Cross-cultural adaptation and validation of the Chinese version of the Health Assessment Questionnaire for the Spondyloarthropathies (HAQ-S)

The Health Assessment Questionnaire for Spondyloarthropathies (HAQ-S) is a commonly used questionnaire to evaluate function and health status of patients with ankylosing spondylitis (AS). The objective of this study was to cross-culturally adapt the HAQ-S into Chinese and then to evaluate its reliability and validity. The Chinese version of the HAQ-S was obtained with a five-step procedure of translation and cross-cultural adaptation. All invited patients met the New York criteria for AS, and a total of 103 patients finally participated in this study. Intraclass correlation coefficient (ICC) was used to evaluate the test-retest and inter-rater reliability of the HAQ-S. Internal consistency of the questionnaire was evaluated by Cronbach’s alpha coefficient. Spearman’s correlation coefficient was calculated to assess the construct validity between the HAQ-S and Bath AS Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI), Bath AS Metrology Index (BASMI), and the laboratory parameters (erythrocyte sedimentation rate, ESR; C-reactive protein, CRP). Test-retest and inter-rater reliability were excellent with intraclass correlation coefficients of 0.987 (p < 0.05) and 0.982 (p < 0.05), respectively. The overall internal consistency of the HAQ-S was found satisfactory (Cronbach’s alpha = 0.914). The Chinese version of the HAQ-S correlated good with the BASFI (r = 0.749, p < 0.01), and moderate with the BASDAI (r = 0.581, p < 0.01) and the BASMI (r = 0.425, p < 0.01). But, the adapted questionnaire correlated poorly with ESR (r = 0.298, p < 0.01) or CRP (r = 0.283, p < 0.01). The Chinese version of the HAQ-S is reliable and valid for the evaluation of Chinese-speaking patients with AS.     

Translation, cultural adaptation, and validation of the Bath questionnaires and HAQ-S in Hindi for Indian patients with ankylosing spondylitis

The disease activity and functional impact of ankylosing spondylitis (AS) is currently measured through various questionnaire instruments, the most popular of which are the Bath indices. However, Hindi versions for use in Indian patients are not available. This study aimed to fill this lacuna. Translation and cross-cultural adaptation of the instruments—Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitits Metrology Index (BASMI), Bath Ankylosing Spondylitis Patient Global Score (BAS-G), and Health Assessment Questionnaire-Spondyloarthropathy (HAQ-S)—were done using standard guidelines. These were then self-administered to patients. The BASMI measurements, occiput-to-wall distance, chest expansion (in centimeters), total enthesis count, ESR, and C reactive protein (CRP) were measured. To assess reliability, the patient was called back on day 14, and the questionnaires were again self-administered, and the intra-class correlation coefficient was calculated to assess reliability. Correlation of questionnaire scores with acute phase reactants, measurements, and enthesitis index were used to assess for construct validity. Some modifications were done in the Bath indices and HAQ-S for cross-cultural adaptation. For validation, 41 patients of ankylosing spondylitis with a mean age of 34?years (±10.2) and disease duration of 5.8?years (±6.2) were included. The Bath Ankylosing Spondylitis Functional Index (BASFI), BASDAI, and HAQ-S showed good correlation among themselves (r?=?0.69 to 0.84, p?<?0.001), except for BAS-G with HAQ-S (r?=?0.53, p?<?0.001). Correlation between BASDAI and ESR (0.31, p?=?0.05), CRP (0.48, p?<?0.001), and enthesitis score (0.32, p?=?0.045) was fair. Similarly, there was fair correlation of BASFI with ESR (0.55, p?<?0.001), CRP (p?=?0.60, p?<?0.001), and various metrological measurements. These suggest convergent validity. However, there was a lack of correlation between metrological measurements and BASDAI, demonstrating divergent validity. The intra-class correlation coefficients between baseline and retest were acceptable: BASDAI intra-class correlation coefficients (ICC) 0.87 (0.78–0.93), BASFI ICC 0.90 (0.82–0.94), BAS-G ICC 0.75 (0.58–0.86), and HAQ-S ICC 0.91 (0.84–0.95). The Hindi versions of the BASDAI, BASFI, BAS-G, and HAQ-S were found to be valid and reliable for use in Hindi-speaking Indian patients with ankylosing spondylitis.     

