Health-Related Quality of Life in Ankylosing Spondylitis: A Survey of 175 Patients Michael M. Ward Objective. To identify aspects of health-related quality of life that are most commonly affected in patients with ankylosing spondylitis (AS). Methods. One hundred seventy-five participants in a longitudinal study of health status in AS com- pleted a cross-sectional survey that asked them to rate the presence and importance of problems in 23 aspects of quality of life, including symptoms, dis- ability, mood, relations with others, and concerns about treatments and the future. Participants also completed the Medical Outcomes Study Short Form 36 Health Survey (SF-36). Results. The mean age of the participants was 51.1 years, and the mean duration of AS was 23.7 years; 119 (68%) were men. The most prevalent quality of life concerns included stiffness (90.2%), pain (83.1%), fatigue (62.4%), poor sleep (54.1%), concerns about appearance (50.6%), worry about the future (50.3%), and medication side effects (41%). Compared with those who had some college educa- tion, participants with 12 years of education or less were 2 to 4 times more likely to have problems or concerns with medication side effects, mobility, housework and self-care tasks, coping with illness, anxiety, payment for treatment, and relationships with spouses, family, and friends. Mean scores on the 8 domains of the SF-36 (range 0 –100; higher scores indicate better function) ranged from 49 (en- ergy/fatigue) to 77 (role limitations due to emotional problems). Patients with 12 years of education or less had significantly lower scores than those with some college on all domains except general health. Conclusions. In addition to pain and stiffness, fa- tigue and sleep problems are important concerns in patients with AS, while few reported problems with mood or social relationships. Less educated patients had lower quality of life in many different aspects. Key words. Health-related quality of life; Anky- losing spondylitis; Socioeconomic status. INTRODUCTION Health-related quality of life encompasses the im- pact of a disease and its treatment on a person’s perception of his or her ability to lead a full and productive life (1). As such, assessments of health- related quality of life usually include a broad array of symptoms, difficulties in physical functioning, work or role functioning, limitations in social interactions, mood, coping with illness, and treatment side ef- fects. Knowing which aspects of quality of life are most affected by a particular illness can help re- searchers prioritize their efforts and help clinicians by identifying prevalent illness-related problems or concerns that may not always be recognized or ad- dressed in the medical encounter. Most studies of health status in patients with an- kylosing spondylitis (AS) have focused on func- tional disability and symptoms of pain and stiffness, and relatively few studies have examined other Supported in part by the Bartman Foundation. Michael M. Ward, MD, MPH, Medical Service, Department of Veterans Affairs Palo Alto Health Care System, Palo Alto, and Divi- sion of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, Stanford, California. Address correspondence to Michael Ward, MD, MPH, Depart- ment of Veterans Affairs Palo Alto 111G, 3801 Miranda Avenue, Palo Alto, CA 94304. Submitted for publication September 21, 1998; accepted in revised form March 23, 1999. © 1999 by the American College of Rheumatology. 0893-7524/99/$5.00 247