Ankylosing Spondylitis Quality Of Life Research Articles

The relationship between clinical parameters and ultrasonographic enthesitis assessment in patients with spondyloarthritis

Objectives: The study aimed to evaluate the role of ultrasonographic assessment of enthesitis in patients with spondyloarthritis (SpA) in terms of disease activity, functionality, and quality of life. Patients and methods: Ninety SpA patients (57 males, 33 females; mean age: 37.5±9.7 years; range, 18 to 60 years) were included in cross-sectional study between November 2016 and January 2017. Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score (ASDAS), Bath Ankylosing Spondylitis Functional Index (BASFI), Short Form-12 (SF-12), and Ankylosing Spondylitis Quality of Life (ASQoL) were utilized for clinical evaluation. The clinical evaluation of enthesitis was performed with the Spondyloarthritis Research Consortium of Canada (SPARCC) and Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) via an algometer calibrated to 4 kg/cm2 of pressure. Ultrasound evaluation was performed according to Madrid Sonographic Enthesitis Index (MASEI). A total of 2,610 entheseal sites were examined clinically, and 1,080 were assessed ultrasonographically. Results: A significant proportion of enthesitis (463/1,080) was detected on ultrasonographic evaluation but not with clinical enthesitis score (MASES and SPARCC). Although ultrasonographic entheseal evaluation detected enthesitis in at least one enthesis of all patients, 35 of the patients had no enthesitis with clinical examination. The sites most frequently involved in the entheses were the proximal patellar tendon and Achilles tendon. The MASEI score did not correlate with the MASES, SPARCC, BASDAI, SF-12, and ASQoL but moderately correlated with the C-reactive protein (CRP) level (r=0.348), ASDAS-CRP (r=0.294), and BASFI score (r=0.244). Conclusion: The association of ultrasonography scores with CRP levels and ASDAS-CRP indicates that ultrasonography is effective in detecting inflammation. The MASEI score weakly correlates with functionality but not with quality of life. Ultrasonographic evaluation is invaluable and merits to be incorporated into SpA disease scoring system.

Relationships of Work Productivity and Activity Impairment With Patient-Reported Outcomes in Ankylosing Spondylitis: Results From Two Trials.

We examined the relationships of work productivity and activity impairment with key patient-reported outcomes (PROs) assessing pain, disease activity, and health-related quality of life (HRQoL) in patients with ankylosing spondylitis (AS). This post hoc analysis pooled available data from baseline to end of the double-blind phase of phase 2 and 3 placebo-controlled tofacitinib trials in patients with active AS. A repeated-measures longitudinal model assessed the relationships (linear or nonlinear) between Work Productivity and Activity Impairment questionnaire in Spondyloarthritis (WPAI:SpA) domains (absenteeism, activity impairment, presenteeism, and productivity loss) as outcomes and key PROs (total back pain, nocturnal spinal pain, Patient Global Assessment of Disease Activity, AS Quality of Life, EuroQol 5-Dimension 3-Level [EQ-5D-3L], and EQ-5D Visual Analog Scale [EQ-5D-VAS]) as predictors. Data from 330 to 475 patients were available, depending on the analysis. Relationships between WPAI:SpA domains and PROs were approximately linear. The worst PRO scores were associated with a decline in patients' work capacity (measured by activity impairment, presenteeism, and productivity loss [>65%]); the best scores were associated with improvements in WPAI:SpA domains (8%-23%). Incremental PRO improvements were associated with improvement of activity impairment, presenteeism, and productivity loss. Relationships between absenteeism and PROs were the weakest, owing to absenteeism being low in the study population. Evidence of linear relationships between work productivity and activity impairment with patient-reported pain, disease activity, and HRQoL was observed. Interventions to control pain and disease activity and improve HRQoL are therefore likely to improve work productivity and reduce activity impairment in patients with AS.

Transfacetal and transpedicular anterior decompression with posterior stablilization: Effective way for managing all cases of andersson lesion

Abstract Background: Andersson lesion (AL), also known as aseptic spondylodiscitis, is a pathological condition characterized by a destructive lesion in the vertebral or discovertebral region. The aim of this study was to assess functional, radiological, and neurological outcome of midline posterior surgery with transfacetal/transpedicular decompression and long-segment instrumentation and fusion in all patients with AL. Materials and Methods: A total of 36 consecutive patients with AL with or without neurodeficit were managed with midline posterior approach with long-segment fixation, decompression and anterior vertebral reconstruction added by same midline approach. The demographic data, visual analogue scale (VAS), modified Oswestry Disability Index (mODI), ankylosing spondylitis quality of life (ASQoL), local and global kyphosis angle, Frankel neurological grade, blood loss, duration of surgery, perioperative complications, and fusion rate were compiled and assessed. Results: The mean age of the patients was 52 years (26 males and 10 females). Among the patients, 9 patients had thoracic, 25 patients had thoracolumbar, and 2 patients had lumbar vertebral involvement. All patients in the study achieved fusion at final follow-up period of 24 months. The mean duration of hospital stay, intraoperative blood loss, and surgery duration was 6.17 days, 252 mL, and 130 min, respectively. VAS improved from mean 7.69 ± 0.98 to 1.67 ± 0.72, mODI from mean 70.28 ± 3.55 to 21.14 ± 2.13, ASQoL from mean 14.22 ± 1.59 to 7.17 ± 1.25, local kyphosis from 23.61 ± 1.67 to 18.52 ± 1.05, and global kyphosis from 57.02 ± 0.72 to 36.16 ± 1.23, leading to better sagittal balance. Except two patients all had full neurological recovery. Conclusions: Posterior midline approach with long-segment instrumentation and anterior decompression by transpedicular/transfacetal approach and bone grafting with selective use of cages can give satisfactory results with excellent fusion rates and good functional outcomes.