Validity and reliability of the Turkish version of the Health Assessment Questionnaire for the Spondyloarthropathies

The Health Assessment Questionnaire for Spondyloarthropathies (HAQ-S) was built by adding five new questions related with cervical and lumbar spine functions to HAQ by Daltroy et al. (in J Rheumatol 17(7):946–945, 1990). The aim of this study was to adapt the added five items into Turkish and then to test its reliability and validity. New questions were adapted to Turkish according to ‘translation-back translation’ method. Seventy-nine patients with ankylosing spondylitis were asked with the Turkish version of HAQ-S (HAQ-S TV). To assess, construct validity patients were evaluated by HAQ, Bath AS Functional Index (BASFI), Bath AS Disease Activity Index (BASDAI), Bath AS Metrology Index (BASMI), Maastricht AS Enthesitis Score (MASES), Ankylosing Spondylitis Quality of Life (ASQoL), and laboratory variables (erythrocyte sedimentation rate, C-reactive protein). Construct validity was investigated with Spearmann’s rank correlation coefficient. Reliability of HAQ-S TV was assessed by internal consistency. Inter- and intra-observer reliability were tested with Cronbach’s alpha score. HAQ-S TV met set criteria of reliability and validity. Reliability of adapted version was found good with high internal consistency value. (Cronbach’s alpha?=?0.89). In addition to this intra-observer and inter-observer reliability were found adequate for total score of HAQ-S (Cronbach’s alphas: 0.999 and 0.998 in order) and also for each added five questions (Cronbach’s alphas >0.7). Positive correlations were found between HAQ-S TV and HAQ, BASFI, BASDAI, BASMI, MASES, ASQoL, ESR, and CRP (P?<?0.05). The results of this study showed that HAQ-S TV was reliable and valid in patients with AS.     

Comparison of the Bath Ankylosing Spondylitis Radiology Index and the modified Stoke Ankylosing Spondylitis Spine Score in Turkish patients with ankylosing spondylitis

The objective of the present study was to compare two radiographic scoring methods (the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) and the Bath Ankylosing Spondylitis Radiology Index-spine (BASRI-spine)) in terms of reliability, construct validity, and feasibility in Turkish ankylosing spondylitis (AS) patients. The study involved seventy-four patients. The patients were evaluated with 100-mm visual analog scale (VAS) for pain, global assessment of patient, and global assessment of doctor. The laboratory evaluations of patients comprised erythrocyte sedimentation rate and serum C-reactive protein. Bath AS Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI), Bath AS Metrology Index (BASMI), and Bath AS Radiology Index (BASRI) were calculated. Bilateral cervical, lumbar spine, and anteroposterior pelvis radiographs of all patients were obtained and evaluated by two radiologists. Each radiograph was scored by two scoring methods, mSASSS and BASRI-spine, and these methods were tested according to the aspects of the Outcome Measures in Rheumatology Clinical Trials filter: reliability, construct validity, and feasibility. The BASRI-spine reached intra- and interobserver intraclass correlation coefficient (ICC) of 0.726 and 0.689, respectively. The mSASSS scores more reliable, with ICC of 0.831 and 0.840, respectively. The BASMI and BASFI correlated significantly with the two scoring systems, respectively (mSASSS r: 0.557, r: 0.319; BASRI-spine r: 0.605, r: 0.285). For the two methods, the magnitude of the correlation with disease duration was similar (mSASSS p < 0.01 and BASRI p < 0.01), but no significant correlation was observed when compared to the BASDAI. It is known that the BASRI-spine is a feasible method that reliably detects damage in patients with AS. However, the present authors believe that, in AS patients, mSASSS should be the radiological scoring method to choose because of less radiation exposure, along with excellent intra- and interobserver reliability.     

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.     

