Home-based exercise therapy in patients with ankylosing spondylitis: effects on pain, mobility, disease activity, quality of life, and respiratory functions

The home-based exercise therapy recommended to the patients with ankylosing spondylitis (AS) is a simply applicable and cheap method. The aim of this study was to investigate the effects of home-based exercise therapy on pain, mobility, function, disease activity, quality of life, and respiratory functions in patients with AS. Eighty patients diagnosed with AS according to the modified New York criteria were included in the study. Home-based exercise program including range of motion, stretching, strengthening, posture, and respiratory exercises was practically demonstrated by a physiotherapist. A training and exercise manual booklet was given to all patients. Patients following home-based exercise program five times a week at least 30 min per session (exercise group) for 3 months were compared with those exercising less than five times a week (control group). Visual analog scale pain (VASp) values at baseline were significantly higher in the exercise group. The exercise group showed improvements in VASp, tragus–wall distance, morning stiffness, finger–floor distance, modified Schober's test, chest expansion, the Bath Ankylosing Spondylitis Disease Activity Index, the Bath Ankylosing Spondylitis Functional Index, Ankylosing Spondylitis Quality of Life Questionnaire (ASQoL), forced expiratory volume in first second, and forced vital capacity at third month. There was significant difference in ASQoL scores between the two groups in favor of the exercise group at third month. Regular home-based exercise therapy should be a part of main therapy in patients with AS. Physicians should recommend that patients with AS do exercise at least five times a week at least 30 min per session.     

Comparison of group-based exercise versus home-based exercise in patients with ankylosing spondylitis: effects on Bath Ankylosing Spondylitis Indices,quality of life and depression

The objective of this non-randomised controlled trial was to evaluate the impact of group-based exercise programme and a home-based exercise programme on Bath Ankylosing Spondylitis Indices, depression and quality of life in patients with ankylosing spondylitis (AS). Approximately 41 patients in a rehabilitation unit were divided into two groups, either group- or home-based exercise programme. Exercise sessions were performed three times a week for a period of 6 weeks. The patients were compared before and after the rehabilitation programme, with respect to Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Disease Assessment Index (BASDAI), Bath Ankylosing Spondylitis Metrology Index (BASMI), Beck Depression Inventory (BDI) and The Nottingham Health Profile (NHP). A statistically significant improvement was observed on BASDAI, BASMI and energy, pain, reaction of emotional and sleep subscores of NHP in both exercise groups after the exercise programme (p < 0.05). No statistically significant changes were detected in BASFI, BDI and social and mobility subscores of NHP in both exercise groups (p > 0.05). No statistically significant differences were found between the two exercise programmes (p > 0.05). Group and home-based exercise programmes are efficient in improving symptoms and mobility and had an important effect on quality of life in patients with AS. Home-based exercise programme, as it is cheaper, more easily performed and efficient, may be preferable for the management programme in AS.     

Effects of Pilates,McKenzie and Heckscher training on disease activity,spinal motility and pulmonary function in patients with ankylosing spondylitis: a randomized controlled trial

The optimal management of ankylosis spondylitis (AS) involves a combination of nonpharmacologic and pharmacologic treatment aiming to maximize health-related quality of life. The primary objective of our study was to demonstrate the benefits of an original multimodal exercise program combining Pilates, McKenzie and Heckscher techniques on pulmonary function in patients with AS, while secondary objectives were to demonstrate the benefits of the same program on function and disease activity. This is a randomized controlled study on ninety-six consecutive patients with AS (axial disease subset), assigned on a 1:1 rationale into two groups based on their participation in the Pilates, McKenzie and Heckscher (group I) or in the classical kinetic program (group II). The exercise program consisted of 50-min sessions performed 3 times weekly for 48 weeks. Standard assessments were done at week 0 and 48 and included pain, modified Schober test (mST) and finger–floor distance (FFD), chest expansion (CE) and vital capacity (VC), as well as disease activity Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), functional Bath Ankylosing Spondylitis Functional Index (BASFI) and metrology index Bath Ankylosing Spondylitis Metrology Index (BASMI). Groups were comparable at baseline; we demonstrated significant improvement between baseline and after 48 weeks of regular kinetic training for all AS-related parameters in both groups. However, significant improvement was found in pain, lumbar spine motility (mST, FFD), BASFI, BASDAI and BASMI in AS performing the specific multimodal exercise program at the end of study (p = 0.001). Although there were significant improvements in CE in both groups as compared to baseline (group I, p = 0.001; group II, p = 0.002), this parameter increased significantly only in group I (p = 0.001). VC measurements were not significantly changed at the end of the study (group I, p = 0.127; group II, p = 0.997), but we found significant differences within groups (p = 0.011). A multimodal training combining Pilates, McKenzie and Heckscher exercises performed regularly should be included in the routine management of patients with AS for better control of function, disease activity and pulmonary function.     

