title: Socioeconomic impact of ankylosing spondylitis in Tunisia.
abstract: OBJECTIVE
  Ankylosing spondylitis (AS) is the second most common chronic inflammatory joint disease after rheumatoid arthritis and causes substantial functional impairment, two features that generate a heavy socioeconomic burden. Here, our objective was to assess the socioeconomic impact of AS and to identify factors associated with higher costs.
  
  
  METHODS
  We retrospectively reviewed the medical charts of 50 patients with AS seen at the Monastir Public Health Service Hospital over the 6-month period from March to September 2006. The following were evaluated: direct costs of medical care; indirect costs related to work incapacity; and impact on marital life, offspring, social activities, and activities of daily living.
  
  
  RESULTS
  There were 42 men and eight women (male-to-female ratio, 5.25) with a mean age of 38.9+/-10.8 years (range, 19-60 years). The median mean direct cost of medical care for AS was 426.072 Tunisian Dinars (TND) (266.295 euro) per year, and the interquartile range (IQR) was 270.468 TND. Of the 34 patients who had paid employment, 12 (35%) were on sick leave. The mean indirect cost was 447.4+/-294.3 TND (279.625+/-183.937 euro) per patient per year. The median mean total cost was 873.472 TND (545,92 euro) per patient per year with an IQR of 292,324 TND. Factors associated with higher costs were the use of nonsteroidal anti-inflammatory drugs and higher values of the BASDAI and BASRI. Among married patients, 44.4% reported sexual problems, which correlated with the BASMI; and 37% reported a negative reaction on the part of the healthy spouse. Adverse effects on schooling and quality of life of the children were noted in 29.6% of cases. Among single patients, 30.4% felt their disease was responsible for their unmarried status. The disease adversely affected the ability to carry out many activities of daily living (grooming in 38% of cases, housework in 76%, shopping in 92%, sporting activities in 96%, socializing in 68%, and traveling in 80%). The patients usually reported receiving support from their family, which was physical in 74% of cases, financial in 52%, and psychological in 90%.
  
  
  CONCLUSIONS
  Our data indicate that AS generates a major socioeconomic burden. Most of the factors associated with higher costs were related to greater disease activity. Therefore, early appropriate treatment is crucial. Despite the many socioeconomic problems generated by AS, the patients remained connected to their social network thanks to support from their family and friends.
authors.affiliation: Service de rhumatologie, EPS Monastir 5000, Tunisia. mohamed_youn@yahoo.fr
authors.forename: Mohamed
authors.initials: M
authors.lastname: Younes
authors.forename: Anis
authors.initials: A
authors.lastname: Jalled
authors.forename: Zohra
authors.initials: Z
authors.lastname: Aydi
authors.forename: Saoussen
authors.initials: S
authors.lastname: Zrour
authors.forename: Wided
authors.initials: W
authors.lastname: Korbaa
authors.forename: Zohra
authors.initials: Z
authors.lastname: Ben Salah
authors.forename: Mondher
authors.initials: M
authors.lastname: Letaief
authors.forename: Ismail
authors.initials: I
authors.lastname: Bejia
authors.forename: Mongi
authors.initials: M
authors.lastname: Touzi
authors.forename: Naceur
authors.initials: N
authors.lastname: Bergaoui
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D018501:Antirheumatic Agents / Q000191:economics / Q000627:therapeutic use; D017281:Cost of Illness; D004651:Employment; D005260:Female; D005102:Health Expenditures; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012189:Retrospective Studies; D012720:Severity of Illness Index; D018582:Sick Leave / Q000191:economics; D018434:Sickness Impact Profile; D013167:Spondylitis, Ankylosing / Q000191:economics* / Q000503:physiopathology / Q000534:rehabilitation; D014416:Tunisia; D014938:Work Capacity Evaluation; D055815:Young Adult
chemical_list: D018501:Antirheumatic Agents