Online physiotherapy for people with axial spondyloarthritis: quantitative and qualitative data from a cohort study

Life-long exercise is essential in axial spondyloarthritis (axSpA) management; however, long-term adherence is challenging. Online exercise programmes are an alternative to face-to-face physiotherapy. (1) To measure adherence to a 12-month, individualised, online physiotherapy programme for people with axSpA, and investigate the effects on disease activity, spinal mobility, work ability, quality of life and function. (2) To investigate associations between programme adherence and outcomes. (3) To explore participants’ views of the programme and factors affecting adherence. Participants were ‘non-exercisers’ recruited from rheumatology outpatient services. Adherence was measured using online diary entries. Outcomes included the BATH indices, health status (EQ5D), Ankylosing Spondylitis Quality of Life (ASQOL), exercise capacity (6MWT), Work, Productivity and Activity Impairment in AS (WPAI), Exercise Attitude Questionnaire (EAQ) and Exercise Motivations Inventory-2 (EMI-2) at baseline, 6 and 12 months. Interviews determined views on the intervention and factors affecting adherence. Fifty participants were recruited. Over the 52-week intervention, adherence (five times/week) ranged from 19% (± 30%) to 44% (± 35%). Significant improvements were found in disease activity (BASDAI), spinal mobility (BASMI), 6MWT, AsQoL and EQ5D-VAS at 6 and 12 months. There were no associations between adherence and baseline variables or demographics. Interviews suggested support from others, routine, and feeling the benefit positively affected adherence. Conversely, lack of motivation, life events and symptoms negatively affected adherence. A 12-month online physiotherapy programme significantly improved symptoms in people with axSpA who were not regular exercisers. Adherence reduced over the intervention period. Online exercise programmes may benefit people with axSpA; however, strategies to improve adherence are required.

A comparison of the clinical characteristics and quality of life of male and female patients with non-radiographic axial spondyloarthritis

ObjectiveThe aim of this study was to compare the clinical characteristics and quality of life of male and female patients with non-radiographic axial spondyloarthritis (nraxSpA) to determine the differences and similarities. Patients and methodsThe study included 100 patients, comprising 50 males and 50 females, aged 18–65 years, who presented at the Rheumatology Clinic and were diagnosed with nr-axSpA according to the Assessment of Spondyloarthritis International Society (ASAS) criteria. The data of patient age, gender, body mass index, disease duration, and drugs used were recorded. Disease activity was evaluated with the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), mobility with the Bath Ankylosing Spondylitis Metrology Index (BASMI), functional status with the Bath Ankylosing Spondylitis Functional Index (BASFI), enthesitis with the Maastricht Ankylosing Spondylitis Enthesitis Score (MASES), and quality of life with the Ankylosing Spondylitis Quality of Life (ASQoL). The patients with nr- axSpA were separated into groups as male and female, and the demographic and clinical data were compared. ResultsThe mean age of female patients was determined to be statistically significantly higher than that of the male patients (39.04 ± 0.70 vs. 34.28 ± 9.26 years, p:0.014). A statistically greater number of male patients were smokers (p:0.007). The disease duration and time since diagnosis were determined to be significantly longer in females than in males (p:0.029, p:0.004). Peripheral arthritis was determined at a significantly higher rate in females (p < 0.001). The MASES score was 2.66 ± 3.46 in females and 0.52 ± 1.03 in males, and the difference was statistically significant (p < 0.001). The BASDAI score was significantly higher in females (3.74 ± 2.35) than in males (2.88 ± 1.95) (p:0.05). No statistically significant difference was determined between the two groups in respect of BASFI, BASMI, ASQoL, and other parameters. ConclusionThe results showed older age, longer disease duration and time to diagnosis, higher rates of peripheral arthritis, and higher MASES and BASDAI scores in the female patients. Thus, there are some differences between male and female patients. Further studies should determine what kind of changes these differences will make in the clinical status, follow-up and treatment of patients.