Health-related quality of life in Moroccan patients with ankylosing spondylitis

The main objective of this study was to assess the aspects of health-related quality of life (QOL) in patients with ankylosing spondylitis (AS) and to explore the disease-related parameters influencing it. One hundred patients with AS according to New York Classification criteria were recruited in this cross-sectional study. The Medical Outcomes Study Short Form 36 Health Survey (SF-36) was used to assess health-related QOL. Assessment criteria included the evaluation of disease activity (Bath Ankylosing Spondylitis Disease Activity index [BASDAI]), global well-being (Bath Ankylosing Spondylitis Global Index [BASGI]), enthesitis (Mander enthesis index [MEI]), functional status (Bath Ankylosing Spondylitis Functional Index [BASFI]); metrology (Bath Ankylosing Spondylitis Metrology Index [BASMI]) and radiographic damage (Bath Ankylosing Spondylitis Radiologic Index [BASRI]). In this study, males comprised 67% of the subjects; mean age was 38 ± 13 years and mean disease duration was 9.5 ± 6.8 years. Among these patients, 52% had hip involvement. Our patients had a moderately active disease and severe functional disability. All domains of SF-36 were deteriorated with low scores. The SF-36 subgroups most affected were role limitation (18.8 ± 28.1), role emotional (19.4 ± 35), general health (44.9 ± 20.3) and vitality (38.0 ± 18.2). Lower scores of SF-36 had good statistically significant correlations with altered functional status (BASFI), worse general well-being (BASGI), altered metrology (BASMI); and moderate correlations with high disease activity (BASDAI), important radiological damage (BASRI); restricted chest expansion and prolonged morning stiffness (p < 0.001). This study states that health-related QOL in Moroccan patients with AS is damaged in a significant way. Mental as well as physical aspects were affected. Functional disability, patient’s well-being, metrology and disease activity are the main factors associated with deteriorating domains of QOL in AS. Recognizing complicated relationships between clinical measures and QOL in patients with AS can help us to develop further management strategies to improve their QOL.     

Improvement in patient-reported outcomes for patients with ankylosing spondylitis treated with etanercept 50 mg once-weekly and 25 mg twice-weekly

OBJECTIVES: The objective of this study was to assess the humanistic impact of ankylosing spondylitis (AS), and compare the effect of etanercept 50 mg once-weekly (QW), etanercept 25 mg twice-weekly (BIW) and placebo on patient-reported outcomes (PROs). METHODS: In a 12-week, double-blind, placebo-controlled multicenter study, 356 patients with active AS received etanercept 50 mg QW, etanercept 25 mg BIW or placebo (3:3:1 randomization, respectively). PROs were assessed using Bath Ankylosing Spondylitis Functional Index, Bath Ankylosing Spondylitis Activity Index fatigue item, EuroQOL-5D (EQ-5D) utility, EQ-5D visual analog scale and the Medical Outcomes Short Form Questionnaire (SF-36) scores at baseline and at regular intervals. Mean changes from baseline in PROs were analysed using analysis of covariance to assess differences between etanercept and placebo, or between the two etanercept groups. RESULTS: Consistent with earlier reports, AS was associated with quality of life (QOL) impairment and functional limitations, similar to or worse than cancer, congestive heart failure, diabetes or depression. Treatment with etanercept 50 mg QW or 25 mg BIW significantly improved QOL and functional status compared with placebo. High proportions of patients achieved clinically meaningful improvements in all PRO measures, including physical function, fatigue, pain, psychosocial domains and general health status. Improvements were similar with the two etanercept dose regimens. CONCLUSIONS: The more convenient etanercept 50 mg QW dose regimen significantly improves function and QOL in patients with AS, similarly to the standard dosing of 25 mg BIW, supporting its use for AS therapy.     