Psychometric evaluation of the Moroccan version of the Bath Ankylosing Spondylitis Functional Index (BASFI) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) for use in patients with ankylosing spondylitis

The objectives of this study are to translate, adapt in the Moroccan cultural context, and validate in patients with ankylosing spondylitis (AS) the Bath Ankylosing Spondylitis Functional Index (BASFI) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). The cross-cultural adaptation of the BASFI and BASDAI was obtained in accordance with the guidelines for translation of the health status measures. Eighty-five patients with AS were included in the study. The test–retest reliability and the internal consistency were analyzed, and both questionnaires were assessed for external construct validity. Structural validity was analyzed with correlation matrix. Twenty-four-hour test–retest reliability was good: BASFI intraclass correlation coefficient (ICC) = 0.96 (confidence interval (CI) at 95%, 0.93–0.97), BASDAI ICC = 0.93 (CI at 95%, 0.90–0.95). Cronbach’s alpha was 0.90 for the BASFI and 0.86 for BASDAI. The construct validity of the instruments was evaluated. The BASFI showed a strong validity when correlating its results with Schober’s test (r = −0.56), occipital wall distance (r = 0.46), chest expansion (r = −0.46), BASDAI (r = 0.54), Bath Ankylosing Spondylitis Metrology Index (r = 0.70), Bath Ankylosing Spondylitis Global Score (BAS-G; r = 0.58), Bath Ankylosing Spondylitis Radiology Index (r = 0.61), and the radiological changes in sacroiliac joints (r = 0.54). A good correlation was observed between the BASDAI and the spinal pain (r = 0.53), the number of nocturnal awakenings (r = 0.57), the morning stiffness (r = 0.65), the enthesic index (r = 0.47), the BAS-G (r = 0.53), the BASFI (r = 0.54), and the erythrocyte sedimentation rate (r = 0.41; for all p < 0.001). The correlation matrix showed an intermediate correlation between items. The Moroccan version of the BASFI and the BASDAI showed adequate reliability and validity. These instruments can be used in the clinical evaluation of Moroccan and Arabic-speaking patients with AS.     

Comparison of performance of the Assessment of Spondyloarthritis International Society,the European Spondyloarthropathy Study Group and the modified New York criteria in a cohort of Chinese patients with spondyloarthritis

Early diagnosis of spondyloarthritis (SpA) is essential as anti-tumor necrosis factor therapy can achieve significant symptomatic relief and control of disease activity. This study aims to compare the clinical characteristics, disease activity, and functional status of a Chinese cohort of SpA patients who were re-classified into ankylosing spondylitis (AS) patients fulfilling the modified New York (MNY) criteria, those with undifferentiated SpA (USpA) fulfilling the European Spondyloarthropathy Study Group (ESSG) classification criteria only (USpA/ESSG) and those who fulfill Assessment of SpondyloArthritis International Society (ASAS) only (USpA/ASAS). Disease activity was evaluated by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), severity of morning stiffness, patient global assessment, and C-reactive protein. Functional status was evaluated by Bath Ankylosing Spondylitis Functional Index (BASFI), modified Schober index, and dimension of chest expansion. One hundred and twenty-eight patients with disease duration of 16.3 ± 10.4 years were recruited. Patients in USpA/ESSG and USpA/ASAS were significantly younger (p = 0.01), had shorter disease duration (p < 0.01), and lower BASFI (p = 0.03) than established AS patients. All three groups have active disease with comparable BASDAI >3. BASFI correlated inversely with dimension of chest expansion and negatively modified Schober index in AS patients (p < 0.01) and modestly with BASDAI (r = 0.25, p < 0.01). BASFI correlated moderately with BASDAI in USpA/ESSG (r = 0.61, p < 0.01) but not with chest expansion or modified Schober index. Compared with established AS patients recognized by MNY criteria, patients fulfilling USpA defined by ESSG or ASAS criteria had earlier disease, as active disease and less irreversible functional deficit.     

T he relationship between enthesitis indices and disease activity parameters in patients with ankylosing spondylitis

