Roxanne Cooksey, Prof Sinead Brophy, Jonathan Kennedy, Helen Davies, Mark Atkinson, Muhammad Jami Husain, Ceri Phillips, Mike Gravenor, Shang-ming Zhou, Elizabeth Irvine, Antonio Sanchez, Grant Pointer, Claire Burrows – Swansea University, Prof Ernest Choy – Cardiff University, Debbie Cook – National Ankylosing Spondylitis Society, Muhhammad Azizur Rahman – Centre for Disease Control and Prevention, Steven Macey – Ash Wales, Stefan Sibert – Glasgow University.
Ankylosing spondylitis (AS) is the second most common inflammatory arthritis after rheumatoid arthritis. However, unlike rheumatoid arthritis, AS typically begins in the teenage years and is more diagnosed in men than women. Since the condition starts early on in the life course, education, employment and family prospects can be limited. The inflammation associated with the condition can result in the permanent fusion of the spine and greatly reduces mobility and quality of life for the individual. People with AS often live with great levels of pain, stiffness and fatigue. The effects of the condition can vary widely from one person to another which makes it difficult to predict who will become most ill from the condition.
It is important that individuals with AS are treated with effective drugs early, in order to prevent structural damage and help avoid the severe symptoms of the disease. However, the drugs used to treat AS are not without their health risks and are also expensive, so it is important that those who truly need these medications are identified and have access to the drugs early on in their condition.
The research linked health data, such as general practice and hospital records held in the Secure Anonymised Information Linkage (SAIL) databank, which removes the identities of individuals. A total of 3630 people with AS were identified. This data was used to investigate any other illnesses people with AS may have had, how often people with AS visited their doctor and the medications they were prescribed.
In addition, over 500 individuals with AS completed questionnaires every 3 months for 2 years, which helped to enhance the information. The questionnaires asked about disease activity, disease flare-ups, functional ability, physical activity, work status and the cost associated with the condition.
It was found that people who had severe disease flares had poorer outcomes in terms of functional ability, disease severity, mental health and employment compared to individuals who did not have severe flares.
The study estimated the cost of AS to be around £20,000 per patient, per year. The majority of the cost of AS was due to functional impairment and loss of work. In order to improve functional ability, it was found that exercise helped, particularly for those with severe disease. Therefore, encouraging individuals with AS to exercise can help improve patient quality of life and reduce the cost associated with condition.
Early findings show that Mindfulness-based stress reduction (MBSR) is useful in reducing anxiety and depression and also in reducing the number of visits to the doctor. Mindfulness-based stress reduction proved to be a cost-effective disease management strategy can empower AS patients to live better with their condition.
Being able to detect those who will be more affected by AS early on, for example, by using early severe flares as a marker, means that individuals can be identified as candidates for expensive medications. Furthermore, knowing the true cost of conditions is important so that accurate cost-benefit calculations can be done and improve the chances of access to medications for those who need them. This study produced the most comprehensive assessment of the true cost of AS to date.
The body of research has been cited by the National Institute for Health & Care Excellence, British Society for Rheumatology and Outcome Measures in Rheumatology.
Further work is being carried improve the detection of AS early on in the condition. In addition, Mindfulness courses delivered over the internet in order to reach those who find it difficult to attend a class due to mobility or transport issues are continuing to assess the true potential of MBSR in AS.