Health-related quality of life in Turkish patients with Ankylosing spondylitis: impact of peripheral involvement on quality of life in terms of disease activity, functional status, severity of pain, and social and emotional functioning

Ankylosing spondylitis (AS) affects sacroiliac joints at early stages and may involve the axial skeleton at later stages of disease. Peripheral involvement usually occurs in lower extremities. When it develops early in the disease course, it is a predictor of more aggressive disease. The aim of this study is to evaluate health-related quality of life (HRQoL) in AS and to assess the impact of peripheral involvement on HRQoL domains in terms of disease activity, functional status, pain, and social and emotional functioning. Seventy-four AS patients were included. Peripheral involvement was present in 51.35 % of the patients. In 65.79 % of these cases the hips, in 31.58 % the knees, in 18.42 % the shoulders and in 13.16 % the ankles were affected. Patients were evaluated by Ankylosing Spondylitis Quality of Life (ASQoL), Short Form-36 (SF-36), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score (ASDAS) and Bath Ankylosing Spondylitis Functional Index (BASFI). ASQoL was strongly correlated with ASDAS, BASDAI, BASFI, and Bath Ankylosing Spondylitis Metrology Index (BASMI), severity of total pain, night pain, fatigue, morning stiffness and ESR. ASDAS and BASDAI showed the strongest correlation with ASQoL. Severity of total pain, functional status and severity of night pain followed it, respectively. Patients with peripheral involvement scored significantly lower in all subgroups of SF36 and significantly higher in ASDAS, BASDAI, BASFI, BASMI and ASQoL scores and levels of pain, night pain, fatigue and morning stiffness. Peripheral involvement is associated with more active disease and functional disability and has a negative influence on HRQoL including physical, social and emotional functioning.     

Fatigue in patients with ankylosing spondylitis: relationships with disease-specific variables, depression, and sleep disturbance

This study was designed to evaluate (a) the frequency of fatigue and its multi-dimensional nature, and (b) its association with demographic variables, disease-specific variables, and other variables, covering depression and sleep disturbance in patients with ankylosing spondylitis (AS). Sixty-two patients with AS were included in the study. Fatigue was assessed by the fatigue item of the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Multidimensional Fatigue Symptom Inventory—Short Form (MFSI-SF). While the disease activity was evaluated by the BASDAI, the functional state was assessed by Bath Ankylosing Spondylitis Functional Index, metrological measurements by Bath Ankylosing Spondylitis Metrology Index, global well-being by Bath Ankylosing Spondylitis Global Score, the pain on rest by VAS (0–10 cm), sleep disturbance by Pittsburgh Sleep Quality Index, and depressive symptoms by Zung Self-Rating Depression Scale. Fifty percent of the patients had severe fatigue. Multi-dimensional assessment with MFSI-SF enabled us to identify fatigue in more detail. The disease-specific variables, covering pain, stiffness, disease activity, and physical functioning, contributed significantly with both BASDAI fatigue and MFSI-SF as dependent variables, accounting for 61.3% and 44.7% of the variance, respectively. Disease activity was the most powerful predictor of both single-dimensioned and multi-dimensioned fatigue. It was also found that the contribution of depression on fatigue was 12%. In conclusion, it was observed that half of the patients had severe fatigue, and multi-dimensional assessment was provided to understand specific aspects of fatigue better. Even though disease activity had a considerable effect on fatigue, the effects of psychogenic factors, especially depression, should be taken into consideration in the management of AS.     

