Coping with rheumatic stressors in long-standing axial spondyloarthritis: association with patient and disease characteristics

OBJECTIVES: Coping strategies have been shown to influence health outcomes of persons with axSpA. This study explores which stable and variable factors are associated with coping and whether coping strategies change over time. METHODS: Data from the Outcome in AS International Study (OASIS) were used. Coping was assessed at year four and six of follow-up with the COping with Rheumatic Stressors (CORS) questionnaire, which assesses coping with pain, limitations and dependence across eight strategies (score 1-4). Factors associated with each strategy, including stable patient characteristics and variable axSpA health scores, were analysed with multivariable Generalized Estimation Equations (GEE). Separate GEE analyses assessed changes in coping strategies over time. RESULTS: A total of 116 patients were included. Of the eight strategies, optimism [mean: 3.1 (SD: 0.5)], comforting cognitions [3.0 (0.5)] and showing consideration [2.8 (0.4)] were the most used. Among stable socio-demographic and disease characteristics, education showed the most prominent associations with higher education being linked to more use of comforting cognitions [β: -0.22 (95%CI: -0.41; -0.03)] and optimism [-0.28 (-0.49; -0.07)]. Among variable health scores, higher Short Form 36 Mental Component Scores were very weakly associated with comforting cognitions [0.01 (0.00; 0.02)] and optimism [0.01 (0.00; 0.02)], while fatigue (BASDAI Q1) was associated with decreasing activities [0.04 (0.00; 0.09)]. Coping strategies did not change over time (range βtime: -0.04-0.07/two years). CONCLUSION: Coping strategies in axSpA are more strongly influenced by stable personal traits than by variable health scores and remain stable over time, suggesting coping reflects individual disposition rather than disease state.