Quality of life and related variables in patients with ankylosing spondylitis

Objectives

To evaluate quality of life (QoL) and related variables in patients with ankylosing spondylitis (AS), a chronic inflammatory disease of the spine.

Methods

Nine-hundred and sixty-two patients with AS from the Turkish League Against Rheumatism AS Registry, who fulfilled the modified New York criteria, were enrolled. The patients were evaluated using the Assessment of SpondyloArthritis International Society core outcome domains including Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), fatigue (BASDAI-question 1), pain (last week/spine/due to AS), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI), Bath Ankylosing Spondylitis Radiology Index (BASRI), Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) and two QoL questionnaires (the disease-specific ASQoL and generic the Short Form-36 [SF-36]).

Results

The mean ASQoL score was 7.1 ± 5.7. SF-36 subscales of general health, physical role and bodily pain had the poorest scores. ASQoL was strongly correlated with disease duration, BASDAI, fatigue, BASFI, BASMI, BASRI, MASES, pain and SF-36 subscales (P < 0.001). SF-36 subscales were also strongly correlated with BASDAI and BASFI. Advanced educational status and regular exercise habits positively affected QoL, while smoking negatively affected QoL.

Conclusions

In patients with AS, the most significant variables associated with QoL were BASDAI, BASFI, fatigue and pain. ASQoL was noted to be a short, rapid and simple patient-reported outcome (PRO) instrument and strongly correlated with SF-36 subscales.     

强直性脊柱炎患者生存质量及影响因素分析

目的了解强直性脊柱炎（ankylosing spondylitis,AS）患者的生存质量现状,探索影响AS患者生存质量的因素,为指导临床治疗,评价预后提供依据。方法整群抽取2010年6月～2011年6月年安徽医科大学第一附属医院风湿科门诊确诊的AS患者129人,采用SF-36量表对这些患者的生存质量进行评价,并对影响AS患者生存质量的因素进行分析。结果与一般人群相比,AS患者的生存质量下降,与活动性AS患者组bath AS疾病活动性指数（bath AS disease activity index,BASDAI）≥4相比稳定性强直性脊柱炎患者组（BASDAI〈4）的各维度得分除社会功能维度外,其余均升高,差异均有统计学意义（均有P〈0.05）;功能状态较好bath AS功能指数（bath ASfunctional index,BASFI）〈5的AS患者与功能状态较差（BASFI≥5）的AS患者相比,前者的SF-36得分除社会功能维度外,其余均高于后者,差异均有统计学意义（均有P〈0.05）;多因素分析结果显示对治疗前景的态度、BASDAI、BASFI可能影响AS患者的生存质量。结论 AS患者的生存质量与一般人群相比下降。针对影响AS患者生存质量的因素进行宣传教育及积极治疗对改善AS患者的生存质量至关重要。     

Anaesthesia for hip replacement in ankylosing spondylitis.

Thirteen total hip replacements in 8 patients with ankylosing spondylitis are reviewed. Complications of the disease which can lead to anaesthetic difficulties are discussed, and the importance of a preoperative visit and the value of indirect laryngoscopy emphasized. As intubation problems may occur, especially in undiagnosed cases, equipment for emergency intubation should always be readily available. The results fully justify the operation.     

强直性脊柱炎早期表现与诊治探讨

目的探讨强直性脊柱炎的早期表现、诊断和治疗。方法回顾分析强直性脊柱炎的早期症状、体征和误诊情况,结合诊断标准,提出诊断建议。结果强直性脊柱炎早期出现不典型临床表现,根据家族史,积极进行骶髂关节和HLA-B27检查,可作出早期诊断。结论强直性脊柱炎早期诊断、合理治疗与观察,对预后和转归有积极影响。     

强直性脊柱炎合并骨质疏松的临床研究

Objective To investigate the incidence of osteoporosis (OP) in patients with ankylosing spondylitis and the relationship between OP and the clinical data. Methods Serum levels of bone alkaline phosphatase (BALP) and tartrate resistant acid phosphatase 5b (TRACP5b) were detected by enzyme linked immunosorbent assay ( ELISA ) in 60 cases with ankylosing spondylitis, and it was compared with normal controls. Bone mineral density (BMD) was measured through dual-energy X-ray absorptiometry ( DXA), including lumbar ( L2 - L4), bilateral femoral neck and greater trochanter. Some clinical data was collected and analyzed at the same time. Results The incidence of OP in AS patients was 35%, and the incidence of OP in the femoral proximal end was higher than that in lumbar. Compared with normal controls[ ( 1.06 ±0. 18 )U/L ], the levels of serum TRACP5b in AS[ (1.31 ± 0. 82 )U/L] patients was significantly higher ( P <0. 05 ). The levels of serum BLAP in OP combined AS group[ ( 21.65 ± 5.41 ) U/L]were significantly lower than non-OP group[ (32. 37 ± 16. 5 ) U/L] ( P <0. 05 ). The disease duration was negatively correlated with the BMD of femoral neck ( P < 0. 01 ). Conclusions There was higher incidence of OP in AS patients, which were related with the abnormality of bone metabolism and the disease duration.Multiple factors participated in the regulation of bone metabolism of AS.     

强直性脊柱炎合并骨质疏松的临床研究

目的 探讨强直性脊柱炎（AS）患者合并骨质疏松症（OP）情况及其与骨代谢、疾病活动性等的关系.方法 ELISA法检测60例AS患者血清骨代谢指标骨特异性碱性磷酸酶（BALP）、抗酒石酸盐酸性磷酸酶异构体5b（TRACP5b）水平,并与正常对照比较;采用双能X线吸收法（DXA）测定腰椎前后位（L2-L4）、双侧股骨颈、大转子的骨密度（BMD）,并与临床指标进行相关分析.结果 60例AS患者OP发生率为35.0%;股骨近端OP发生率明显高于腰椎;AS组[（1.31±O.82）U/L]较正常对照组[（1.06±0.18）U/L]血清TRACP5b水平显著升高（P〈0.05）;AS合并OP者血清BALP水平[（21.65±5.41）U/L]低于非OP者[（32.37±16.5）U/L]（P〈0.05）;股骨近端BMD与病程呈负相关（P〈0.01）.结论 AS患者存在较高的OP发生率,继发OP与骨代谢异常及病程相关,是多因素共同影响的结果.     

Unexpected back pain in the elderly ankylosing spondylitis patient

A 63-year-old man with ankylosing spondylitis (AS) presented with persistent pain in his back after minor trauma. Radiographs revealed no acute pathology. Six weeks later an MRI scan was performed which showed a vertebral fracture at level Tiii with kyphotic deformity. Another 63-year-old male AS patient presented with back pain after minor trauma 10 days before presentation. At plain radiology a vertebral fracture of Tx was discovered. A third patient, an 83-year-old male AS patient complained about back pain after minor trauma; CT imaging revealed a Tx vertebral fracture. All three patients underwent surgical fixation and were discharged without major complications. In principle, an older patient with an established AS complaining of back pain must be regarded as having a fracture of the vertebral column until the contrary is proven, even in the absence of any recent history of trauma. This strategy can prevent major complication in these patients.