Home-based exercise therapy in ankylosing spondylitis: short-term prospective study in patients receiving tumor necrosis factor alpha inhibitors

The importance of exercise and regular physiotherapy in patients with ankylosing spondylitis (AS) under treatment with tumor necrosis factor alpha inhibitors (TNFα inhibitors) was reported in some studies, but the literature on this topic is still scarce. The aim of this study was to assess the effects of home-based exercise therapy on functional capacity, disease activity, spinal mobility, quality of life, emotional state and fatigue in patients with AS receiving TNFα inhibitors. Forty-two AS patients were trained on the disease, and home-based exercise program was demonstrated to all the patients. At baseline and at the end of 10 week, we evaluated Bath AS Disease Activity Index, Bath AS Functional Index, Bath AS Metrology Index, Multidimensional Assessment of Fatigue Scale, Beck Depression Inventory and Short-Form 36. Patients following home-based exercise program five times a week at least 30 min per session (exercise group) were compared with those exercising less than five times a week (control group). At baseline, exercise and control group had similar demographic features. After 10 weeks, all outcome parameters showed statistically significant improvements in exercise group. There were significant differences in all the parameters except social functioning subscale of Short-Form 36 between groups in favor of exercise group at 10th week (P < 0.05). Home-based exercise program is an effective therapy in increasing functional capacity and joint mobility, decreasing disease activity, improving emotional state, fatigue and quality of life for AS patient receiving TNFα inhibitors. We need to find out new ways to provide continuity of AS patients with it.     

A Turkish version of the Bath Ankylosing Spondylitis Disease Activity Index: reliability and validity

The aim of this study was to develop a Turkish version of the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and assess its reliability, validity, and sensitivity to change. The Turkish version was obtained after a translation and back-translation process. Seventy-one patients with ankylosing spondylitis were assessed with it. To assess its validity, patients were also evaluated with the Turkish version of the Bath Ankylosing Spondylitis Functional Index (BASFI), the Bath Ankylosing Spondylitis Metrology Index (BASMI), the Bath Ankylosing Spondylitis Patient Global Score (BAS-G), and physicians assessments of disease activity. Over 24 h, the Turkish BASDAI did not show significant differences between the two assessments (P>0.05). Correlations were found between BASDAI and all of the evaluation parameters except BASMI (P<0.01). Both BASDAI and BASMI showed significant improvements after 8-week home exercise programmes. The results of this study show that the Turkish version of the BASDAI is reliable, valid, and sensitive to change.     

Efficacy and safety of infliximab in patients with ankylosing spondylitis: results of a randomized, placebo-controlled trial (ASSERT)

OBJECTIVE: The signs and symptoms of ankylosing spondylitis (AS) respond inadequately to nonsteroidal antiinflammatory drugs, corticosteroids, and disease-modifying antirheumatic drugs in quite a number of patients. Tumor necrosis factor inhibitors have demonstrated success in reducing AS disease activity in a limited number of clinical trials. The objective of this multicenter, randomized, placebo-controlled study was to evaluate the efficacy and safety of infliximab in patients with AS. METHODS: Patients were randomly assigned to receive infusions of placebo or 5 mg/kg infliximab at weeks 0, 2, 6, 12, and 18. Efficacy was assessed using the ASsessment in Ankylosing Spondylitis (ASAS) International Working Group criteria, the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), night pain, patient's global assessment, the Bath Ankylosing Spondylitis Functional Index (BASFI), the Bath Ankylosing Spondylitis Metrology Index (BASMI), chest expansion, the Mander enthesis index, the total swollen joint index, the C-reactive protein level, and the Short Form 36 (SF-36) health survey questionnaire. The primary end point in this study was the proportion of patients with a 20% improvement response according to the ASAS International Working Group criteria (ASAS20 responders) at week 24. RESULTS: Of the 357 patients screened, 201 were assigned to receive 5 mg/kg infliximab and 78 were assigned to receive placebo. After 24 weeks, 61.2% of patients in the infliximab group were ASAS20 responders compared with 19.2% of patients in the placebo group (P < 0.001). Clinical benefit was observed in patients receiving infliximab as early as week 2 and was maintained over the 24-week study period. Patients receiving infliximab also showed significant improvements in the BASDAI, BASFI, BASMI, chest expansion, and physical component summary score of the SF-36. Adverse events were reported by 82.2% of patients receiving infliximab and by 72.0% of patients receiving placebo; however, most adverse events in both treatment groups were mild or moderate in severity. CONCLUSION: Infliximab was well tolerated and effective in a large cohort of patients with AS during a 24-week study period.     