AB1809-HPR DETERMINATION OF PRE-SARCOPENIA IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS

BackgroundSarcopenia is described as the decline in muscle mass and strength that generally occurs with increased age which may cause increased fall risk, mortality, disability, and adverse health outcomes. Patients with axial spondyloarthritis (axSpA) may be more prone to sarcopenia due to the presence of chronic inflammation.ObjectivesThis study aims to determine the presence of sarcopenia or pre-sarcopenia and to clarify the associated factors with pre-sarcopenia.MethodsThis cross-sectional study recruited 39 patients with axSpA. Sarcopenia was assessed according to the European Working Group on Sarcopenia in Older People in 2018 (EGSWOP2) criteria by evaluating muscle mass, gait speed, and grip strength. Muscle mass was measured using a bioimpedance body analyzer. Physical performance was assessed with the five times sit-to-stand (FTSTS) test and Short Physical Performance Battery (SPPB). Quality of life (QoL) and physical activity level were evaluated using Ankylosing Spondylitis Quality of Life (ASQoL) questionnaire and the International Physical Activity Questionnaire – Short Form (IPAQ-SF) respectively. Between-group comparison and correlation analysis were performed.ResultsThe mean age of the patients was 47.58±6.78 with (64.1 % women), the mean disease duration was 8.17±7.33 years, and the mean body mass index was 28.05±4.74 kg/m2. Pre-sarcopenia was detected in 43.6% of all patients which was defined by low grip strength and no patients had sarcopenia. Patients with pre-sarcopenia were more physically inactive, had worse quality of life, and had lower physical performance compared with those without pre-sarcopenia (p &lt; 0.05). The grip strength as the indicator of pre-sarcopenia was significantly moderately correlated with the SPPB (r = -0.48, p = 0.002), FSST (r = -0.43, p = 0.006), ASQoL (r = -0.45, p = 0.003), and IPAQ-SF (r = 0.48, p = 0.002).ConclusionPre-sarcopenia is commonly detected in axSpA patients and physical performance is impaired which may result in a further decline in functional status. Maintaining adequate muscle strength and muscle function in patients with axSpA may contribute toward improving QoL. Patients with axSpA should be assessed in terms of sarcopenia-related findings.

An Innovative and Highly Efficient Single-Port Endoscopic Nipple-/Skin-Sparing Mastectomy and Dual-Plane Direct-to-Implant Breast Reconstruction: A Prospective Study from a Single Institution.

The difficulty in creating and maintaining a stable workspace of the breast makes endoscopic nipple-/skin-spring mastectomy (E-N/SSM) develop slowly. This study aims to report the preliminary results of a novel endoscopic technique for N/SSM followed by dual-plane direct-to-implant (DP-DTI) breast reconstruction. A prospectively maintained database was reviewed that included patients who underwent single-axillary-incision E-N/SSM and DP-DTI breast reconstruction from September 2020 to April 2021 at a single institution by three surgeons. The data were collected prospectively and analyzed to determine the efficacy, feasibility, safety, and esthetic results of the operation, as well asquality of life (QoL). During the study period, a total of 68 E-N/SSM and DP-DTI reconstruction procedures through a single axillary incision were performed in 63 female patients. Among all the procedures, the majority were performed for grade 1-3 ptotic breasts (n =46, 73.0%). During the median follow-up of 26.5 months, themajor and minor surgical complication rates were 1.6% (1/63) and 9.5% (6/63), respectively. The cosmetic complication rate was 14.3%. One patient suffered local recurrence 4 months postoperation. The average scores in patient-reported outcomes at 2 years postoperation of satisfaction with breast (66.57), psychosocial well-being (75.93) and sexual well-being (56.29) were not significantly different compared with the baseline, except for physical well-being: chest (69.85). The proposed procedure for E-N/SSM and DP-DTI breast reconstruction is feasible, time-saving and safe with good outcomes in terms of cosmetic results and QoL and expands the indications of DTI reconstruction to ptotic breasts, making it easier to popularize. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Validation of the Korean Ankylosing Spondylitis Quality of Life Questionnaire.

Measuring accurate and reliable scores of quality of life in patients with ankylosing spondylitis (AS) is important in both decision-making and treatment planning for the disease. Questionnaire, The ankylosing spondylitis quality of life (ASQoL), is one of the representative tools for assessing how seriously AS patients view their disease severity, activity, as well as their overall health. To make these types of questionnaires readable and understandable, local language translation of surveys should be required. A Korean version of the ASQoL questionnaire has accordingly been developed. This study assessed the Korean version of the ASQoL survey to evaluate the reliability and validity of it. Translation and reverse translation of the English ASQoL survey were conducted. A total of 120 consecutive AS patients received a mail including the Korean-translated 36-Item Short Form Survey (SF-36), the ASQoL survey, and the visual analog scale (pain). The coefficient of intraclass correlation and Cronbach's alpha were computed, and factor analysis, as well as reliability assessments utilizing the kappa agreement statistics for each item, was undertaken. By analyzing the responses to SF-36 and ASQoL questionnaire utilizing Pearson's correlation coefficient, construct validity was calculated. Factor analysis was performed regarding pain, physical function, and mental function. The kappa statistic of agreement was larger than 0.6 for all items. The ASQoL questionnaire had adequate test and re-test reliability (0.814). Furthermore, Cronbach'sα, the internal consistency, was very good (0.877). The Korean-translated ASQoL questionnaire demonstrated a significantly strong correlation between the single domain and total SF-36 scores. The Korean version of the ASQoL questionnaire showed acceptable properties of measurement and successful translation. Thus, it can be said that the questionnaire is appropriate for evaluating the outcomes of Korean patients with AS.

