Abstract：
OBJECTIVE: The aim of this study was to investigate the status of health-related quality of life in Chinese patients with ankylosing spondylitis (AS) and to analyze factors associated with the Assessment of SpondyloArthritis international Society Health Index (ASAS-HI) in AS and its relationship with disease activity and psychological status.
METHODS: A cross-sectional study of 484 patients with AS attending 10 hospitals in China from March 2021 to September 2023 was recruited. The ASAS-HI assessed general health and functional status; the Depression Anxiety Stress Scales (DASS-21) assessed psychological disorders such as anxiety, depression, and stress; and the Functional Assessment of Chronic illness Therapy-Fatigue Scale (FACIT-F) assessed patients\' fatigue symptoms; the Ankylosing Spondylitis Disease Activity Score-C-Reactive Protein (ASDAS-CRP), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), and Bath Ankylosing Spondylitis Measurement Index (BASMI) were used to assess patients\' disease activity and functional impairment. The correlation between ASAS-HI and the ASDAS, poor psychological status, and fatigue symptoms was observed. Univariate and multivariate logistic regression analyses were used to explore the relevant influencing factors of ASAS-HI.
RESULTS: A total of 484 patients were included in this study of whom 162 were in poor health, 139 in moderate health, and 183 in good health. On univariate analysis, disease activity is an important factor affecting ASAS-HI. People with extremely high disease activity (ASDAS ≥ 3.5) had a 12 times elevated risk of having poor health status (OR = 12.53; P < 0.001). Other significant covariates included age ≥ 36 (OR = 1.58; P = 0.015), BMI ≥ 24 kg/m2 (OR = 2.93; P = 0.013), smoke (OR = 1.96; P = 0.002), BASFI (OR = 1.49; P < 0.001), BASMI (OR = 1.22; P < 0.001), fatigue (OR = 6.28; P < 0.001), and bad psychological conditions such as depression (OR = 10.86; P < 0.001), anxiety (OR = 3.88; P < 0.001), and stress (OR = 4.65; P < 0.001). The use of bMARDs is inversely associated with the appearance of adverse health status (OR = 0.54; P = 0.012). There was no significant relationship between HLA-B27 and sex. Multivariable logistic regression showed that higher disease activity (ASDAS ≥ 3.5) (OR = 5.14; P = 0.005), higher scores of BASMI (OR = 1.10; P = 0.009), self-reported depression (OR = 3.68; P = 0.007), and fatigue (OR = 2.76; P < 0.001) were factors associated with adverse health status.
CONCLUSIONS: The health status of AS patients is related to age, BMI, smoking, disease activity, poor psychological status, and fatigue and is influenced by a combination of multiple factors such as emotional state, economic level, pain, and dysfunction. Therefore, clinicians should pay attention to the early assessment of ASAS-HI in order to improve the prognosis of the disease. Key Points •Ankylosing spondylitis (AS) is a chronic inflammatory autoimmune disease with a long course and heavy disease burden, which greatly affects patients\' quality of life. Therefore, this study aims to evaluate the health status of ankylosing spondylitis in the Chinese population and its influencing factors. •This is a multi-center cross-sectional study in China, which can better reflect the overall situation of the Chinese population.
METHODS: A cross-sectional study of 484 patients with AS attending 10 hospitals in China from March 2021 to September 2023 was recruited. The ASAS-HI assessed general health and functional status; the Depression Anxiety Stress Scales (DASS-21) assessed psychological disorders such as anxiety, depression, and stress; and the Functional Assessment of Chronic illness Therapy-Fatigue Scale (FACIT-F) assessed patients\' fatigue symptoms; the Ankylosing Spondylitis Disease Activity Score-C-Reactive Protein (ASDAS-CRP), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), and Bath Ankylosing Spondylitis Measurement Index (BASMI) were used to assess patients\' disease activity and functional impairment. The correlation between ASAS-HI and the ASDAS, poor psychological status, and fatigue symptoms was observed. Univariate and multivariate logistic regression analyses were used to explore the relevant influencing factors of ASAS-HI.
RESULTS: A total of 484 patients were included in this study of whom 162 were in poor health, 139 in moderate health, and 183 in good health. On univariate analysis, disease activity is an important factor affecting ASAS-HI. People with extremely high disease activity (ASDAS ≥ 3.5) had a 12 times elevated risk of having poor health status (OR = 12.53; P < 0.001). Other significant covariates included age ≥ 36 (OR = 1.58; P = 0.015), BMI ≥ 24 kg/m2 (OR = 2.93; P = 0.013), smoke (OR = 1.96; P = 0.002), BASFI (OR = 1.49; P < 0.001), BASMI (OR = 1.22; P < 0.001), fatigue (OR = 6.28; P < 0.001), and bad psychological conditions such as depression (OR = 10.86; P < 0.001), anxiety (OR = 3.88; P < 0.001), and stress (OR = 4.65; P < 0.001). The use of bMARDs is inversely associated with the appearance of adverse health status (OR = 0.54; P = 0.012). There was no significant relationship between HLA-B27 and sex. Multivariable logistic regression showed that higher disease activity (ASDAS ≥ 3.5) (OR = 5.14; P = 0.005), higher scores of BASMI (OR = 1.10; P = 0.009), self-reported depression (OR = 3.68; P = 0.007), and fatigue (OR = 2.76; P < 0.001) were factors associated with adverse health status.
CONCLUSIONS: The health status of AS patients is related to age, BMI, smoking, disease activity, poor psychological status, and fatigue and is influenced by a combination of multiple factors such as emotional state, economic level, pain, and dysfunction. Therefore, clinicians should pay attention to the early assessment of ASAS-HI in order to improve the prognosis of the disease. Key Points •Ankylosing spondylitis (AS) is a chronic inflammatory autoimmune disease with a long course and heavy disease burden, which greatly affects patients\' quality of life. Therefore, this study aims to evaluate the health status of ankylosing spondylitis in the Chinese population and its influencing factors. •This is a multi-center cross-sectional study in China, which can better reflect the overall situation of the Chinese population.
摘要：
目的：本研究的目的是调查中国强直性脊柱炎（AS）患者的健康相关生活质量状况，并分析与关节炎国际社会健康指数（ASAS-HI）评估AS的相关因素及其与疾病活动和心理状态的关系。
