Abstract
BackgroundAnkylosing spondylitis is a major chronic rheumatic disease that predominantly affects axial joints, determining a rigid spine from the occiput to the sacrum. The dorsal hyperkyphosis may induce the patients to stand in a stooped position with consequent restriction in patients’ daily living activities. The aim of this study was to develop a method for quantitatively and objectively assessing both balance and posture and their mutual relationship in ankylosing spondylitis subjects.MethodsThe data of 12 healthy and 12 ankylosing spondylitis subjects (treated with anti-TNF-α stabilized), with a mean age of 51.42 and 49.42 years; mean BMI of 23.08 and 25.44 kg/m2 were collected. Subjects underwent a morphological examination of the spinal mobility by means of a pocket compass needle goniometer, together with an evaluation of both spinal and hip mobility (Bath Ankylosing Spondylitis Metrology Index), and disease activity (Bath Ankylosing Spondylitis Disease Activity Index). Quantitative evaluation of kinematics and balance were performed through a six cameras stereophotogrammetric system and a force plate. Kinematic models together with a test for evaluating balance in different eye level conditions were developed. Head protrusion, trunk flexion-extension, pelvic tilt, hip-knee-ankle flexion-extension were evaluated during Romberg Test, together with centre of pressure parameters.ResultsEach subject was able to accomplish the required task. Subjects’ were comparable for demographic parameters. A significant increment was observed in ankylosing spondylitis subjects for knee joint angle with the target placed at each eye level on both sides (p < 0.042). When considering the pelvic tilt angle a statistically significant reduction was found with the target placed respectively at 10° (p = 0.034) and at 30° (p = 0.019) less than eye level. Furthermore in ankylosing spondylitis subjects both hip (p = 0.048) and ankle (p = 0.029) joints angles differs significantly. When considering the posturographic parameters significant differences were observed for ellipse, center of pressure path and mean velocity (p < 0.04). Goniometric evaluation revealed significant increment of thoracic kyphosis reduction of cervical and lumbar range of motion compared to healthy subjects.ConclusionsOur findings confirm the need to investigate both balance and posture in ankylosing spondylitis subjects. This methodology could help clinicians to plan rehabilitation treatments.
Highlights
Ankylosing spondylitis is a major chronic rheumatic disease that predominantly affects axial joints, determining a rigid spine from the occiput to the sacrum
Ankylosing spondylitis (AS) is a major chronic rheumatic disease that predominantly affects axial joints, determining a diffuse stiffness and with the advanced stage producing a rigid spine from the occiput to the sacrum, for a chronic process of inflammation of the fibrous connective and bone in the tendon and ligament insertions [1,2,3,4,5,6]
This was chosen in agreement with Assessment in Spondyloarthritis International Society (ASAS), whose guidelines suggests that disease monitoring of patients with AS should include: patient history, clinical parameters, laboratory tests, and imaging
Summary
Ankylosing spondylitis is a major chronic rheumatic disease that predominantly affects axial joints, determining a rigid spine from the occiput to the sacrum. Ankylosing spondylitis (AS) is a major chronic rheumatic disease that predominantly affects axial joints, determining a diffuse stiffness and with the advanced stage producing a rigid spine from the occiput to the sacrum, for a chronic process of inflammation of the fibrous connective and bone in the tendon and ligament insertions [1,2,3,4,5,6]. The clinical manifestations of AS are pain, stiffness, fatigue, reduced spinal mobility and respiratory restriction. Other registered symptoms and objective clinical signs of AS are precocious loss of lumbar lordosis, increased dorsal kyphosis and inversion of cervical lordosis, abdominal relaxation for diaphragm breath, hip flexion contracture and consequent knee flexion compensation [2,9]
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