Cross-cultural adaptation and validation of the Ukrainian version of the Standardized Evaluation of Pain (StEP) — a tool for assessing neuropathic pain in the lower back in patients with ankylosing spondylitis

Objective — to create a Ukrainian‑language version of the Standardized Evaluation of Pain (StEP) through translation and cross‑cultural adaptation with subsequent validation in patients with ankylosing spondylitis (AS).&#x0D; Methods and subjects. The translation and cross‑cultural adaptation of the StEP questionnaire was carried out in accordance with the standard recommendations of the Guidelines for the process of cross‑cultural adaptation of self‑report measures. 49 patients with a diagnosis of AS according to the modified New York criteria and duration of pain in the lower back ≥ 3 months and 31 persons of the control group were examined. AS activity in patients was assessed using the ASDAS (Ankylosing Spondylitis Disease Activity Score) and BASDAI (Bath Ankylosing Spondylitis Disease Activity Index), functional status — according to the BASFI (Bath Ankylosing Spondylitis Functional Index) and BASMI (Bath Ankylosing Spondylitis Metrology Index) indices. The ASQoL (Ankylosing Spondylitis Quality of Life Questionnaire) index was used to assess the quality of life of AS patients. The intensity of pain in AS patients was determined using a visual analog scale. The Leeds assessment of neuropathic symptoms and signs (LANSS) and the DN4 questionnaire (Douleur Neuropathique en 4 Questions) were used to compare the results of the StEP questionnaire. The statistical analysis of the results was carried out using the methods of variational statistics using the SPSS22 software package (SPSS Inc.).&#x0D; Results. According to disease activity indices, high and very high disease activity prevailed in patients with AS: the average value according to ASDAS was 3.8 ± 0.8, according to BASDAI — 5.5 ± 1.2. Functional disorders according to BASFI were 5.2 ± 1.8 on average, range of motion in the spine according to BASMI was 5.2 ± 2.3. The quality of life of patients with AS according to ASQoL was on average 8.3 ± 4.4. Pain intensity according to the visual analog scale — 6.1 ± 1.5. The reliability of the Ukrainian‑language version of the StEP questionnaire was assessed by the test‑retest method with an interval of 7 days in 22 patients with AS. The analysis of the received data proved the high reliability of the StEP questionnaire (intraclass correlation coefficient was 0.987). Cronbach’s alpha coefficient (0.987) confirmed the internal consistency of the Ukrainian version of the StEP questionnaire. The sensitivity of the StEP questionnaire showed a close pairwise correlation (Spearman’s correlation coefficient — 0.955). Testing of the StEP questionnaire in patients with AS revealed the presence of neuropathic pain in 55.1 % of cases. The average value of the StEP questionnaire in AS patients was 4.6 ± 5.3, in the control group it was 0.1 ± 0.4. The final values of the StEP questionnaire were statistically significantly correlated with LANSS and DN4 indicators (p &lt; 0.01).&#x0D; Conclusions. The Ukrainian‑language version of the StEP questionnaire was created, and its cross‑cultural adaptation and validation was carried out. The Ukrainian‑language version of the StEP questionnaire showed a sufficient level of reliability and validity for further use in scientific and medical practice for the Ukrainian‑speaking population. In patients with AS, using the Ukrainian version of the StEP questionnaire, the presence of a neuropathic component of the pain syndrome is detected in 55 % of cases, which should be taken into account when treating this cohort of patients.&#x0D;  

The Effect of Neuropathic Pain on Sleep Quality in Patients with Axial Spondyloarthritis

Objective: This study aims to determine whether neuropathic pain (NP) presence affects sleep quality in patients with axial spondyloarthritis (AxSpA). Materials and Methods: Demographic data of the patients were documented. The patient's NP was evaluated with painDETECT questionnaire. Pittsburgh Sleep Quality Index (PSQI), Ankylosing Spondylitis Quality of Life (AsQoL), Ankylosing Spondylitis Disease Activity Score (ASDAS-CRP), and visual analog scale (VAS) were used to evaluate sleep quality, quality of life (QoL), pain severity and disease activity, respectively. Results: Among the 108 patients who participated in the researh, 51 were female and 57 were male. NP was found in 41.7% of them. 65.7% Of all patients had a sleep disorder. AxSpA patients with NP had a statistically significant higher VAS-activity, VAS-night, and VAS-rest scores (p&lt;0.001, p&lt;0.001, p=0.002, respectively). They also had higher ASQoL scores and higher disease activity. (p=0.008, p=0.012, respectively). Although impaired sleep was detected in 71.1% of AxSpA patients with NP, it was present in 61.9% of AxSpA patients without NP, and we didn’t find a statistically significant difference (p=0.32). Total painDETECT scores were correlated with PSQI ASQoL, and VAS scores (p&lt; 0.001). But there was no correlation with ASDAS-CRP scores (p=0.57). Conclusion: A large majority of AxSpA patients have a sleep problem, independent of the presence of NP. Not only targeting the inflammatory pain but also targeting NP and sleep disorder together in the follow-up of patients with AxSpA will improve QoL.