In this study, patients with ankylosing spondylitis (AS) were assessed both by patient and physician using two enthesitis indices and the relationship between these indices and disease activity parameters was investigated. The study involved 100 AS patients. The patients were evaluated with 10-cm visual analog scale (VAS) for spinal pain (VAS-S), peripheral joint pain (VAS-P), global assessment of patient, and global assessment of doctor. In the laboratory evaluations, the erythrocyte sedimentation rates (ESR) and serum C-reactive protein levels of the patients were determined. Bath AS disease activity index (BASDAI), Bath AS functional index (BASFI), Bath AS metrology index, and Bath AS radiology index were calculated. The severity of enthesitis was evaluated according to Mander enthesitis index (MEI) and Maastricht ankylosing spondylitis enthesitis score applied by both the patient (MASES-P) him/herself and the physician (MASES-D). There was a correlation between BASDAI and BASFI as well as MEI, MASES-D, and MASES-P indices (r = 0.447, r = 0.342, r = 0.663, r = 0.530, r = 0.464, and r = 0.435, respectively). No correlation between the laboratory parameters and enthesitis indices were detected. In multiple linear regression analysis, BASFI, VAS-S, and female gender (41.3%) were the best predictors of MEI-D, whereas BASFI, VAS-S, female gender, and ESR (32.5%) were the best predictors for MASES-D and BASFI (18.9%) was the best predictor of MASES-P. The assessment of simple and easily applicable MASES score by a patient may be expected to help the physician in clinical practice. When the disease activity of the patients with AS are evaluated, both BASDAI, the clinical importance of which has been confirmed in numerous studies and which is recommended by ASAS, and BASFI, which is valued by patients, should be considered.     

Diet,disease activity,and gastrointestinal symptoms in patients with ankylosing spondylitis

The aims of this study were to investigate, firstly, the relationship between diet and disease activity and, secondly, the presence of gastrointestinal symptoms and their relationship to diet among patients with ankylosing spondylitis (AS) using a cross-sectional design. One hundred sixty-five individuals diagnosed with AS were invited to complete a self-administered postal questionnaire regarding demographic data, diet, medication, and gastrointestinal symptoms in addition to two established disease assessment questionnaires, i.e., the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI). No significant correlation between diet and disease activity was found. Overall, 27% of the patients reported aggravating gastrointestinal problems when consuming certain foodstuff(s). The 30% of patients who reported suffering from gastrointestinal pain had significantly greater disease activity and poorer functional status according to their BASDAI and BASFI scores (p < 0.01 and p = 0.01, respectively). Patients who reported gastrointestinal pain had a significantly higher consumption of vegetables (p < 0.01) and lower consumption of milk and soured milk (p = 0.04). No significant correlation was found between the use of non-steroidal anti-inflammatory drugs (NSAID) and gastrointestinal symptoms. In multiple regression models, BASDAI and the consumption of vegetables were independent and statistically significant predictors of gastrointestinal pain. To conclude, in a group of Swedish AS patients, no correlation between diet and disease activity could be detected. There were, however, correlations between diet and gastrointestinal pain. Gastrointestinal problems were also found to be prevalent in AS, independent of NSAID usage.     

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.     

THE BATH ANKYLOSING SPONDYLITIS PATIENT GLOBAL SCORE (BAS-G)

In the absence of an ideal objective measure for assessing ankylosingspondylitis (AS), self-administered measures of disease activity(the Bath Ankylosing Spondylitis Disease Activity Index, BASDAI)and function (the Bath Ankylosing Spondylitis Functional Index,BASFI) have been developed, in addition to an objective measureof spinal mobility (the Bath Ankylosing Spondylitis MetrologyIndex, BASMI). However, a more global assessment is also desirable.We report on the design and validation of a global measure (theBath Ankylosing Spondylitis Patient Global Score, BAS-G) whichreflects the effect of AS on the patient's well-being. A pilotstudy was performed to select the most appropriate wording forBAS-G. Using 392 patients with AS, BAS-G's construct and predictivevalidity and test-retest reliability were assessed. Correlationsbetween BAS-G and BASDAI/BASFI were calculated, and multipleregression was used to examine the significant correlates. Thedistribution of the responses covered the whole scale. As predicted,BAS-G correlated best with BASDAI (r= 0.73), followed by BASFI(r = 0.54). The best fitting regression equation included thesescales as well as patients' gender and current age. One weekand 6 month scores were significantly different (P < 0.001).Construct validity was good: BAS-G correlated more stronglywith each component of BASDAI and BASFI than with BASMI or withgender. Predictive validity was satisfactory: there was an improvement(mean = 29%) in in-patient BAS-G scores over a 2 week treatmentperiod (P < 0.001). Test-retest reliability was excellent(1 week r = 0.84, 6 months r = 0.93). BAS-G correlates wellwith both BASDAI and BASFI, suggesting that disease activityand functional ability play a major role in patients' well-being,whereas metrology does not. The score is sensitive to change,reliable, and meets face, predictive and construct validitycriteria. KEY WORDS: Ankylosing spondylitis, Global score, Validation, Well-being, Outcome     

