Spondyloarthritis & psoriatic arthritis
Final validation of the hierarchical framework for outcomes in axial spondyloarthritis: longitudinal determinants of health-related quality of life
Authors' conclusion
A validated longitudinal framework has been established for interpreting HRQoL: even correcting for contextual factors, disease activity consistently impacts HRQoL-primarily through functional impairment, but also directly.
Study context
- Population
- Patients with axial spondyloarthritis (axSpA) (symptoms <3 years) from the Devenir des Spondylarthropathies Indifferénciées Récentes cohort (46% males, mean age 33.5 [8.6] years)
- Participants
- 663 patients
- Exposure
- Association of disease activity and function with health-related quality of life (HRQoL)
- Outcome
- HRQoL: SF-36 PCS and MCS (higher = better), ASQoL (higher = worse)
- Follow-up
- 10 years
Methodological details10-year follow-up, multivariable generalised estimating equations, standard and autoregressive models, mediation analysis
- 10-year follow-up
- Multivariable generalised estimating equations
- Standard and autoregressive models
- Mediation analysis
Main finding
As reported in the abstract
- PCS, ASDAS: beta coefficient
- −2.93 [−3.28, −2.58] (95% CI)
- PCS, BASFI: beta coefficient
- −2.13 [−2.31, −1.96] (95% CI)
- MCS, ASDAS: beta coefficient
- −2.38 [−2.91, −1.86] (95% CI)
- MCS, BASFI: beta coefficient
- −1.10 [−1.36, −0.84] (95% CI)
- ASQoL, ASDAS: beta coefficient
- 1.18 [1.02, 1.36] (95% CI)
- ASQoL, BASFI: beta coefficient
- 1.08 [0.99, 1.17] (95% CI)
Observational data: associations, not effects.
Further findings
Mediation of ASDAS effect on HRQoL by BASFI
- Mediated by BASFI
- ∼75%
- Direct effect
- ∼25%
Original publication
Final validation of the hierarchical framework for outcomes in axial spondyloarthritis: longitudinal determinants of health-related quality of life. Ann Rheum Dis. Published 13 November 2025. doi:10.
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