Tele-yoga in the management of ankylosing spondylitis amidst COVID pandemic: A prospective randomized controlled trial

PurposeAnkylosing spondylitis (AS) signficantly affect day to day activities contributing to signficant disability. Patients with AS often report to have psychological problems and poor quality of life (QoL). This study investigates the effect of a three-month tele-yogic intervention on disease activity, functional index, inflammatory markers, quality of life and mental health measures in patients with AS. MethodsOne hundred and twenty AS patients were assigned to either the yoga intervention group (YG) or the control group (CG). The YG (n = 57) received a 60-min structured yoga module online for 3 months in addition to standard medical care. The CG participants (n = 52) received only standard care during the same period. Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Ankylosing Spondylitis-Quality of Life (ASQOL) and psychological and inflammatory biomarkers were assessed at baseline and after three months. ResultsYG showed significant improvement in BASDAI (p = 0.001), anxiety (p = 0.0004), and depression (p = 0.001) at three months compared to baseline. The CG showed no significant change in similar outcome measures. At three months, the intervention resulted in a significant improvement in BASDI (−0.79; 95% CI (−1.3, to −0.29); p = 0.0021), BASFI (−0.86, 95% CI (−1.59, to −0.14); p = 0.0193), anxiety (−0.42, 95% CI (−0.84 to −0.01), p = 0.0468), and AS-QoL (−3.37; 95% CI (−5.21 to 1.53); p = 0.0004) compared to the CG. ConclusionsThe present study suggests that yoga helps improve pain, functional index, and mental health in patients with AS. Tele-yoga intervention is feasible and effective in treating AS.

The effect of Aqua Stretching exercises and Pilates on pain, function and spine posture in patients with ankylosing spondylitis: a randomized controlled trial

BackgroundAqua Pilates and Aqua Stretch exercises are different and new methods for the rehabilitation of musculoskeletal disorders. This study aimed to compare the effectiveness of Aqua Stretch and Aqua Pilates interventions in the treatment of pain, function, and posture of the spine in ankylosing spondylitis (AS) patients.MethodsForty patients participated in this study who were randomly allocated into Aqua Stretch, aqua Pilates, and control. The experimental groups received four 60-min training sessions each week for six weeks. However, the control group had only its routine drug treatment (NSAIDs & Anti TNF). Pain with Visual Analog Scale (VAS), function with Bath Ankylosing Spondylitis Functional Index (BASFI) and 40-m walking test (MWT), quality of life with ankylosing spondylitis quality of life (ASQoL), and posture of the spine with the Spinal Mouse were evaluated. Evaluations were performed before and after the interventions. Repeated measure ANOVA was employed to determine the main and interaction effects.ResultsAqua Stretch and Aqua Pilates had a significant effect on pain (Aqua-Pilates: P = 0.0001; Aqua-Stretch: P = 0.0001), BASFI (Aqua-Pilates: P = 0.01; Aqua-Stretch: P = 0.02), 40-MWT (Aqua-Pilates: P = 0.006; Aqua-Stretch: P = 0.0001) and ASQoL (Aqua-Pilates: P = 0.01; Aqua-Stretch: P = 0.001), spinal range of motion (ROM) (Aqua-Pilates: P = 0.0001; Aqua-Stretch: P = 0.0001) at a similar ratio. However, the control group did not present any improvement in these factors (P > 0.05). Moreover, the minimal clinically important difference (MCID) revealed that the Aqua Stretch group performed better than the Aqua Pilates group in terms of VAS, ASQOL, and 40-MWT factors.ConclusionsAqua Stretch and Aqua Pilates had statistically the same effect on improving pain, function, quality of life, and spinal ROM, while MCID results revealed that the Aqua Stretch group performed better than the Aqua Pilates in terms of VAS-ASQOL-40-MWT.Trial registration It is notable that local ethics committee approval was obtained (IR.KUMS.REC.1399.1137), and the study was registered in Iranian Registry of Clinical Trials (IRCT; IRCT20190426043377N3; registered on 22/05/2021, https://fa.irct.ir/user/trial/56058/view) and patient recruitments were started on 06/07/2021.

Effects of Brief Intervention of Behavioural Change on Pain, Mobility, Function, and Quality of Life in Patients with Chronic Ankylosing Spondylitis: A Randomised Clinical Trial