Functional disability and quality of life in patients with ankylosing spondylitis

The aim of this study was to evaluate functional disability and quality of life (QOL) in patients with ankylosing spondylitis (AS) and determine the relationship between functional status and measures of clinical condition including QOL. Fifty-one AS patients (45 male, six female) with a mean age of 37.2+/-10.8 years were included. The demographic data of the patients were recorded. Their clinical status was assessed using the Bath Ankylosing Spondylitis Metrology Index (BASMI), Bath Ankylosing Spondylitis Radiology Index (BASRI), and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Global pain of the patients was determined with a visual analog scale (VAS), and QOL status was evaluated with the Nottingham Health Profile (NHP). Twenty-seven patients (52.9%) had peripheral articular involvement. Sixty percent had mild-to-moderate and 25.4% of the patients had severe functional disability, while 5.8% did not report any functional loss. A significant change in the mean scores of all clinical measures except BASRI was observed between patients with and without peripheral arthritis. The clinical measures of disease (BASRI, BASMI, and BASDAI) were all correlated with each other and with laboratory variables. The strongest factors correlating with functional loss were BASMI and BASDAI. The scores of all sections of the NHP were significantly higher, indicating a poor quality of life in AS patients. Peripheral joint involvement had a significant role in the deterioration of QOL. Physical domains of NHP such as pain and physical activity had highest correlations with functional disability, whereas psychosocial domains of NHP were found to correlate more highly with BASDAI and VAS pain scores. These results show the effect of AS, especially when the disease is active and associated with peripheral involvement. In conclusion, current management strategies should focus on decreasing pain, maintaining physical activity, and efforts to improve psychosocial health aspects for increasing QOL in patients suffering from AS.     

Adaptation of the Bath measures on disease activity and function in ankylosing spondylitis into Danish

OBJECTIVE: Adaptation of the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Global Score (BASG), and the Bath Ankylosing Spondylitis Functional Index (BASFI) for defining disease status in ankylosing spondylitis (AS) and related diseases for use in Denmark. METHODS: The BASDAI, BASFI, and BASG were translated into Danish and subsequently field-tested among 17 AS patients for relevance, face, and content validity. Reliability and validity were assessed by administering the new measures and a comparator instrument to 113 AS patients on two occasions. RESULTS: Test-retest reliability was high (>0.90) and the random measurement error was within+/-2.0 for the BASG and within approximately+/-1.5 for BASDAI and BASFI, which is acceptable for most clinical settings. The measures have good internal consistency and are able to discriminate between functional impairment and disease activity according to the Nottingham Health Profile (NHP) and the Stanford Health Assessment Questionnaire (HAQ). CONCLUSION: Danish versions of the BASG, BASDAI, and BASFI are feasible for application in clinical trials and epidemiological studies on AS in Denmark.     

Tramadol/acetaminophen combination as add-on therapy in the treatment of patients with ankylosing spondylitis

This study aimed to determine the safety and efficacy of tramadol 37.5 mg/acetaminophen 325 mg combination tablets (Ultracet®) in patients with ankylosing spondylitis (AS). This was a 12-week, randomized, double-blind, placebo-controlled study. Sixty patients with active AS according to the Modified New York Criteria were enrolled. Active disease was defined by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) for more than 3 at randomization. Subjects were randomized equally into two groups: the treatment group received aceclofenac plus Ultracet® one tablet twice a day, and the control group received aceclofenac plus placebo for 12 weeks. The primary endpoint was a difference of Assessment in Ankylosing Spondylitis (ASAS20) response criteria between two groups at week 12. At week 12, ASAS20 was achieved by 53.3 % of the aceclofenac plus Ultracet group and 31 % of the aceclofenac alone group (p?=?0.047). For the pain visual analogue scale at week 12, there was a reduction of 45.6 % in aceclofenac plus Ultracet group and 25.7 % in the aceclofenac alone group (p?=?0.087). There was no statistically significant difference between two groups in BASDAI, Bath Ankylosing Spondylitis Functional Index, Bath Ankylosing Spondylitis Global Index, Physician Global Assessment, spinal mobility, ESR, hs-CRP, and Ankylosing Spondylitis Quality of Life Questionnaire. A slight increase in total adverse events was noted with dizziness (7.5 vs 1.5 %), vertigo (4.5 vs 1.5 %), and nausea/vomiting (6 vs 0 %) in the Ultracet arm compared to placebo. The tramadol 37.5 mg/acetaminophen 325 mg combination tablet (Ultracet®) might has additional effect to nonsteroidal anti-inflammatory drugs in the treatment of patients with ankylosing spondylitis. It showed marginal benefit in pain and disease activity. However, a slight increase in minor adverse events was noted.     

