RT Journal Article SR Electronic T1 Influence of Environmental Factors on Disease Activity in Spondyloarthritis: A Prospective Cohort Study JF The Journal of Rheumatology JO J Rheumatol FD The Journal of Rheumatology SP 469 OP 475 DO 10.3899/jrheum.121081 VO 40 IS 4 A1 Nadine Zeboulon-Ktorza A1 Pierre Yves Boelle A1 Roula Said Nahal A1 Maria Antonietta D'agostino A1 Jean François Vibert A1 Clément Turbelin A1 Homa Madrakian A1 Emmanuelle Durand A1 Odile Launay A1 Alfred Mahr A1 Antoine Flahault A1 Maxime Breban A1 Thomas Hanslik YR 2013 UL http://www.jrheum.org/content/40/4/469.abstract AB Objective. Spondyloarthritis (SpA) is a complex inflammatory disorder. We investigated the influence of environmental factors on SpA disease activity. Methods. A prospective cohort of adults with SpA was followed for 3 years. Patients logged on to a secured Website every 3 months to complete a questionnaire. They reported whether they had been exposed to environmental factors such as stressful or traumatic life events, infections, or vaccinations. Outcome variables included the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Functional Index (BASFI), and pain and patient global assessment (PGA) on visual numerical scales (each rated 0–10). Analyses were performed using a generalized estimating equation for repeated measures, adjusted for the outcome variable collected by the previous questionnaire. Results. In total, 272 patients were included in the analysis, completing the questionnaire on 2240 occasions. The average time (mean ± SD) between 2 connections to the Website was 4.0 ± 2.0 months. Occurrence of life events was followed by an increase of 0.5 (95% CI 0.4–0.7) in the BASDAI, 0.5 (95% CI 0.3–0.6) in the BASFI, 0.7 (95% CI 0.5–0.9) in the PGA, and 0.8 (95% CI 0.6–1.0) for pain (p < 0.0001 for all variations). A moderately statistically significant link was found between vaccination and an elevation of the BASDAI of 0.3 (95% CI 0.0–0.5; p = 0.032). No influence of other factors was detected. Conclusion. This prospective study in a dedicated SpA cohort shows for the first time a link between stressful events and disease activity. Although this link was statistically highly significant, its clinical meaning remains to be determined because the average magnitude of variation of the different variables studied was rather mild.