Expression of IL-2 and IL-11 and its significance in patients with ankylosing spondylitis

ObjectiveTo explore the expression of IL-2 and IL-11 and its significance in patients with ankylosing spondylitis (AS).MethodsA total of 48 active AS patients in our hospital and 40 normal control subjects were selected in our study. Bath ankylosing spondylitis disease activity index (BASDAI), Bath ankylosing spondylitis functional index (BASFI), Bath ankylosing spondylitis metrology index (BASMI), ESR and CRP expression levels were compared before treatment, 12 h after treatment and 24 h after treatment. IL-2 and IL-11 expression were also compared between these two groups.ResultsThe BASDAI score, BASFI score and BASMI score of the AS patients before treatment significantly decreased compared with those 12 weeks and 24 weeks after treatment (P<0.05). ESR and CRP levels of the AS patients 12 weeks and 24 weeks after treatment significantly decreased compared with those before treatment (P<0.05). Difference was significant in serum IL-2 and IL-11 levels between 12 weeks and 24 weeks after treatment and before treatment (P<0.05). And no statistically significance was observed for serum IL-2 and IL-11 levels between normal control group and those of patients in AS group 24 weeks after treatment (P>0.05). Pearson's linear-correlation analysis showed that serum IL-2 level had a positive correlation with BASDAI, BASFI, BASMI, ESR and CRP (r=0.661,0.547,0.474,0.362,0.416, P<0.05) and serum IL-11 level had a negative correlation with BASDAI, BASFI, BASMI, ESR and CRP (r=-0.629, ?0.412, ?0.422, ?0.387, ?0.408, ?0.315, P<0.05).ConclusionsSerum levels of IL-2 in active AS patients significantly increase and will decrease after treatment. However, serum levels of IL-11 significantly decrease and will increase after treatment, which indicates that serum IL-2 has a positive correlation with the degree of AS and serum IL-11 has a negative correlation with the degree of AS, both of which are correlated closely with the onset of AS.     

No effect of physiotherapy on the serum levels of adipocytokines in patients with ankylosing spondylitis

To investigate the effect of intensive physiotherapy on disease activity and serum levels of adipocytokines in patients with ankylosing spondylitis (AS). Twenty-six patients with AS were included in this study. Intensive physiotherapy was performed twice a week for a period of 3 months. The Bath AS Disease Activity Index (BASDAI) and the Bath AS Functional Index (BASFI) were assessed at inclusion and after 3 months. Leptin, adiponectin, resistin and visfatin serum levels were analysed by ELISA assays. Patients had mild to moderate disease activity. Baseline levels of adipocytokines did not correlate with indicators of disease activity, functional status or acute-phase reactants. After the 3 months of intensive physiotherapy, BASDAI significantly decreased from 2.98 to 1.8 (p = 0.01) and BASFI improved from 2.31 to 1.37 (p = 0.05), while there were no changes in serum levels of CRP, ESR and adipocytokines. In addition, baseline levels of adipocytokines did not predict the change of disease activity or functional ability. Intensive physiotherapy effectively reduces all clinical measures of disease activity, but it is not associated with a significant change in acute-phase reactants or serum levels of adipocytokines.     

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.     

Adaptation of the Bath Ankylosing Spondylitis Functional Index to the Turkish population, its reliability and validity: functional assessment in AS

The aim of this study was to adapt the Bath Ankylosing Spondylitis Functional Index (BASFI) to the Turkish population and investigate the reliability and the validity of the Turkish version. Seventy-six patients with ankylosing spondylitis (AS) were included in the study. The functional status of the patients was assessed by using the adapted Turkish version of the BASFI twice, at recruitment and 24 h later. For validity analysis, patients were also assessed by the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) evaluating disease activity, the Bath Ankylosing Spondylitis Global Score (BAS-G) indicating effect of the disease on patients well-being, physicians assessment of the disease activity and pain intensity. Spinal mobility was assessed by the Bath Ankylosing Spondylitis Metrology Index (BASMI). Erythrocyte sedimentation rate (ESR) and serum C-reactive protein (CRP) levels of the patients were also recorded. The lumbar region and the sacroiliac joints were assessed by Stoke Ankylosing Spondylitis Spine Score (SASSS) and the hip joints were assessed by Bath Ankylosing Spondylitis Radiology Index hip (BASRI-h). The internal consistency was 0.89 (Cronbachs alpha), which showed a high reliability for the Turkish version of the BASFI. Test-retest reliability was good, with a high intraclass correlation coefficient between the two time points (ICC=0.93). Significant correlations were detected between the BASFI and the BASDAI, BAS-G, doctors global assessment, and general pain intensity (r=0.62, p<0.001; r=0.47, p<0.001; r=0.55, p<0.001; r=0.47, p<0.001, respectively). The adaptation of the BASFI to the Turkish population was successful and it was found to be reliable and valid among Turkish patients. Thus, studies using the Turkish BASFI can be compared with international studies.     

