Background Patients (pts) with rheumatoid arthritis (RA) and axial spondyloarthritis (axSpA) have personal fears related to their disease which can impact therapeutic strategy.1 We previously reported high levels of fears in RA and axSpA pts in a French multicenter survey.2
Objectives To identify factors associated with high levels of fears in RA and axSpA pts.
Methods This national cross-sectional study was performed in 2014–2015 in France.2 Rheumatologists recruited 6–20 pts with RA (ACR/EULAR criteria) or axSpA (ASAS criteria). Pts self-completed the “Opinions and fears of pts with chronic inflammatory rheumatism” (QOC-RIC) questionnaire2 comprising 44 items including 23 questions on pt fears; each scored between 0–10 (10 = “totally agree”). Eighteen questions related to progression and consequences of the disease and 5 questions related to treatment. For each fear, descriptive analysis explored the percentage of pts with scores ≥7/10. A cluster analysis was run on the whole population to identify homogeneous groups (clusters) of pts according to their fears and beliefs (hierarchical ascendant classification). A multivariate multinomial logistic regression model using backward selection and multiple missing data imputation explored the variables (eg. epidemiological, socioeconomic, clinical) with p<0.05 on differences between clusters.
Results Overall, 672 pts recruited by 100 rheumatologists were analyzed (432 RA, 240 axSpA). For RA and axSpA pts respectively, 74.0% and 45.2% were female, average age was 58.3 (±13.1) and 47.0 (±13.2) years, and 77.3% and 72.7% were treated with biologics. Mean Disease Activity Score 28 (DAS28[ESR]) in RA pts was 2.64 (±1.24) and mean Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) in axSpA pts was 3.3 (±2.2).
Four pt clusters were identified corresponding to very high (31.6%), high (21.9%), moderate (32.7%) or low (13.8%) levels of fears (Figure). Variables related to the highest fear cluster were gender (female vs male; OR=2.38, p=0.013), high Pt Global Assessment of Disease Activity (PtGA [VAS]; >60 vs ≤30; OR=3.03, p=0.029), anxiety (HADS, anxiety score; >10 vs <8; OR=4.55, p<0.001) and depression (HADS, depression score; ≥8 vs <8; OR=3.23, p=0.011). Socioprofessional and family status did not have an associated p value <0.05 between populations with lowest and highest fears.
Conclusions Pts with the highest fears were most likely to be women with higher PtGA and anxiety/depression scores. Fears may reflect overall psychological distress in this population of pts and interventions to decrease these fears should be further assessed.
Nestoriuc Y. Arthritis Care Res 2010;62:791–9;
Gossec L. Ann Rheum Dis 2015;74(S2):323
Acknowledgement The authors acknowledge Costello Medical Consulting, funded by UCB Pharma, for writing and editorial assistance. This study was funded by UCB Pharma and Arthritis Foundation Olivier Courtin.
Disclosure of Interest L. Gossec: None declared, P. Chauvin: None declared, C. Hudry: None declared, M. Poussière: None declared, T. de Chalus Employee of: UCB Pharma, V. Saulot: None declared, F. Russo-Marie: None declared, J. Joubert Employee of: UCB Pharma, A. Saraux: None declared, F. Berenbaum: None declared