Background: Exercise is essential for maintaining the flexibility and functionality of the joints in patients with ankylosing spondylitis. Additionally, it could ease pain, enhance posture, correct muscular imbalances, facilitate breathing, and generally enhance the quality of life. However, since patient education is poorly structured, patients fail to consider this significant element. Objective: To determine the effects of brief intervention of behavioural change on pain, mobility, function, and quality of life in patients with chronic ankylosing spondylitis Methods: This was a randomized controlled trial with 80 patients in two groups: brief intervention and control. Purpose sampling was used to enrol ankylosing spondylitis patients aged 18 to 60 with stable medical management. Patients with respiratory, cardiac, neurological, pregnancy, or inability to walk unassisted were excluded. All participants provided written informed consent. Cardiorespiratory test duration, physical activity duration per week, flexibility measured by chest expansion, back pain usual, back pain at night, global disease activity, Bath Ankylosing Spondylitis Functional Index (BASFI) and Ankylosing Spondylitis Quality of Life (ASQoL) scale. Week 0 before treatment, 6th week end, and 12th week follow-up were assessed. Data was analysed in SPSS 25.0. Results: The results showed that the demographic variables were equally distributed in both groups without a significant association to any group (p value &gt;0.05) except for urban residence where urban residents were having more percentage of ankylosis spondylitis. The results regarding outcome variables post-interventional 8th week showed that Cardiorespiratory test duration 881±(47.23) and 812±(56.89), Flexibility, chest expansion 6.7±(2.75) and 5.2±(2.14), Back pain usual 2.7±(0.79) and 3.4±(1.04), Back pain at night 3.8±(1.78) and 4.4±(1.54), Global disease activity 6.2±(1.97) and 6.7±(2.03), Bath Ankylosing Spondylitis Functional Index (BASFI) 7.4±(1.16) and 7.2±(1.69) and Ankylosing Spondylitis Quality of Life (ASQoL) scale 12.6±(1.25) and 15.7±(1.05). while the p value (&lt;0.05) showed significant difference in favour experimental group, brief intervention for all variables. Similarly, the follow up results measured at 16th week were significantly different in favour experimental group, brief intervention for all variables, p value (&lt;0.05 Conclusion: The findings of study concluded that brief intervention-based health improving physical activity was significantly on pain, mobility, function, and quality of life in patients with chronic ankylosing spondylitis. Keywords: Brief Intervention, Physical Activity, Ankylosing Spondylitis, Back Pain, Spinal Mobility

Ankilozan spondilitte iş engelliliği ve iş verimliliği kaybı ile ilişkili faktörler

Objective: To assess the rate of employment and factors associated with work productivity loss in Ankylosing spondylitis (AS).&#x0D; Material and Method: This study was designed as a cross-sectional study that included 70 patients with AS. Fatigue, morning stiffness, and pain were assessed on a visual analogue scale (VAS). Disease activity, physical function, quality of life, anxiety and depression were assessed using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Ankylosing Spondylitis Quality of Life (ASQoL), and Hospital Anxiety and Depression Scale (HAD), respectively. We used the Work Productivity and Activity Impairment Questionnaire (WPAI) to determine the impact of AS on work productivity. The clinical and demographic characteristics of working and not working patients were compared. Factors associated with absenteeism and presenteeism were assessed using univariable logistic and linear regression analysis, respectively.&#x0D; Results: Mean age of 70 patients (24 women, 46 men) with AS was 42.96 ± 7.83 years. The percentages of working patients was 65.7%. The percentages of presenteeism and absenteeism were 60.21% and 37%, respectively. The clinical and demographic characteristics of working and not working patients were not different (p&gt;0.05). Absenteeism was associated with low educational level (odds ratio [OR]=7.636; 95% confidence interval [CI]=1.782-32.723; p=0.006), morning stiffness (OR=1.545; 95% CI=1.118-2.134; p=0.008), BASDAI (OR=1.645; 95% CI=1.088-2.489; p=0.018), and ASQoL (OR=1.392; 95% CI=1.094-1.772; p=0.007). In the linear regression model, BASDAI (β=8.394; 95% CI=5.570-11.217; p

The effects of clinical pilates training on disease-specific indices, core stability, and balance in patients with ankylosing spondylitis

ObjectiveTo assess the effects of clinical Pilates training on disease-specific indices, core stability, and balance in ankylosing spondylitis (AS) patients. MethodsAS patients were randomly assigned to either the Pilates group (PG) or control group (CG). The PG participated in Pilates training 3 times a week for 8 weeks. Patients in the CG were instructed to follow a home exercise program for 8 weeks. Assessments were performed before and after the interventions. BASDAI, BASFI, BASMI, and the AS Quality of Life (ASqOL) questionnaire were used were used to evaluate disease activity, functionality spinal mobility and quality of life respectively. Static core endurance was assessed with trunk flexor, extensor endurance, and lateral bridge tests, while dynamic core endurance was assessed using modified sit-up test. Balance was evaluated with bilateral and unilateral stance static postural stability (PS), bilateral stance dynamic PS and limits of stability (LOS) tests using the Biodex Balance System. ResultsTwenty-one patients in the PG and 21 patients in the CG completed the study. PG showed statistically significant improvements in BASDAI, BASFI, BASMI, and ASQoL scores, all core endurance tests, and dynamic PS and LOS results. The CG demonstrated significant improvement only in flexor endurance and LOS results. Post-intervention BASDAI, BASMI, and all core endurance tests were significantly better in the PG than in the CG (p < 0.05). ConclusionPilates training has positive effects on disease activity and functional capacity, spinal mobility, core endurance, balance, and quality of life in AS patients. Clinicaltrials.gov identifierNCT04292028.