方法：对2021年3月至2023年9月在中国10家医院就诊的484例AS患者进行了横断面研究。ASAS-HI评估一般健康和功能状态;抑郁焦虑应激量表（DASS-21）评估心理障碍，如焦虑，抑郁症,和压力；慢性疾病治疗功能评估-疲劳量表（FACIT-F）评估患者的疲劳症状；强直性脊柱炎疾病活动评分-C反应蛋白（ASDAS-CRP），巴斯强直性脊柱炎疾病活动指数（BASDAI），巴斯强直性脊柱炎功能指数（BASFI），和Bath强直性脊柱炎测量指数（BASMI）用于评估患者的疾病活动和功能损害。ASAS-HI与ASDAS之间的相关性，不良的心理状态，并观察到疲劳症状。采用单因素和多因素logistic回归分析探讨ASAS-HI的相关影响因素。
结果：本研究共纳入484例患者，其中162例健康状况不佳，139中度健康，183，身体健康。在单变量分析中，疾病活动性是影响ASAS-HI的重要因素。疾病活动度极高（ASDAS≥3.5）的人健康状况差的风险增加了12倍（OR=12.53；P<0.001）。其他显著协变量包括年龄≥36岁(OR=1.58;P=0.015)，BMI≥24kg/m2（OR=2.93；P=0.013），烟雾（OR=1.96；P=0.002），BASFI（OR=1.49；P<0.001），BASMI（OR=1.22；P<0.001），疲劳(OR=6.28；P<0.001)，抑郁等不良心理状况(OR=10.86;P<0.001),焦虑（OR=3.88；P<0.001），和应力（OR=4.65；P<0.001）。bMARDs的使用与不良健康状况的出现呈负相关（OR=0.54；P=0.012）。HLA-B27与性别无显著关系。多因素logistic回归分析显示,疾病活动度(ASDAS≥3.5)较高(OR=5.14;P=0.005),BASMI得分较高（OR=1.10；P=0.009），自我报告抑郁（OR=3.68；P=0.007），和疲劳(OR=2.76;P<0.001)是与不良健康状况相关的因素。
结论：AS患者的健康状况与年龄有关，BMI,吸烟,疾病活动,不良的心理状态，和疲劳，并受到多种因素的综合影响，如情绪状态，经济水平,疼痛,和功能障碍。因此,临床医生应重视ASAS-HI的早期评估，以改善疾病的预后。要点•强直性脊柱炎（AS）是一种慢性炎症性自身免疫性疾病，病程长，疾病负担重，这极大地影响了患者的生活质量。因此,本研究旨在评估中国人群强直性脊柱炎的健康状况及其影响因素。•这是中国的一项多中心横断面研究，能更好地反映中国人口的整体状况。
方法：对2021年3月至2023年9月在中国10家医院就诊的484例AS患者进行了横断面研究。ASAS-HI评估一般健康和功能状态;抑郁焦虑应激量表（DASS-21）评估心理障碍，如焦虑，抑郁症,和压力；慢性疾病治疗功能评估-疲劳量表（FACIT-F）评估患者的疲劳症状；强直性脊柱炎疾病活动评分-C反应蛋白（ASDAS-CRP），巴斯强直性脊柱炎疾病活动指数（BASDAI），巴斯强直性脊柱炎功能指数（BASFI），和Bath强直性脊柱炎测量指数（BASMI）用于评估患者的疾病活动和功能损害。ASAS-HI与ASDAS之间的相关性，不良的心理状态，并观察到疲劳症状。采用单因素和多因素logistic回归分析探讨ASAS-HI的相关影响因素。
结果：本研究共纳入484例患者，其中162例健康状况不佳，139中度健康，183，身体健康。在单变量分析中，疾病活动性是影响ASAS-HI的重要因素。疾病活动度极高（ASDAS≥3.5）的人健康状况差的风险增加了12倍（OR=12.53；P<0.001）。其他显著协变量包括年龄≥36岁(OR=1.58;P=0.015)，BMI≥24kg/m2（OR=2.93；P=0.013），烟雾（OR=1.96；P=0.002），BASFI（OR=1.49；P<0.001），BASMI（OR=1.22；P<0.001），疲劳(OR=6.28；P<0.001)，抑郁等不良心理状况(OR=10.86;P<0.001),焦虑（OR=3.88；P<0.001），和应力（OR=4.65；P<0.001）。bMARDs的使用与不良健康状况的出现呈负相关（OR=0.54；P=0.012）。HLA-B27与性别无显著关系。多因素logistic回归分析显示,疾病活动度(ASDAS≥3.5)较高(OR=5.14;P=0.005),BASMI得分较高（OR=1.10；P=0.009），自我报告抑郁（OR=3.68；P=0.007），和疲劳(OR=2.76;P<0.001)是与不良健康状况相关的因素。
结论：AS患者的健康状况与年龄有关，BMI,吸烟,疾病活动,不良的心理状态，和疲劳，并受到多种因素的综合影响，如情绪状态，经济水平,疼痛,和功能障碍。因此,临床医生应重视ASAS-HI的早期评估，以改善疾病的预后。要点•强直性脊柱炎（AS）是一种慢性炎症性自身免疫性疾病，病程长，疾病负担重，这极大地影响了患者的生活质量。因此,本研究旨在评估中国人群强直性脊柱炎的健康状况及其影响因素。•这是中国的一项多中心横断面研究，能更好地反映中国人口的整体状况。
