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Ankylosing Spondylitis: The AS-WIS Screening Tool

December 11, 2020
A newly studied screening tool may be useful for assessing a patient's ability to work when they have axSpa.

Axial spondyloarthritis (axSpA) most commonly affects younger adults, with the average age of onset 28 years – right in the prime working years, which adds to the disease’s already significant burden.1,2

“It has been known for many years that these patients have significant problems with work disability,” explained Atul Deodhar, MD, a rheumatologist and professor of medicine at The Ohio State University School of Medicine. “The problem,” Dr. Deodhar said, is often “presenteeism,” when people aren’t absent from work, but their effectiveness has gone down.”

Screening for potential work instability can be a good way for clinicians to determine which patients are ready to return to work and which are not. The Ankylosing Spondylitis Work Instability Scale (AS-WIS) is a 20-item screening questionnaire that enables clinicians to quickly assess work instability (defined as a mismatch between the demands of work and the patient’s ability to perform them) in patients with axSpA.

According to Irina Cucos, MD, of the Saint Mary Hospital, in Bucharest, Romania, the AS-WIS has been validated, however, there have been limited studies on the predictive value of AS-WIS, specifically on axSpA. With this in mind, Dr. Cucos and a team of researchers at the Pitie Salpetriere Hospital, Rheumatology Department in Paris, France, designed a study to test the scale’s effectiveness. Their research was published in The Journal of Rheumatology in September 2020 and is summarized below.3

Screening for potential work instability can be a good way for clinicians to determine which patients with ankylosing spondylitis are ready to return to work and which are not.

Methods

The prospective cohort study looked at patients at two timepoints: at baseline and after one-and-a-half years. Subjects were identified based on being seen in one of three medical centers in Paris between September 2013 and February 2014 (n=240). The patients were determined to have axSpA by a rheumatologist, and they met the  Assessment of Spondyloarthritis International Society criteria for axSpA.

The AS-WIS questionnaire was sent by mail to 240 patients. A second questionnaire was sent after 1 year to those patients who answered the first/baseline questionnaire and were in a paid work position. Ultimately 101 respondents were included in the study.

The researchers collected the following demographic information: age, gender, body mass index, education level, and work status (employed, unemployed, or unable to work). Of the 101 patients who answered the second questionnaire, mean age at inclusion in the study was 45 years. Fifty-two percent were male, and duration of disease averaged 14 years. Sixty-two percent of the patients had more than a high-school level education; more subjects (62%) had white-collar jobs than blue collar jobs.

In addition, patients were asked to complete the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Bath Ankylosing Spondylitis Functional Index (BASFI). Researchers consulted the medical records of the patients to ascertain the presence of HLA-B27, radiographic sacroiliitis, and high CRP.

Results

At follow-up, 37 patients (3%) reported an adverse work outcome (AWO), 25 requiring short-term sick leave and 12 requiring long-term sick leave during the course of the study. All disruptions of employment were related to axSpa. A higher AS-WIS score was significantly related to adverse work outcomes.

“The risk of AWO was almost trebled by a moderate/high work instability risk as assessed by the AS-WIS,” the researchers wrote.3 Because of the strong association between the AS-WIS score and sick leave or unemployment, “This questionnaire can be helpful to screen for difficulties in the workplace,” Dr. Cucos told PPM.

Professional Takeaways

Dr. Deodhar adds this tool might become useful in research, however he doubts usefulness in clinical practice – not because it is not predictive but because it is time-consuming. “In clinical practice you are busy seeing patients quickly and you can just ask them this question,” he said. In his practice, he uses the RAPID3 screening (Routine Assessment of Patient Index Data 3) firstdeveloped for rheumatoid arthritis but since validated for ankylosing spondylitis.

However, the Cucos study suggests that patients with axSpA might be well served if clinicians take just a bit more time to screen with the AS-WIS to help prevent adverse work outcomes.

View our new PainScan Literature Review for the latest on overall axSpA: Early and Differential Diagnoses 

Last updated on: December 11, 2020
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