Which Metrological Index, the BASMI or EDASMI, is Best Correlated with Disease-Related Parameters in Spondylarthritis Patients?

This study aimed at comparing the Edmonton Ankylosing Spondylitis Metrology Index (EDASMI) and Bath Ankylosing Spondylitis Metrology Index (BASMI) to determine which of the two is best correlated with disease-related parameters in axial spondyloarthritis (axSpA) patients. A cross-sectional study was carried out involving 86 patients with radiographic axSpA. Sociodemographic data, the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Ankylosing Spondylitis Disease Activity Score (ASDAS), the Bath Ankylosing Spondylitis Functional Index (BASFI), and the Ankylosing Spondylitis Quality of Life (ASQoL) questionnaire were applied. Spinal mobility was assessed by two indices: the BASMI and the EDASMI. Structural damage of the spine was also evaluated by two indices: the Bath Ankylosing Spondylitis Radiology Index (BASRI) and the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). Eighty-six patients with an average age of 43.21 ± 11.43 years (20-79) were included. Impaired spinal mobility, which corresponds to higher BASMI scores, was correlated with prolonged disease duration (p < 0.01, r = 0.310), higher ASDAS-CRP (p < 0.001, r = 0.386), severe functional disability on the BASFI (p < 0.01, r = 0.505) and poorer quality of life according to the ASQoL (p < 0.01, r = 0.369). However, the EDASMI score did not correlate with any disease parameter. The BASMI was correlated with the total BASRI (p < 0.01, r = 0.634) and mSASSS (p < 0.01, r = 0.388). Unlike the BASMI, the EDASMI was neither correlated with the BASRI (p = 0.520, r = 0.245) nor the mSASSS (p = 0.252, r = -0.120). Our results indicate that among the studied metrological indices, the BASMI is more contributory since it is correlated with clinical disease parameters and structural damage, unlike the EDASMI.

Association of fear assessment in inflammatory rheumatic diseases (FAIR) questionnaire with ankylosing spondylitis quality of life and disease activity in patients with ankylosing spondylitis

Background/Aim: Fear against disease course, treatment, and limitations in family, work, and social life are commonly seen but mostly overlooked by physicians of patients with chronic inflammatory rheumatic diseases. Ankylosing spondylitis (AS) is a chronic inflammatory disease in young adults characterized by limitations in spinal mobility. The Fear Assessment (FAIR) Questionnaire was designed especially for patients with rheumatoid arthritis and spondyloarthritis to assess the level of fear from the patient’s perspective. Here we evaluate the FAIR score in AS patients and its association with disease activity, AS quality of life (ASQoL), depression, anxiety, and fatigue levels.&#x0D; Methods: This cross-sectional study included 79 patients with AS, and disease activity was assessed by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), AS-Disease Activity Score-C reactive protein, and functional status was assessed by Bath Ankylosing Spondylitis Functional Index (BASFI). Patient global assessment of disease and pain were scored on 0–10 cm visual analog scores. All patients completed FAIR and ASQoL questionnaires. The depression and anxiety were evaluated by Hospital Anxiety and Depression Scale (HADS), and fatigue was assessed by Fatigue Severity Scale (FSS).&#x0D; Results: The mean age of AS patients (62% male) was 41.7 (11.3) years. Most of the patients were on biological disease-modifying anti-rheumatic drugs (bDMARDs). The patients’ median BASDAI, ASDAS-CRP, and BASFI were 5.4 (range, 3.8–7.4), 3.83 (1.4), and 4.0 (range, 2.3–6.2), respectively. The overall FAIR, ASQoL, FSS, HADS-depression, and HADS-anxiety scores were 75 (range, 52–91), 9.6 (5.2), 5.4 (range, 4.1–7), 7.7 (4.4) and 9.6 (5.2), respectively. There were statistically significant correlations between disease activity indices and FAIR, ASQoL, FSS, and HADS scores. The FAIR scores significantly correlated with ASQoL, FSS, and HADS scores. The patients with active disease (BASDAI ≥ 4) had significantly higher levels of FAIR, ASQoL, FSS, and HADS. The best cut-off value for the FAIR score of AS patients with moderate to severe disease activity was 50 (AUC: 0.734, 95% CI [0.599–0.870], P = 0.002), with a sensitivity of 89.8%, specificity of 55%, positive likelihood ratio of 1.99, and Youden index of 0.45.&#x0D; Conclusion: This study shows that AS patients face a high level of fear which is associated with higher disease activity, higher risk of mood disorders, and lower quality of life. Physicians should not only focus on the physical improvement of the patient but also handle the fear of patients against their diseases and their treatment. This holistic approach will improve the dialogue between the physician and the patient, which will result in increased compliance with treatment and will raise the quality of care.

