Background: Earlier studies have found strong correlations between worse health and an unhealthy lifestyle, such as not meeting recommendations of moderate-to-vigorous physical activity, being overweight or obese and the use of tobacco in patients with spondyloarthritis (SpA). The impact of more than one unhealthy lifestyle habit (LsH) is however, scarcely described.

Objectives: To study the combined effects of unhealthy LsHs on health-related quality of life (HRQoL) and physical and mental functions in patients with SpA. Differences between SpA subgroups and gender were also studied.

Methods: Postal questionnaires were in 2009 and 2011 sent to all patients diagnosed with SpA and registered in the Skane Healthcare Register. This study included patients who at both time points responded to the survey, were ≥20 years, and had ankylosing spondylitits (AS), psoriatic arthritis (PsA) or undifferentiated spondyloarthritis (USpA). Cross-sectional data from the 2011 questionnaire were available for 1601 patients (AS n=455, PsA n=883, USpA n=263), with a mean age of 58 (13) years (52% women). Self-reported levels of weekly physical activity at moderate or vigorous intensity, (MVPA), use of tobacco (cigarettes and/or snuff) and BMI (overweight or obese) were dichotomized as “healthy” or “unhealthy”. The number of unhealthy LsH were then summarized and stratified into four groups (scoring 0-3, 0=no unhealthy LsH). HRQoL was assessed with EQ-5D (0-1, worst-best), and physical function with BASFI. Disease activity (BASDAI), pain, fatigue (0-10, best-worst), anxiety, and depression (HADa/d) (0-21, no distress-maximum distress) were also measured. Statistical analyses were performed with Chi Square test and ANOVA.

Results: Fourteen percent (n=226) reported none of the studied unhealthy LsH, while 35% (n=555) reported one, 38% (n=611) two, and 13% (n=209) three unhealthy LsH. Reports of one and more unhealthy LsH had increasing negative impact on HRQoL (from mean 0.74 (SD 0.19) to 0.57 (0.30)), disease activity (from 3.2 (2.1) to 4.5 (2.3)), physical function (2.3 (2.1) to 4.4 (2.6)), VAS-pain (3.4 (2.3) to 4.8 (2.5)), VAS-fatigue (4.2 (2.7) to 5.5 (2.7)), anxiety (4.8 (4.2) to 5.6 (4.4)) and depression (3.3 (3.3) to 4.8 (3.8)) in patients with SpA (p=0.019-<0.001).

Patients with PsA (p≤0.001) and men (p=0.040) reported more often ≥2 unhealthy LsHs, while patients with USpA were least likely to have ≥2 unhealthy LsHs (Figure 1,2). The negative impact on HRQoL, physical and mental functions still remained significant when stratified into different SpA subgroups and gender, except for anxiety in women, and for patients with PsA or USpA.

Conclusion: Our findings support that the combined effect of unhealthy lifestyle habits have negative impact on many aspects of health. There is a need for interventions aiming at screening for not only one but several unhealthy lifestyle habits combined, and to offer coaching to increase behavioral change and promote better health. © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.