Quality of Life Research
The impact of axial spondyloarthritis on quality of life (QoL):
a comparison with the impact of moderate to end-stage chronic
kidney disease on QoL
Yu Heng Kwan
· Warren Fong
· Priscilla How
· Hwee‑Lin Wee
· Ying Ying Leung
· Jie Kie Phang
Nai Lee Lui
· Chuen Seng Tan
· Rahul Malhotra
· Truls Østbye
· Julian Thumboo
Accepted: 31 May 2018
© Springer International Publishing AG, part of Springer Nature 2018
Purpose The purpose of the study was to assess the impact of axial spondyloarthritis (axSpA) on patients’ quality of life
(QoL) compared to patients with moderate to end-stage chronic kidney disease (CKD).
Methods We conducted secondary analysis of QoL data obtained from patients with axSpA and CKD from 2011 to 2014.
QoL was assessed using the SF-36 version 2 and KDQoL-SF for patients with axSpA and CKD, respectively. Patients with
CKD were subcategorized to CKD-pre-dialysis, hemodialysis (CKD-HD) and peritoneal dialysis (CKD-PD). Linear regres-
sion was used to compare QoL between patients with axSpA and CKD after adjusting for age, gender, ethnicity, education
level, and marital status.
Results A total of 765 patients (mean age 54.6, 63.0% males, 69.0% Chinese) were analyzed, of which 188 (24.5%) had
axSpA. Patients with axSpA had poorer SF-36 bodily pain (BP) scores (axSpA: reference; CKD-pre-dialysis β: 11.04,
p < 0.001; CKD-HD β: 9.52, p < 0.001; CKD-PD β: 10.35, p < 0.001) and higher general health scores (axSpA: reference;
CKD-pre-dialysis β: − 7.87, p < 0.001; CKD-HD β: − 7.14, p < 0.001, CKD-PD β: − 7.25, p < 0.001) as compared to patients
with CKD. Generally, patients with axSpA had poorer SF-36 scores than patients with CKD-pre-dialysis and similar SF-36
scores compared to patients with CKD-HD or CKD-PD.
Conclusions The burden of axSpA on QoL is not trivial and is comparable to patients with CKD-HD or CKD-PD.
Keywords Axial spondyloarthritis · Quality of life · Chronic kidney disease · SF-36 · Comparison · Rare disease
As curative treatment options for chronic diseases are lim-
ited, maintaining and improving quality of life (QoL) of
patients with chronic diseases are essential . Axial spon-
dyloarthritis (axSpA) and chronic kidney disease (CKD)
aﬀect about 1 and 10% of the general population respectively
[2, 3] and both cause signiﬁcant mental and physical stress
that aﬀects patients’ QoL .
axSpA is a chronic autoimmune disease with diverse
clinical manifestations including inﬂammatory back pain,
enthesitis, peripheral arthritis, uveitis, and inﬂammatory
bowel disease. Patients with axSpA experience signiﬁcant
mobility impairment, fatigue and pain, which signiﬁcantly
aﬀect their QoL . As the prevalence of axSpA is low at
around 0.9–1.4%, clinicians, especially non-rheumatologists,
may not appreciate the impact of this relatively uncommon
disease on QoL, resulting in poor treatment outcomes .
Electronic supplementary material The online version of this
article (https ://doi.org/10.1007/s1113 6-018-1900-x) contains
supplementary material, which is available to authorized users.
* Julian Thumboo
Program in Health Services and Systems Research, Duke-
NUS Medical School, Singapore, Singapore
Department of Rheumatology and Immunology, Singapore
General Hospital, Singapore, Singapore
Department of Pharmacy, Faculty of Science, National
University of Singapore, Singapore, Singapore
Duke-NUS Medical School, Singapore, Singapore
Department of Medicine, Yong Loo Lin School of Medicine,
National University of Singapore, Singapore, Singapore
Division of Nephrology, Department of Medicine, National
University Hospital, Singapore, Singapore
Saw Swee Hock School of Public Health, National University
of Singapore, Singapore, Singapore