Sonographic Comparison of Neck Extensor Muscle Thickness of Ankylosing Spondylitis and Non-radiographic Axial Spondyloarthritis Patients with Healthy Volunteers

Abstract Introduction This study examines the neck extensor muscle thickness of patients with ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (nr-axSpA) by comparing them with healthy volunteers. It also aims to evaluate the relationship between muscle thickness and disease activity, functional parameters, neck disability and quality of life in patients with AxSpA. Method In this cross-sectional study, 30 patients with AS and 30 patients with nr-AxSpA who were admitted to a Physical Medicine and Rehabilitation outpatient clinic were included consecutively. Thirty healthy participants were included as a control group. The thickness of muscles was measured bilaterally by ultrasound and the muscle thickness average was recorded. All patients with axSpA were asked to complete the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Functional Index (BASFI), the Bath Ankylosing Spondylitis Metrology Index (BASMI), the Ankylosing spondylitis Quality of Life (AsQoL) scale and the Neck Disability Index (NDI). Results Mean patient age was 42.36±10.0 in the AS group, 38.13±7.94 in the nr-axSpA group and 39.06±8.25 in the healthy group. A statistically significant decrease was found in multifidus, semispinalis capitis, semispinalis cervicis and splenius capitis muscle thickness in AS patients compared with the healthy group, and in semispinalis cervicis muscle thickness in nr-axSpA patients compared with the healthy group. However, when trapezius muscle thickness was compared between the groups, no statistical difference was found. There was a significant negative correlation between neck extensor muscle thickness and age, BASDAI, NDI and AsQoL in patients with axSpA. Conclusion The thickness of the neck extensor muscles is decreased in patients with AxSpA compared with healthy individuals, and this situation can be reliably detected by ultrasound.

Minimal Impact of the COVID-19 Pandemic on Disease Activity and Health-Related Quality of Life in Patients With Ankylosing Spondylitis Receiving Bimekizumab: Exploratory Analyses From a Phase 2b Open-Label Extension Study.

ObjectiveThe impact of the COVID‐19 pandemic on patients with inflammatory rheumatic diseases, such as ankylosing spondylitis (AS), has been variable. Here, we assess disease activity and health‐related quality of life (HRQoL) through the pandemic in patients with AS.MethodsIn the open‐label extension (OLE) of the phase 2b BE AGILE study, patients with AS received 160 mg of subcutaneous bimekizumab every 4 weeks. We assessed Ankylosing Spondylitis Disease Activity Score with C‐reactive protein (ASDAS‐CRP), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Quality of Life (ASQoL) scores in the OLE immediately before and during the COVID‐19 pandemic (September 2019 to April 2021).ResultsA total of 232 patients remained in the BE AGILE OLE and were included in this post hoc study at the start of the analysis period (September 1, 2019); 12 patients had a COVID‐19 treatment‐emergent adverse event, and no cases resulted in death. The number of missed bimekizumab doses due to COVID‐19 (11 doses) was minimal, and missed assessments remained low (≤5%) compared with the prepandemic period. Mean ASDAS‐CRP (1.8), BASDAI (2.4), and ASQoL scores (2.8) in the OLE were low at pre‐pandemic baseline and remained stable at 1.7 to 1.8, 2.2 to 2.4, and 2.0 to 2.8, respectively, across successive 3‐month periods immediately before and during the pandemic. ASDAS‐CRP, BASDAI, and ASQoL stability was consistent across major study countries.ConclusionDisease activity and HRQoL remained stable during the COVID‐19 pandemic in patients with AS receiving bimekizumab in the BE AGILE OLE, with no indication of negative effects on these outcomes.

Residual Disease in Patients with Axial Spondyloarthritis: A Post-Hoc Analysis of the QUASAR Study.

In this study, we evaluated the presence of residual disease in patients with axial spondyloarthritis (axSpA) in remission/low disease activity (LDA) status. This cross-sectional post-hoc analysis of the QUASAR study involving 23 rheumatology centres across Italy included adults with axSpA classified according to the Assessment of SpondyloArthritis International Society criteria. Patients with inactive disease (score < 1.3) or at least LDA status (score < 2.1) at baseline visit according to Ankylosing Spondylitis Disease Activity Score were investigated to evaluate how residual disease activity impacts patients’ quality of life. They were assessed using the Ankylosing Spondylitis Quality of Life (ASQoL) and EuroQoL 5-Dimension 5-Level (EQ-5D-5L) questionnaires. This study included 480 patients with axSpA (mean age, 47.5 ± 12.9 years, 64% male). In total, 123 patients (25.6%) had inactive disease and 262 (54.6%) had at least LDA. Using the ASQoL, ranges of 10–25% and 20–40% of patients with inactive disease and with LDA status, respectively, experienced tiredness/fatigue. Despite being classified with inactive disease, 48.8% of patients reported light pain/discomfort according to the EQ-5D-5L, with 4.1% reporting moderate pain/discomfort, whereas 55.7% of patients with LDA reported light pain/discomfort and 13% had moderate pain/discomfort. Using the ASQoL questionnaire, in patients with at least LDA, a higher proportion of women compared with males and a higher proportion of patients > 48 years of age (vs. patients ≤ 48 years) experienced tiredness. In this post-hoc analysis, ≥25% of axSpA patients in remission/LDA status were still burdened by residual disease, mainly characterised by pain and fatigue.