Relationship between spinal mobility measures and quality of life in patients with ankylosing spondylitis

The aim of this study was to assess spinal mobility status and Quality of life (QoL) of patients with ankylosing spondylitis (AS) and determine the relationship between spinal mobility and measures of clinical condition including QoL. A total of 74 patients with AS were included in this study. Disease specific instruments Bath Ankylosing Spondylitis Metrology Index (BASMI), Bath Ankylosing Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI) were applied, and mobility testing: occiput-wall distance and chest expansion. QoL was assessed by the Short Form-36 (SF-36). The mean age was 48.5 years; there were significant correlations between BASMI score and age (P < 0.001), disease duration (P < 0.001), symptoms duration (P < 0.001) and BASFI (P < 0.001). BASMI was negatively correlated with SF-36 physical function subscale (P < 0.001) and general health subscale (P = 0.029). In multivariate regression analysis, BASFI score (P < 0.001) was independently associated factor with physical function domain of SF-36. This study showed that in AS spinal mobility measures are associated with physical function, general health, emotional role and mental health domains of QoL.     

Does exercise affect the antioxidant system in patients with ankylosing spondylitis?

We aimed to investigate the effect of regular supervised exercise program on functinal status, disease activity, and total antioxidant status (TAS) level in patients with ankylosing spondylitis (AS). Thirty-two patients (mean age: 44 years) with AS were included in the study and divided into two groups. Group 1, the exercise group (n = 16), attended a supervised exercise program that consisted of aerobic, strengthening, and stretching exercises for 1 h a day, five times a week for 3 weeks. Group 2, the control group, received a home exercise program (n:16). Bath AS Activity Index (BASDAI) and Bath AS Functional Index (BASFI) were calculated and serum TAS levels were measured for each patient at 0 and 3 weeks. There was no significant difference in patients' baseline characteristics (age, disease duration, BASFI, and BASDAI scores) between exercise and control groups. In the exercise group, there were significant improvements between pre-exercise and post-exercise assessments in BASFI (2.8 ± 1,8; 1.7 ± 1,40, p = 0.004) and BASDAI scores (2.1 ± 1.7; 1.2 ± 1.3, p = 0.01). Mean TAS levels were significantly decreased after supervised exercise program (1.48 ± 0.16 mmol/L; 1.36 ± 0.20 mmol/L, p = 0.03). In the control group, BASFI score (2.4 ± 1.7; 2.9 ± 2.1, p = 0.19), BASDAI score (2.6 ± 2.2; 3.1 ± 2.6, p = 0.33), and mean TAS levels (1.38 ± 0.23 mmol/L; 1.39 ± 0.20 mmol/L, p = 0.66) did not differ significantly between 0 and 3 weeks. Short-term, supervised exercise program improved functional status and decreased disease activity. However, the mechanism of this beneficial clinical effect does not seem to be through antioxidant activity.     