Assessment of fatigue in patients with ankylosing spondylitis: a psychometric analysis

OBJECTIVES: To investigate whether the single-item fatigue question of the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Multidimensional Fatigue Inventory (MFI) are appropriate instruments to measure fatigue in ankylosing spondylitis (AS); to identify factors that influence fatigue in AS; and to assess how fatigue in all its aspects is associated with quality of life in AS. METHODS: A total of 812 patients with AS were included. Patients completed questionnaires on disease activity (BASDAI), functional ability (Bath Ankylosing Spondylitis Functional Index [BASFI]), global well-being (Bath Ankylosing Spondylitis Global Score [BAS-G]), overall perceived health (EuroQoL visual analog scale), and quality of life (Ankylosing Spondylitis Quality of Life questionnaire, and Short Form 36 [SF-36]). Patients were dichotomized into a F+ group (fatigue = major symptom) if the BASDAI fatigue score was > 5.0 and a F- group (fatigue = minor symptom) if the fatigue score was < 5.0. Reproducibility was assessed with intraclass correlation coefficients, and responsiveness was calculated according to 3 different methods. Logistic regression analysis was used to determine which factors were associated with fatigue. Multiple regression analysis was used to investigate whether fatigue contributes in explaining quality of life. RESULTS: Fifty-three percent of the patients were assigned to the F+ group. They scored significantly worse compared with the F- group with respect to each dimension of the MFI and to all other questionnaires studied (all P < 0.001). The BASDAI fatigue question, as well as each separate dimension of the MFI, showed moderate to good reproducibility (0.57-0.75) and responsiveness (0.23-0.96). Fatigue was, in the opinion of the patients, highly associated with pain (70% of patients) and stiffness (54% of patients). Logistic regression analysis showed that scores on BASDAI, BASFI, BAS-G, and mental health status (SF-36) were independently associated with fatigue (R(2) = 0.52). Multiple regression analysis showed that scores on the BASDAI fatigue question were significantly associated with quality of life. With the 5 MFI dimensions as explanatory variables, different aspects of fatigue were associated with different domains of quality of life. CONCLUSIONS: Fatigue as a major symptom of AS can effectively be measured with either a single-item question on the intensity of fatigue or with the MFI. The MFI, however, provides more insight into specific dimensions of fatigue. Fatigue appears to be associated with the level of disease activity, functional ability, global well-being, and mental health status. In addition, fatigue negatively influences different aspects of quality of life.     

Relationship between the severity of enthesitis and clinical and laboratory parameters in patients with ankylosing spondylitis

In this study, we evaluated the relationship between the severity of enthesitis and outcome of measurement indices, clinical and laboratory parameters in patients with ankylosing spondylitis (AS). Thirty-three patients who fulfilled the modified New York criteria for AS were included in this study. Patients were asked to record the severity of current pain, night pain and morning stiffness on a 10-cm visual analogue scale. Stoke Enthesitis Index (SEI) was used to measure the severity of enthesitis. Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI) and Bath Ankylosing Spondylitis Metrology Index (BASMI) were calculated. SEI was correlated positively only with BASDAI (r = 0.370, P = 0.034). There was no relation between SEI and laboratory parameters (Erythrocyte Sedimentation Rate and C Reactive Protein). Our data suggest that using an enthesitis index such as SEI can be a valuable tool in the evaluation of disease activity in patients with AS. However, evaluation of enthesitis severity is based on information given by patient and should be combined with objective parameters such as spinal measurements when assessing disease activity.     

