Ann Rheum Dis: Comparison of prognosis and treatment responses in patients with central and axial spinal arthritis in urban and rural areas

The study aims to explore differences in clinical and patient outcomes, including work, in patients with axial spinal arthritis (axSpA) in rural and urban areasDesigned using a sequential, explanatory hybrid approach, using the British Society for Rheumatology bioregistration data for strong scoliosis: (a) characterizing axSpA participants in rural and urban areas, and (b) assessing differences in outcomes after starting biotherapy (phase 1)The semi-structured interview (Phase 2) further explored the results of Phase 1Patients with axSpA in rural areas are older and more likely to perform manual labourThere was no difference in response to biologics in patients who used biologics, but rural residents reported more attendance and overall work impairments after age, gender and partial deprivationThe effects of work can be explained by considering individual differences in disease activity, fatigue, somatic function, and type of workThe interview highlighted the complex relationship between clinical factors, background factors (work environment, job requirements) and work barriersThe ability to work and flexibility in what tasks are performed, when and how they are performed are importantSupport from employers varies, and healthcare professionals are generally considered unsupportedDiseases reported by patients with axSpA in rural areas have a greater impact on productivityNew measures are needed to capture important background factors and to identify the effects of long-term illness on workFuture European Alliance for Rheumatics axSpA guidelines should include job support as a goal to optimize the quality of life of axSpA patients