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Abstract
Objective To examine differences in clinical and patient-reported outcomes, including work, in individuals with axial spondyloarthritis (axSpA) living in rural and urban settings.
Methods Using a sequential, explanatory mixed-method design, data from the British Society for Rheumatology Biologics Register for Ankylosing Spondylitis were used to (1) characterise participants with axSpA living in rural and urban areas and (b) assess any differences in outcome after commencement of biologic therapy (phase 1). Semistructured interviews (phase 2) further explored the results from phase 1.
Results Patients with axSpA living in rural areas were older and more likely to work in a physical job. Among patients prescribed biologics, there were no differences in response to biologics, but after adjustment for age, sex and local area deprivation rural dwellers reported more presenteeism and overall work impairment. Work effects could be explained by accounting for individual differences in disease activity, fatigue, physical function and job type. Interviews highlighted the complex relationship between clinical factors, contextual factors (work environment, job demands) and work disability. The ability to work and flexibility in terms of what, when and how tasks are undertaken were important. Support from employers was variable and healthcare professionals were often perceived as unsupportive.
Conclusions Patients with axSpA living in rural areas report a greater impact of their disease on work productivity. New measures are needed to capture important contextual factors and comprehensively determine the impact of long-term conditions on work. Future European League Against Rheumatism axSpA recommendations should include support to work as a target to optimise quality of life in patients with axSpA.
- epidemiology
- qualitative research
- spondyloarthritis
- outcomes research
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Footnotes
Handling editor Josef S Smolen
Twitter @UAberdeenEpi
Contributors RJH and GJM conceived the idea for the study and wrote the analysis plan, which was undertaken by LED. JS, RJH and KW-B developed the qualitative study, and KS undertook the interviews and analysis, supported by RJH and KW-B. The manuscript was written by RJH, together with LED, KS and KW-B. All authors reviewed the data and critically reviewed the manuscript for important intellectual content.
Funding The BSRBR-AS is funded by the British Society for Rheumatology, which has received funding, in part, from Pfizer, AbbVie and UCB. These companies receive advance copies of the results but have no input in determining the topics for analysis or work involved. This work was conducted within the Versus Arthritis/Medical Research Council Centre for Musculoskeletal Work and Health (grant no: 20665).
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval The BSRBR-AS received ethical approval from the National Research Ethics Service (NRES) Committee North East - County Durham and Tees Valley (REF: 11/NE/0374). Qualitative interviews received ethical approval from NRES Committee West of Scotland REC 1 (REF: 19/WS/0013).
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Access to BSRBR-AS registry data is by application to the British Society for Rheumatology.