Relationship of the sexual functions with the clinical parameters, radiological scores and the quality of life in male patients with ankylosing spondylitis

The aim of this study was to explore the impact of ankylosing spondylitis (AS) and the disease-related variables on the patients’ sexual function according to the International Index of Erectile Function (IIEF) scoring system. A total of 70 sexually active male AS patients and 60 healthy controls were enrolled in this study. Their demographic data were evaluated, and the pain was assessed according to the visual analogue scale (VAS). Laboratory tests were conducted in order to measure the C-reactive protein (CRP) and erythrocyte sedimentation rates (ESR) of the patients. The disease activity was evaluated using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Functional statement was evaluated with the help of the Bath Ankylosing Spondylitis Functional Index (BASFI) and with the scores obtained from the spinal measurements with the Bath Ankylosing Spondylitis Metrology Index (BASMI). The Bath Ankylosing Spondylitis Radiology Index (BASRI) was used to evaluate the radiological damage. The disease-related quality of life was measured with the Ankylosing Spondylitis Quality of Life Questionnaire (ASQoL). The anxiety and depression level of the patients was revealed through the Hospital Anxiety and Depression Scale (HADS). In comparison with the healthy control group, patients with AS had significantly lower scores in each of the 5 domains of the IIEF (p < 0.0001). The BASDAI, BASFI, BASMI, BASRI, ASQoL, HADS scores and CRP levels were negatively correlated with IIEF (p < 0.05). Orgasmic function and sexual desire scores were significantly lower in patients with peripheral arthritis (p < 0.05). No significant correlation was observed with the disease duration, smoking status, pain (VAS), and ESR levels when the total scores and the scores from the domains of IIEF were compared. The multivariate regression analyses indicated that BASFI and BASMI were independently associated with the sexual function. The sexual function is impaired in male patients with AS. This impairment in the sexual function is especially correlated with the BASFI and BASMI among the clinical and laboratory parameters.     

Effect of Pilates training on people with ankylosing spondylitis

The objective of this study was to investigate the effects of Pilates on pain, functional status, and quality of life in patients with ankylosing spondylitis. The study was performed as a randomized, prospective, controlled, and single-blind trial. Fifty-five participants (30 men, 25 women) who were under a regular follow-up protocol in our Rheumatology Clinic with the diagnosis of AS according to the modified New York criteria were included in the study. The participants were randomly assigned into two groups: in group I, Pilates exercise program of 1?h was given by a certified trainer to 30 participants 3 times a week for 12?weeks, and in group II, designed as the control group, 25 participants continued previous standard treatment programs. In groups, pre-(week 0) and post treatment (week 12 and week 24) evaluation was performed by one of the authors who was blind to the group allocation. Primary outcome measure was functional capacity. Evaluation was done using the Bath Ankylosing Spondylitis Functional Index (BASFI). Exploratory outcome measures were Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Metrology Index (BASMI), Chest expansion, and ankylosing spondylitis quality of life (ASQOL) questionnaire. In group I, BASFI showed significant improvement at week 12 (P?=?0.031) and week 24 (P?=?0.007). In group II, this parameter was not found to have significantly changed at week 12 and week 24. Comparison of the groups showed significantly superior results for group I at week 24 (P?=?0.023). We suggest Pilates exercises as an effective and safe method to improve physical capacity in AS patients. Our study is the first clinical study designed to investigate the role of Pilates method in AS treatment. We believe that further research with more participants and longer follow-up periods could help assess the therapeutic value of this popular physical exercise method in AS.     

