease duration was 13.0 (SD 7.3) months and the mean ASDAS 2.4 (SD 1.0). Patients reported 4.2 (SD 2.3) symptoms to be associated with axSpA on average, see Figure 1. Pain, joint stiffness, fatigue, and sleeping problems were the most reported symptoms according to patients in the illness identity dimension. All other dimensions showed a mean of approximately 3, except psychological attributions, risk factors, immunity and accident of the causal section, which had a mean of approximately 2. Patients with axSpA attributed their complaints mostly to heredity, chance or bad luck, or stress and worries. Six dimensions of the IPQ-R were associated with ASDAS. A stronger illness identity (β=0.63, p=0.003), stronger beliefs in severe consequences (β=0.32, p<0.001), less illness coherence (β=-0.24, p=0.003), more negative emotions towards their complaints (β=0.22, p=0.003), stronger beliefs of psychological attributions as a cause only in men (β=0.22, p=0.034), and the belief of immunity as a cause (β=0.17, p=0.010) were statistically significantly associated with a higher ASDAS.
Conclusions Negative illness perceptions, such as experiencing more symptoms, believing in severe consequences, less illness coherence, and negative emotions towards axSpA, are associated with disease activity in patients with early axSpA.
Disclosure of Interest None declared