Identification of symptom clusters in patients with ankylosing spondylitis

Symptom cluster refers to a group of 3 or more related symptoms that occur together. Our objectives were to: (1) investigate the frequency, severity and gender difference of symptoms in patients with ankylosing spondylitis (AS); and (2) identify symptom clusters in AS patients. A cross‐sectional questionnaire‐based survey was conducted using the Patient Health Questionnaire Symptoms Group combined with self‐designed variables. Demographic and symptom variables between male and female patients in terms of C‐reactive protein (CRP) and human leukocyte antigen (HLA)‐B27 status were analyzed with 2‐tailed independent t test for continuous variables and Chi‐square or Fisher's exact test for categorical variables. Symptom clusters were extracted and analyzed by principal component analysis. There were 122 AS patients included in the study. The most severe symptoms included severe back pain, extremity or joint pain, difficulty in breathing, constipation, intestine discomfort and diarrhea. Stomachache was more prevalent in male patients in which odds ratio was 4.60 (CI 1.59‐12.97) (P = .006). Patients with HLA‐B27 negativity or a higher CRP value were more likely to have dry mouth. Four symptom clusters were classified, which explained 58.4% of the total variation. They were named as the gastrointestinal‐cardiac cluster, the fatigue‐sleep disturbance cluster, the headache‐chest pain cluster, and the mouth‐eye cluster. The symptoms appeared to cluster into 4 groups in AS patients, which should be noticed in clinical care.

[1]  Jialing Wu,et al.  Dynamics of Adaptive Immune Cell and NK Cell Subsets in Patients With Ankylosing Spondylitis After IL-17A Inhibition by Secukinumab , 2021, Frontiers in Pharmacology.

[2]  Yuqing Song,et al.  Evaluating Chinese Mobile Health Apps for Ankylosing Spondylitis Management: Systematic App Search , 2021, JMIR mHealth and uHealth.

[3]  L. Carmona,et al.  2021 EULAR recommendations for the implementation of self-management strategies in patients with inflammatory arthritis , 2021, Annals of the Rheumatic Diseases.

[4]  J. Birt,et al.  Which patient-reported outcomes do rheumatology patients find important to track digitally? A real-world longitudinal study in ArthritisPower , 2021, Arthritis Research & Therapy.

[5]  Huji Xu,et al.  Fatigue in Ankylosing Spondylitis Is Associated With Psychological Factors and Brain Gray Matter , 2019, Front. Med..

[6]  L. Weng,et al.  Factors associated with depressive symptoms in patients with ankylosing spondylitis in Northern Taiwan , 2019, PloS one.

[7]  Zhiming Lin,et al.  Using Mobile Apps for Health Management: A New Health Care Mode in China , 2019, JMIR mHealth and uHealth.

[8]  A. Ogdie,et al.  Real-World Patient Experience on the Path to Diagnosis of Ankylosing Spondylitis , 2019, Rheumatology and Therapy.

[9]  Á. Lanas,et al.  NSAID induced gastrointestinal damage and designing GI-sparing NSAIDs , 2018, Expert review of clinical pharmacology.

[10]  Md Nazrul Islam,et al.  The colon and terminal ileum in patients with ankylosing spondylitis and controls in Bangladesh: a macroscopic and microscopic study , 2018, Rheumatology advances in practice.

[11]  R. V. van Vollenhoven,et al.  Gender Differences in Axial Spondyloarthritis: Women Are Not So Lucky , 2018, Current Rheumatology Reports.

[12]  Zhiming Lin,et al.  Prevalence of comorbidities and evaluation of screening in Chinese patients with spondyloarthritis , 2018, Clinical Rheumatology.

[13]  Zhiming Lin,et al.  Prevalence of psychological disorders, sleep disturbance and stressful life events and their relationships with disease parameters in Chinese patients with ankylosing spondylitis , 2018, Clinical Rheumatology.

[14]  R. Sandler,et al.  Symptom clusters in adults with inflammatory bowel disease , 2017, Research in nursing & health.

[15]  M. Dougados,et al.  Treating axial spondyloarthritis and peripheral spondyloarthritis, especially psoriatic arthritis, to target: 2017 update of recommendations by an international task force , 2017, Annals of the rheumatic diseases.

[16]  Liying Zhang,et al.  An update in symptom clusters using the Edmonton Symptom Assessment System in a palliative radiotherapy clinic , 2017, Supportive Care in Cancer.

[17]  E. Akl,et al.  How to treat ankylosing spondylitis and nonradiographic axial spondyloarthritis. Key practical messages from the 2015 American College of Rheumatology recommendations. , 2016, Polskie Archiwum Medycyny Wewnetrznej.

[18]  Zhangsuo Liu,et al.  The relationship between disease activity measured by the BASDAI and psychological status, stressful life events, and sleep quality in ankylosing spondylitis , 2015, Clinical Rheumatology.

[19]  Wissam Hamou,et al.  Clonal analysis reveals a common origin between nonsomite-derived neck muscles and heart myocardium , 2015, Proceedings of the National Academy of Sciences.

[20]  H. An,et al.  Cervical spine manifestations in patients with inflammatory arthritides , 2013, Nature Reviews Rheumatology.

[21]  M. Dougados,et al.  Treating spondyloarthritis, including ankylosing spondylitis and psoriatic arthritis, to target: recommendations of an international task force , 2013, Annals of the rheumatic diseases.

[22]  C. Beş,et al.  Serious menstrual bleeding associated with use of TNF alpha blocker: two cases , 2012, Rheumatology International.

[23]  B. Schmidt,et al.  Association between pro- and anti-inflammatory cytokine genes and a symptom cluster of pain, fatigue, sleep disturbance, and depression. , 2012, Cytokine.

[24]  F. Cantini,et al.  Frequency of anemia of inflammation in patients with ankylosing spondylitis requiring anti‐TNFα drugs and therapy‐induced changes , 2012, International journal of rheumatic diseases.

[25]  E. Doğanavşargil,et al.  Sjögren’s syndrome in patients with ankylosing spondylitis , 2006, Clinical Rheumatology.

[26]  L. Tulman,et al.  Symptom Clusters: Concept Analysis and Clinical Implications for Cancer Nursing , 2005, Cancer nursing.

[27]  K. Suk,et al.  Clinical Outcome Results of Pedicle Subtraction Osteotomy in Ankylosing Spondylitis With Kyphotic Deformity , 2002, Spine.

[28]  R. Spitzer,et al.  The PHQ-15: Validity of a New Measure for Evaluating the Severity of Somatic Symptoms , 2002, Psychosomatic medicine.

[29]  S. Paul,et al.  Symptom clusters and their effect on the functional status of patients with cancer. , 2001, Oncology nursing forum.

[30]  A. Cats,et al.  Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. , 1984, Arthritis and rheumatism.

[31]  M. Soucek,et al.  AXIAL SPONDYLOARTHRITIS , 2023 .