Relationship Between Psychiatric Status,Self-Reported Outcome Measures,and Clinical Parameters in Axial Spondyloarthritis

This article aims to compare the risks of depression and anxiety in patients with ankylosing spondylitis (AS) and nonradiographic axial spondyloarthritis (nr-axSpA) and investigate the relationship among self-reported outcome measures, clinical parameters, and physical variables of patients with axSpA.Patients with axSpA were recruited from Erciyes Spondyloarthritis Cohort. The patients met Assessment of Spondyloarthritis International Society classification criteria for axial SpA and were assessed in a cross-sectional study design for visual analog scale (VAS) pain, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Ankylosing Spondylitis Quality of Life questionnaire (ASQoL), and Ankylosing Spondylitis Disease Activity Score–C-reactive protein (ASDAS-CRP). Psychological status was evaluated using the hospital anxiety and depression scale (HADS). Multivariate logistic regression analysis was applied to determine the associations between psychological variables and clinical parameters after adjusting for confounding variables.Of the 316 patients (142 nr-axSpA, 174 AS), 139 (44%) had high risk for depression (HADS-D score ≥7) and 71 (22.5%) for anxiety (HADS-A score ≥10). HADS-D and HADS-A scores were similar between patients with AS and nr-axSpA. Patients with high risk for depression and anxiety had higher scores in BASDAI, BASFI, and ASDAS-CRP, and also poorer scores in VAS pain and ASQoL. Multivariate logistic regression analysis showed that the ASDAS-CRP, ASQoL, BASDAI, as well as educational level were factors associated with the risk of depression whereas the ASQoL and educational level were factors associated with the risk of anxiety.Patients with nr-axSpA and AS have similar burden of psychological distress. The quality of life (ASQoL) and educational level were factors associated with the risk of both depression and anxiety whereas disease activity (BASDAI and ASDAS-CRP) was the independent risk factor associated with depression but not anxiety in axSpA. These findings suggest that psychological status should be examined while assessing patients with axSpA including AS and nr-axSpA.     

Quality of life in patients with ankylosing spondylitis: a pilot study

The aims of this study were to evaluate quality of life (QOL) in patients with ankylosing spondylitis (AS) and to determine the relationship between QOL and clinical condition/functional status. Forty-six AS patients (37 males) were included in the study. The demographic data of the patients were recorded. Disease activity Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), enthesitis involvement Mander Ehthesis Index (MEI), functional evaluation Bath Ankylosing Spondylitis Functional Index (BASFI), and quality of life Short-Form 36 (SF-36) were assessed. The mean age of the patients was 39.2 (SD: 11. 46) years. Most MEI was found related to physical function (P = 0.014), physical role (P = 0. 01), pain (P = 0.002) and vitality (P = 0.004) in SF-36 subgroups. Among the subgroups, the best correlations with the general health was found in BASDAI (P = 0.014) and secondly in MEI (P = 0.038). None of the mental health and social function subgroups had any significant correlation with any of the parameters (P > 0.05). A significant relationship was found between the emotional role and BASFI, and chest expansion (P = 0.004). Clinical and functional state were affecting QOL of patients with AS. It has been found out that in patients with AS, the QOL subgroups are mostly related with enthesis involvement.     

Spinal mobility and its impact in Moroccan patients with ankylosing spondylitis

The main objective of this cross-sectional study was to assess spinal mobility and its relationship with disease-related parameters of activity, severity, and quality of life in Moroccan patients with ankylosing spondylitis (AS). One hundred patients with AS according to New York Classification criteria were recruited. Chest expansion, Schober index, occiput-to-wall distance, and the combined index of Bath Ankylosing Spondylitis Metrology Index (BASMI) were used to assess spinal mobility. Assessment criteria included the evaluation of disease activity (Bath Ankylosing Spondylitis Disease Activity index), functional status (Bath Ankylosing Spondylitis Functional Index), and radiographic damage (Bath Ankylosing Spondylitis Radiologic Index).The short form-36 (SF-36) generic instrument was used to assess health-related quality of life. The mean age of patients was 38?±?13?years. There were 67% of males in our data. Our patients had moderate disease activity, severe functional disability, and important radiological damage. The mean value of occiput-to-wall distance was 4?±?6.2?cm, chest expansion was 3.4?±?1.2?cm, Schober index was 2.7?±?1.2?cm, and BASMI was 4?±?3. Impaired spinal mobility, corresponding to higher scores of BASMI, had good statistically significant correlations with prolonged disease duration, severe functional disability (BASFI), important radiological damage (BASRI) and with the deterioration of most domains of SF-36 (p?相似文献