Loss of Balance and Fall Risk, and their Relationship with Disease Activity, Functional Status, Spinal Mobility, Quality of Life and Enthesitis Score in Patients with Ankylosing Spondylitis: A Cross-Sectional Study

Abstract

Objective: This study evaluates the loss of balance and fall risk in patients with Ankylosing Spondylitis (AS), and assesses their relationship with disease activity, functional status, spinal mobility, quality of life and enthesitis score. Method: Included in the study were 50 AS patients who were diagnosed in accordance with the modified New York criteria, and 50 healthy volunteers of similar age and gender. For the AS patients, disease activity was assessed using the Bath Ankylosing Spondylitis Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score (ASDAS) C-reactive protein/Erythrocyte sedimentation rate (CRP/ESR); functional status was assessed using the Bath Ankylosing Spondylitis Functional Index (BASFI); spinal mobility was assessed using the Bath Ankylosing Spondylitis Metrology Index (BASMI); and quality of life was assessed using the Ankylosing Spondylitis Quality of Life Questionnaire (ASQoL). Additionally, a Short form-36 (SF-36) was used to assess quality of life in both the AS patients and the healthy control group; while a Timed Up and Go-test (TUG), Functional Reach Test (FRT), Berg Balance Scale (BBS) and Tinnetti’s Falls Efficacy Scale (TFES) were used to assess balance and fall risk. Enthesitis in the AS patients was evaluated using Maastricht Ankylosing Spondylitis Enthesitis Score (MASES). Results: A comparison of the AS patients and the healthy controls in terms of BBS, FRT, TUG and TFES revealed balance loss and fall risk to be higher in the AS patient group, to a statistically significant degree (p<0.001). BBS, FRT, TUG and TFES were statistically significantly correlated with BASDAI, BASMI, BASFI, ASDAS-ESR, ASDAS-CRP and ASQoL in AS patients (p<0.05), while no statistically significant correlation was identified between BBS, FRT, TUG, TFES and MASES (p>0.05). Conclusions: Loss of balance and fall risk are higher in AS patients than in healthy individuals. Loss of balance and fall risk is associated with disease activity, poor functional status, limited spinal mobility and quality of life in AS patients. That said, there is no association between enthesitis score and loss of balance and fall risk in AS patients. These findings suggest that loss of balance loss and fall risk should be assessed in patients with AS.