Quality of Life in Turkish Ankylosing Spondylitis Patients

Quality of Life in Turkish Ankylosing Spondylitis Patients Introduction Ankylosing spondylitis (AS) is a chronic inflammatory rheumatological disease characterized by spinal inflammation, usually in the form of sacroiliitis and spondylitis which may lead to syndesmophyte formation and ankylosis in the further course of the disease [1]. AS most commonly begins in the second and third decade of life as persistent inflammatory back pain that can already be associated with significant loss of function, work disability and impaired quality of life early in the disease [2-4]. In studies conducted previously, risk factors affecting the functional status and quality of life in patients with AS have been evaluated. Age, duration of symptoms, pain severity, stiffness, peripheral arthritis, total hip arthroplasty, smoking habit of patient, having history of more physically demanding jobs and lower levels of education have been demonstrated as risk factors for functional limitations and quality of life in patients with AS [3-8]. In other rheumatic diseases, level of education has been found to be possibly associated as a risk factor [9-11]. In this study, we planned to determine the possible risk factors affecting functional situation and quality of life in Turkish patients with AS. Materials and Methods Eigthy nine Turkish AS patients diagnosed with AS according to the Modified 1984 New York Criteria who were admitted to the Rheumatology Outpatient Clinics of Akdeniz University and Adnan Menderes University were included in the study. This study was approved by the Research Eth ­ics Committee Yet, one patient, who did not want to participate, was excluded from the study. Thus, a total of 88 volunteer Turkish AS patients consisting of 24 females (27.3%) and 64 males (72.7%) with their age ranging from 21 to 81 were enrolled in the study. Demographic information of the patients was obtained, their heights and weights were measured and these values were recorded. Then body mass indices (BMIs) of the patients were calculated by dividing the body weight as kilograms by the square of height in meters. Levels of education of the patients were investigated and recorded (0: illiterate, 1: literate, 2: primary school graduate, 3: secondary school graduate, 4: high school graduate, 5: university graduate). Dates of diagnosis of the patients, drug(s) they used, their duration of morning stiffness (as minutes) were investigated and recorded. Patients with diagnosis of AS who were admitted to the Rheumatology Outpatient Clinics are routinely instructed with a home-based exercise program. Exercises recommended are as breathing and posture exercises, and range of motion/stretching exercises for all joints. Patients were inquired about the extent they do these recommended exercises, and they were rated as 0 (not doing the exercises) , 1 (doing irregularly or occasionally), 2 (doing regularly every day), and the results were recorded. Smoking habits of the patients were evaluated. Those who have smoked at least one cigarette a day for a period of longer than 6 months during their lifetime were included in the smoking group. Whether or not the individuals in this group were currently smoking and how many cigarettes a day and for how many years they have smoked were determined. â€Å"Packs/year† term was calculated by multiplying amount of cigarettes (as packs) smoked daily by smoking period (as years). Indices have been developed to measure the activation status, functional status, spinal mobility values and quality of life of patients with ankylosing spondylitis. Bath AS Disease Activity Index (BASDAI), developed for evaluating disease activity, consists of 6 visuel analog scale (VAS) measurements comprising of fatigue, spinal and peripheral joint pain, severity and morning stiffness [12]. Bath AS Functional Index (BASFI), developed for functional evaluation, was determined to have been superior regarding sensitivity to the change to the Dougados Functional Index (DFI) which was developed for the same purpose [13]. Bath AS metrology index (BASMI) was developed by evaluating 20 different clinical assessment methods and selecting 5 among them with the property of the highest validity, reliability, repeatability, and sensitivity to the change [14]. Developed to assess the quality of life of patients with AS, Ankylosing Spondylitis Quality of Life Questionnaire (ASQoL) has been demons trated to be a valid and reliable tool that can be used both in clinical practice and in scientific research [15]. To evaluate the functional status, disease activity, spinal mobility and quality of life of the patients, BASFI, BASDAI, BASMI and ASQoL scales were used respectively. All indices were assessed by the same physician. Turkish versions of BASFI, BASDAI and ASQoL were used. The reliability of the Turkish versions of BASFI, BASDAI, and ASQoL has been confirmed [16-19]. BASMI is a combined index comprising five assessments of spinal mobility in AS patients. The index include assessments of lateral lumbar flexion, tragus-to-wall distance, lumbar flexion, intermalleolar distance and cervical rotation [20]. These measurements have been found to be clinically practical and reliable in reflecting axial status [1]. In our study, measurements of tragus-to-wall distance, modified Schober, cervical rotations (mean of the sum of right and left rotations was taken), lumbar lateral flexion difference (mean of the sum of right and left lateral flexion differences was taken), intermalleolar distance were performed by the same physician on all patients to obtain BASMI score. Apart from these mobility assessments performed, occiput-to-wall distance, chin-to-sternum distance, chest expansion, thoracic Schober, lumbar Schober, hand-to-ground distance and intermalleolar distance were measured. As laboratory values of the patients, erythrocyte sedimentation rate (using Standard Westegren Method) and serum C-reactive protein (CRP) levels were measured. SPSS 14.0 (SPSS Inc., Il., USA) software package was used for data analysis. Results for continuous variables were presented as maximum, minimum and mean  ± standard deviation (SD). Descriptive statistical method was used to obtain these values. For the correlation analysis of the results, Pearson Correlation test was used. Multivariate regression models were constructed to evaluate associations between identified variables. A p value of