ABS0628 FUNCTIONAL LIMITATIONS IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS. A GLOBAL OVERVIEW FROM THE IMAS STUDY

Background: Axial spondyloarthritis (axSpA) is a chronic inflammatory condition that profoundly affects physical function, limiting patients' ability to perform daily activities. Objectives: This analysis offers a comprehensive overview of the patient-reported functional limitations globally and by region. Methods: IMAS is a cross-sectional online survey (2017-2022) of 5,557 unselected axSpA patients from 27 countries across five regions globally (Europe, North America, Latin America, Asia and Africa). The Functional Limitation Index is an index developed by the University of Seville specifically for the IMAS study to assess the degree of limitations in axSpA (Cronbach alpha=0.967). The index assesses the degree of limitation in 18 activities of daily living that patients considered relevant: dressing, grooming, bathing, tying shoelaces, moving around the home, stairs, getting to/out of bed, toilet, shopping, preparing meals, eating, cleaning, walking, using public transportation, going to the doctor, driving, physical exercise, sexual relations. Scores ranged from 0–3 (0 no limitation, 1 low limitation, 2 medium limitation, and 3 high limitation). The summated index scores ranged between 0 and 54 points with higher values indicating higher functional limitation. Thus, a global functional limitation value between 0 and 18 implies low level of limitations, between 18 and 36 medium level, and between 36 and 54 high level of limitations. The independent variables evaluated included sociodemographic factors (age, gender, and patient organizations membership), disease characteristics (age at symptoms onset, diagnostic delay, HLA-B27, uveitis, inflammatory bowel disease, and psoriasis), patient-reported outcomes (disease activity [BASDAI 0-10], spinal stiffness [3-12], functional limitation [0-54], and mental health [GHQ-12]), mental comorbidities (anxiety, depression, and sleep disorders), and previous treatments (non-steroidal anti-inflammatory drugs [NSAIDs], conventional synthetic disease-modifying antirheumatic drugs [csDMARDs], and biologic disease-modifying antirheumatic drugs [bDMARDs]). Mann-Whitney test, Pearson correlation, univariable and multivariable linear regression analysis was applied to evaluate factors associated with functional limitation (N = 1,293). Results: Of the 5,482 IMAS patients who responded to the 18-items of the Functional Limitation Index the mean score was 19.8 (out of 54), with a low functional limitation in 49.6%, medium limitation in 32.3%, and high functional limitation in 18.1%. Overall, the major functional limitations reported by axSpA patients were engaging physical activity, housework, and going up or down stairs, while the less frequent functional limitations were eating, going to the doctor, and going to the toilet (Figure 1). Engaging in physical exercise was the main functional constraint in all regions except Asia, for which it was the second most frequent, the first being tying shoe laces. Greater functional limitations in patients with axSpA were more frequent in older patients, females, members of patient organizations, younger age at symptom onset, longer diagnostic delay, negative HLA-B27 test, presence of inflammatory bowel disease, presence of psoriasis, higher disease activity, greater spinal stiffness, worse mental health, presence of anxiety, depression and sleep disorders, and lower use of NSAIDs and csDMARDs. In the multivariable linear regression, the factors associated with greater functional limitation were higher disease activity (b= 1.98), greater spinal stiffness (b= 0.41), poorer mental health (b= 0.44) and presence of depression (b= 1.93; Table 1). Conclusion: Nearly 1 in 5 patients with axSpA suffer a high functional limitation in their activities of daily living. Greater functional limitation was associated with higher disease activity, greater spinal stiffness and poorer mental health. In addition, the presence of depression was related to patients' daily limitations. Globally, the most common challenges include physical activity, household chores and going up or down stairs, although with important differences between regions of the world. These variations highlight the need for tailored interventions to address the specific challenges faced by patients in different parts of the globe. REFERENCES: NIL . Figure 118-items of Functional Limitation Index in overall IMAS patients Table 1Univariable and multivariable linear regression analysis of factors associated with functional limitation (N= 1,293)Univariable Linear RegressionMultivariable linear regressionb95% CIb95% CIAge0.050.01, 0.080.03-0.04, 0.10Gender. Female2.962.16, 3.750.90-0.55, 2.34Patient organization membership. Yes1.020.22, 1.820.65-0.71, 2.01Age at symptoms onset-0.14-0.17, -0.10-0.06-0.15, 0.02Diagnostic delay0.240.19, 0.280.04-0.06, 0.14HLA-B27. Negative1.190.05, 2.330.06-1.43, 1.55Inflammatory bowel disease. Yes1.550.36, 2.730.92-0.88, 2.72Psoriasis. Yes3.171.77, 4.560.78-0.99, 2.54BASDAI (0-10)2.432.26, 2.601.981.60, 2.36Spinal stiffness (3-12)1.491.34, 1.650.410.08, 0.73GHQ-12 (0-12)0.990.89, 1.080.440.24, 0.64Anxiety. Yes3.222.36, 4.09-1.02-2.86, 0.82Depression. Yes3.202.32, 4.081.930.09, 3.77Sleep disorders. Yes3.062.21, 3.910.53-1.10, 2.16NSAIDs. No2.741.70, 3.790.44-1.78, 2.65csDMARDs. no1.210.35, 2.080.48-0.90, 1.86 Acknowledgements: This study was supported by Novartis Pharma AG. As of 2 January 2024, IMAS is owned solely by ASIF, following an in-kind donation of the project by Novartis Pharma AG. The authors would like to thank all patients who participated in the study. Disclosure of Interests: Victoria Navarro-Compán AbbVie, Eli Lilly, Fresenius Kabi, Janssen, MSD, Novartis, Pfizer, UCB Pharma, AbbVie, Alfasigma, Eli Lilly, Galapagos, MoonLake, MSD, Novartis, Pfizer, UCB Pharma, AbbVie, Novartis, Marco Garrido-Cumbrera Novartis, Fernando Sommerfleck Abbvie, Eli Lilly, Janssen, Novartis, Abbvie, Novartis, Janssen, José Correa-Fernández: None declared, Jo Lowe No personal funding, but ASIF has received funding from Novartis, UCB, Lilly, Abbvie, Boehringer Ingleheim, Pfizer, Janssen, Christine Bundy AbbVie, Amgen, Celgene, Janssen, Lilly, Novartis and Pfizer, Souzi Makri Novartis, GSK and Bayer, Shashank Murlidhar Akerkar Pfizer, Novartis, Eli Lilly, Jansen, Denis Poddubnyy AbbVie, BMS, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, Roche and UCB, AbbVie, MSD, Novartis, and Pfizer. © The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Neither EULAR nor the publisher make any representation as to the accuracy of the content. The authors are solely responsible for the content in their abstract including accuracy of the facts, statements, results, conclusion, citing resources etc.

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