title: Burden of illness associated with non-radiographic axial spondyloarthritis: a multiperspective European cross-sectional observational study.
abstract: OBJECTIVE
  To assess the impact of non-radiographic axial spondyloarthritis (nr-axSpA) on patients and society based on real-world evidence from the Adelphi nr-axSpA Disease Specific Programme, a cross-sectional survey of rheumatologists and their patients in Germany, France, Spain, Italy and the UK.
  
  
  METHODS
  Physicians completed patient record forms for the next two patients consulting with nr-axSpA (diagnosis at the physician's judgement); patients were invited to complete a patient self-completion form. Outcomes were assessed in responders and non-responders and those treated with and without biological agents.
  
  
  RESULTS
  In total, 631 patients were included. Fulfilment of classification criteria varied across countries. Assessment of SpondyloArthritis international Society classification criteria were most commonly met; other criteria, including Amor and European Spondyloarthropathy Study Group criteria, were applied less frequently. Most German and UK patients had their condition classified without formal criteria. Despite being diagnosed with nr-axSpA, 13% of patients met the criteria for ankylosing spondylitis. EuroQol 5-Dimensions (3L) utility scores were lower in patients with nr-axSpA versus general population matched controls (0.776 vs. 0.884; p<0.001); non-responders to treatment had impaired activity (as measured by the Work Productivity and Activity Impairment questionnaire) of 47.4% versus 33.3% in responders (p<0.001). Clinical outcomes were consistently better in biological-treated versus -naïve patients. Average pretreatment pain levels were 6.6 and 6.2, respectively (p=0.072) but reduced to 2.5 and 4.0, respectively (p<0.001) at the time of the survey.
  
  
  CONCLUSIONS
  nr-axSpA was associated with a significant QoL and societal burden in this study of German, French, Spanish, Italian and UK patients. Treatment with biological agents was associated with improved QoL. Considerable variability in patients' clinical characteristics were observed across the countries studied and further education, aimed at improving awareness of the condition, may be needed.
authors.affiliation: Klinikum Benjamin Franklin der Freien Universität Berlin, Germany. joachim.sieper@charite.de.
authors.forename: Joachim
authors.initials: J
authors.lastname: Sieper
authors.affiliation: Health Economics and Outcomes Research, Adelphi Real World, Macclesfield, UK.
authors.forename: Tim
authors.initials: T
authors.lastname: Holbrook
authors.affiliation: Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Black
authors.affiliation: Health Economics and Outcomes Research, Adelphi Real World, Macclesfield, UK.
authors.forename: Robert
authors.initials: R
authors.lastname: Wood
authors.affiliation: Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA.
authors.forename: Xiaohan
authors.initials: X
authors.lastname: Hu
authors.affiliation: Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA.
authors.forename: Sumesh
authors.initials: S
authors.lastname: Kachroo
mesh_terms: D000328:Adult; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001688:Biological Products / Q000627:therapeutic use; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011788:Quality of Life; D012720:Severity of Illness Index; D025241:Spondylarthritis / Q000175:diagnosis* / Q000188:drug therapy; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D001688:Biological Products