Portuguese version of the bath indexes for ankylosing spondylitis patients: a cross-cultural adaptation and validation

The Bath Ankylosing Spondylitis Activity Index (BASDAI), Functional Index (BASFI), Metrology Index (BASMI), and Global Score (BASG) are commonly used to assess patients with ankylosing spondylitis (AS). The aim of this study was to cross-culturally adapt and validate these indexes into the Portuguese language. Seventy-eight patients were included in the study. After forward and backward translations, the questionnaires were administered and tested for internal consistency, test–retest reliability, face validity, content validity, and construct validity. The outcome measures HAQ, EQ-5D, and SF-36 were also implemented. Metrological parameters (BASMI components) and chest expansion were evaluated. Correlation coefficients for test–retest were 0.875, 0.937, 0.831, and 0.961 for BASDAI, BASFI, BASMI, and BASG, respectively. Internal consistency coefficients were between 0.747 and 0.953. The adapted and translated questionnaires demonstrated an acceptable comprehensibility by a panel of patients, and face validity was assured by the cognitive debriefing performed. Content validity was assured by comparing the scores obtained by the questionnaires when age and gender, age of symptoms onset, and disease duration were considered. Construct validity was assured by significant correlations established between the Bath scores and generic health status HAQ, EQ-5D and SF-36, morning stiffness duration, chest expansion, and physician disease activity assessment. The Portuguese version of the BASDAI, BASFI, BASG, and BASMI showed adequate reliability and validity in patients with AS. The measurement properties were comparable to versions in other languages, indicating that the indexes can be used for evaluation of Portuguese-speaking AS patients.     

Serum IL-6 level as a marker of disease activity in ankylosing spondylitis patients with pure axial involvement

BackgroundThe assessment of disease activity in patients with ankylosing spondylitis (AS) continues to be a challenging issue. The currently available markers like C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) show poor correlation with clinical disease activity.ObjectivesTo compare serum IL-6 and hs-CRP levels between patients with AS with pure axial involvement and healthy controls; and to correlate them with Bath ankylosing spondylitis disease activity index (BASDAI), Bath ankylosing spondylitis functional index (BASFI) and Bath ankylosing spondylitis metrology index (BASMI).MethodsSixty-two consecutive patients of AS with pure axial involvement satisfying the modified New York criteria and 60 age-matched healthy controls were recruited. In all patients, Bath indices were measured and fasting venous blood samples for serum IL-6 and hs-CRP levels were obtained. Comparison of median of serum IL-6 and hs-CRP levels was done between cases and healthy controls and levels also correlated with Bath indices by appropriate statistical methods.ResultsThe median serum IL-6 and hs-CRP levels were significantly higher in cases as compared to healthy controls (p = 0.001). Serum IL-6 levels correlated significantly with BASDAI and BASFI (r = 0.61, p = 0.001 and r = 0.27, p = 0.032 respectively) but no correlation was found with BASMI (r = −0.08, p = 0.53). Serum hs-CRP did not correlate with Bath indices except BASMI (r = 0.28, p = 0.03).ConclusionSerum IL-6 levels can be reliably used as an aid in monitoring of disease activity in AS patients with pure axial involvement.     

Reproducibility of the Bath Ankylosing Spondylitis Indices of disease activity (BASDAI), functional status (BASFI) and overall well-being (BAS-G) in anti-tumour necrosis factor-treated spondyloarthropathy patients

The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Function Index (BASFI) and the Bath Ankylosing Spondylitis Global Score (BAS-G) (ranges 0–10) have gained widespread in use as self-reported measures of disease activity, functional impairment and overall well-being in patients with ankylosing spondylitis and other spondyloarthropathies (SpA). In Denmark, BASDAI, BASFI and BAS-G are systematically used to monitor treatment response in patients treated with tumour necrosis factor (TNF) inhibitors. The purpose of the present study was to examine the reproducibility of the indices in anti-TNF-treated SpA patients already familiar with the use of the indices. Testing was performed twice on two different days (median interval 7 days, range 4–10 days) under standardised conditions in 26 out-clinic patients (median age 39 years, range 22–56 years). Limits of agreement were calculated as the 95% likely range for the difference between paired scores. Test–retest results were significantly intercorrelated with r _s = 0.90 for BASDAI, 0.92 for BASFI and 0.74 for BAS-G. Limits of agreement for BASDAI, BASFI and BAS-G were ±1.8, ±1.4 and ±3.2, respectively. Reproducibility as expressed as the mean of individual standard deviations was significantly poorer for BAS-G than for BASDAI and BASFI (p < 0.01). Internal consistency reliability and construct validity of BASDAI and BASFI were acceptable. In conclusion, in a sample of anti-TNF-treated patients experienced with the use of BASDAI, BASFI and BAS-G, random measurement errors of the scores were not negligible. The finding should be considered when monitoring anti-TNF treatment in daily clinical practice.