ASSESSMENT OF BIOPSYCHOSOCIAL CONDITION OF ANKYLOSING SPONDYLITIS PATIENTS

Background: Biopsychological and social conditions in patients with ankylosing spondylitis (AS) are a major concern for physicians, health allied professionals and health authorities that work and deal with them.Objectives: To assess and to characterise the familial, professional, social, economic and functional impact of AS from a patient point of view.Patients and Methods: Transversal study promoted by ANEA, the Portuguese ankylosing spondylitis patients Society with the co-ordination of an ANEA's social worker. It was based in a self fill questionnaire to characterise marital status, education level, job, earnings, self image, wellbeing at home, disability, social adjustment, deal with the disease, hopes for the future and level of satisfaction with health services.Results: The questionnaire was send to ANEA members and 173 were valid to analyse. Out of the 173 patients, 62,4% were males and 37,6% were females. The mean age was 49 years (range 17 to 81). 77,5% were married, 11,6% single and 6,9% divorced. The level of education was low in 41,1%, medium in 36,4% and high in 22,5%. 38,7% were employed, 22,5% had disability allowance, 17,9% were retired and 2,9% unemployed. 68,8% answered that their economic status impaired the accessibility to treatment. 88,4% felt good at home and 91,9% liked to be with their families at home, however only 40,5% said that they ``never feel depressed at home''. 46,3% didn't work. 67,6% lost working hours in physical treatments. 43% of the workers have some difficulties in the job to go to medical appointments or treatments. 52,6% have been evaluated in a medical evaluation insurance commission and in 89% of the cases a disability pension was granted. The level of disability conferred was 60-70% in 27,1% patients, 70-80% in 18,6%, 80-90% in 16% and 90-100% in 8,5% of the patients. 23,7% of the patients felt angry for suffering from AS and 23,7% felt social discrimination. 11,6% reported conflicts with family, 4% with colleagues and 4% with friends. 46,8% reported intense pain, 61,3% fatigue, 67,7% of the patients were not able to perform activities as they did before onset of disease, 33,5% reported emotional disturbances and 24,3% behavioural distress. Only 21,4% considered that they would get better, 47,4% ``live in peace with the disease'' and 50,3% considered that physician's advice could influence the disease outcome. In the last months the health services used were outpatient clinic in 82,7%, hospital emergency in 10,4% and inpatient hospital department in 3,5%. The health services were classified as medium in 57,8%, bad in 20,8%, good 12,1%, very bad in 8,1% and very good in 1,2%.Global assessment of disease was medium in 47,4%, weak in 31,6%, good in 12,1% and excellent in 0,6%. 26,6% of the patients were willing to abandon treatment, 17,3% had no wish to live, 11% considered themselves a failure, 15% had lost the freedom to decide about their lives and 23,1% had low expectations for the future.Discussion: This questionnaire had the aim to assess patients' emotions and feelings. We report a high percentage of pain and depression in these patients. The physicians, social workers and other allied professions should be alert to the patients' satisfaction and expectation for a better therapy adjustment and a better outcome.Citation: , volume , supplement , year 2003, page Session: