Article Text

Download PDFPDF
Determining factors related to poor quality of life in patients with axial spondyloarthritis: results from the British Society for Rheumatology Biologics Register (BSRBR-AS)
  1. Gary J Macfarlane1,
  2. Ovidiu Rotariu1,
  3. Gareth T Jones1,
  4. Ejaz Pathan2,
  5. Linda E Dean1
  1. 1 Epidemiology Group, University of Aberdeen, Aberdeen, Scotland, UK
  2. 2 Spondylitis Program, University Hospital Network, Toronto Western Hospital, Toronto, Ontario, Canada
  1. Correspondence to Professor Gary J Macfarlane, School of Medicine, Medical Sciences and Nutrition, Foresterhill, Aberdeen, AB25 2ZD, UK; g.j.macfarlane{at}


Objective To determine modifiable factors associated with poor quality of life (QoL) in patients with axial spondyloarthritis (axSpA).

Methods Analysis of data from the British Society for Rheumatology Biologics Register in Ankylosing Spondylitis (BSRBR-AS) and validation of a previous model using data from 1810 patients with axSpA recruited during 2012–2017. Data collected included clinical and patient-reported measures. QoL was assessed using the Ankylosing Spondylitis Quality of Life (ASQoL) measure. Linear regression models predicting ASQoL scores were used first to validate a previous model from a national study, to extend this with additional information available in BSRBR-AS and finally to identify a ‘de novo’ model from BSRBR-AS of which factors impact on poor QoL.

Results Four out of five factors included in a previous model of poor QoL in patients with axSpA were confirmed: Bath Ankylosing Spondylitis Disease Activity Index and Bath Ankylosing Spondylitis Functional Index, fatigue and widespread pain, although the performance of the model was improved by the addition of measures of mood and sleep disturbance. In a de novo model in BSRBR-AS, there were six factors (other than disease activity and function) that predicted ASQoL: depression (β=0.16), sleep disturbance (β=0.08), activity impairment (β=0.04), fibromyalgia (Symptom Severity Scale (β=0.24) and Widespread Pain Index (β=0.10)) and tobacco smoking (β=0.66).

Conclusion This study confirms that poor QoL in patients with axSpA, in addition to high disease activity and poor function, is independently influenced by sleep disturbance, mood and widespread pain. These additional factors are not considered targets for treatment in current European League Against Rheumatism (EULAR) guidelines for managing the condition.

  • quality of life, axial spondyloarthritis
  • disease register
  • fatigue
  • mood
  • sleep

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Handling editor Josef S Smolen

  • Twitter @UAberdeenEpi, @hteraG_senoJ

  • GJM and OR contributed equally.

  • Contributors All authors discussed and contributed to designing this study. GJM, OR and LED designed the analysis plan, which was undertaken by OR and overseen by LED and GJM. Results were reviewed by all authors. OR and GJM both contributed to drafting the first version of the manuscript, which was critically reviewed by all authors.

  • Funding The British Society for Rheumatology Biologics Register in Ankylosing Spondylitis is funded by the British Society for Rheumatology, which has received funding for this from Pfizer, AbbVie and UCB. These companies receive advance copies of manuscripts for comments but made none in relation to this manuscript.

  • Disclaimer Pfizer, AbbVie and UCB have no input in determining the topics for analysis or work involved in undertaking it.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the National Research Ethics Service Committee North East-County Durham and Tees Valley (Research Ethics Committee reference 11/NE/0374), and informed consent was obtained from all participants.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available.