Ankilozan spondilitli bireylerde spinal mobiliteyi etkileyen faktörler

Yıl 2023, Cilt: 10 Sayı: 3, 219 - 227, 29.12.2023

Elif Gur Kabul Bilge Başakcı Çalık Sinem Kuru Uğur Karasu

https://doi.org/10.15437/jetr.1136159

Öz

Amaç: Bu çalışmanın amacı Ankilozan Spondilit (AS)’li bireylerde spinal mobiliteyi etkileyen faktörleri incelemekti.
Yöntem: Çalışmaya AS tanısı konmuş 18-65 yaş aralığında, yaş ortalaması 43,37±11,56 yıl olan 154 kişi dahil edildi. Katılımcıların demografik (cinsiyet, yaş, boy, kilo, tanı alma süresi, eğitim süresi, çalışma durumu, soygeçmiş, egzersiz alışkanlığı, sigara kullanımı) ve klinik verileri (sabah tutukluğu, kronik solunum hastalık öyküsü) kaydedildikten sonra, mobiliteleri Bath Ankilozan Spondilit Metroloji İndeksi (BASMİ) ile değerlendirildi. Bağımsız grup farklılıkların karşılaştırılmasında Mann Whitney U testi kullanıldı. Sürekli değişkenlerin arasındaki ilişkiler Pearson Korelasyon Analizi ile değerlendirildi.
Bulgular: BASMİ skorları gruplar arasında karşılaştırıldığında; cinsiyet açısından kadınlara göre erkeklerin tragus duvar mesafesi (p=0,013), gövde lateral fleksiyon (p=0,001), lumbar fleksiyon (modifiye Schober) (p=0,001) skorları; çalışma durumu açısından çalışmayanların çalışanlara göre maksimum intermalleoler mesafe (p=0,001) ve toplam BASMI (p=0,019) skorları; kronik solunum hastalığı öyküsü bulunanların bulunmayanlara göre servikal rotasyon (p=0,013) skorları daha yüksekti. BASMİ skorları ile sürekli değişkenler arasındaki ilişki incelendiğinde; yaş ile tragus duvar mesafesi hariç tüm BASMİ skorları arasında orta düzeyde; tanı alma süresi ile maksimum intermalleoler mesafe hariç tüm BASMİ skorları arasında düşük ve orta düzeyde; eğitim süresi ile tüm BASMİ skorları arasında düşük ve orta düzeyde ilişki vardı (p<0,05).
Sonuç: AS’li erkek bireylerin kifozları daha fazla, gövde lateral fleksiyon hareketleri ve lumbar omurga fleksiyon hareketlilikleri daha azdır. Herhangi bir işte çalışmak kalça abduksiyonunu ve genel mobiliteyi arttırabilir. Kronik solunum hastalık öyküsü, servikal rotasyonda azalmaya neden olabilir. Ayrıca, yaşın ilerlemesi ve hastalık yılının artması ile mobilite azalabilirken, eğitim yılı arttıkça mobilite daha az etkilenebilmektedir.

Anahtar Kelimeler

Ankilozan spondilit, Hareket kısıtlılığı, Postür

Factors affecting spinal mobility in individuals with ankylosing spondylitis

Öz

Purpose: The aim of this study was to examine the factors affecting spinal mobility in individuals with Ankylosing Spondylitis (AS).
Methods: A total of 154 participants, aged between 18-65 years, who were diagnosed with AS, with a mean age of 43.37±11.56 years, were included in the study. After the demographic (sex, age, height, weight, diagnosis year, education year, employment status, family history, exercise habit, smoking) and clinical data (morning stiffness, history of chronic respiratory disease) of the participants were recorded, their mobility was assessed with the Bath Ankylosing Spondylitis Metrology Index (BASMI). Mann Whitney U test was used to compare independent group differences. Relationships between continuous variables were evaluated with Pearson Correlation Analysis.
Results: When BASMI scores were compared between the groups; the tragus to wall distance (p=0.013), lateral lumbar flexion (p=0.001), lumbar flexion (modified Schober) (p=0.001) scores of men were higher than women in terms of sex; maximal intermalleolar distance (p=0.001) and total (p=0.019) scores of the unemployed were higher than employee in terms of occupation; cervical rotation (p=0.013) scores of those with a history of chronic respiratory disease were higher than those without. When the relationship between BASMI scores and continuous variables is examined; age had moderate correlation with all BASMI scores except tragus to wall distance; diagnosis year had low and moderate correlation with all BASMI scores except maximal intermalleolar distance; education year had low and moderate correlation with all BASMI scores (p<0.05).
Conclusion: Men individuals with AS have more kyphosis, less trunk lateral flexion movements and less lumbar spine flexion movements. Working any job can increase hip abduction and overall mobility. A history of chronic respiratory disease may result in decreased cervical rotation. In addition, while mobility may decrease with increasing age and disease duration, mobility may be less affected as years of education increase.

Anahtar Kelimeler

Ankylosing spondylitis, Mobility limitation, Posture

Kaynakça

• Braun J, Sieper J. Ankylosing spondylitis. Lancet. 2007;369:1379–1390.
• Chen C-H, Chen H-A, Liu C-H, et al. Association of obesity with inflammation, disease severity and cardiovascular risk factors among patients with ankylosing spondylitis. Int J Rheum Dis. 2020;00:1–10.
• Pimentel-Santos FM, Mourão AF, Ribeiro C, et al. Spectrum of ankylosing spondylitis in Portugal. Development of BASDAI, BASFI, BASMI and mSASSS reference centile charts. Clin Rheumatol. 2012;31(3):447-454.
• Türk AC, Arslan S, Karavelioğlu Y, et al. Pulmonary function, aerobic capacity and related variables in patients with ankylosing spondylitis. Arch Rheumatol. 2019;34(3):317-325.
• Van der Heijde D, Calin A, Dougados M, et al. Selection of instruments in the core set for DC-ART, SMARD, physical therapy, and clinical record keeping in ankylosing spondylitis: progress report of the ASAS Working Group. Assessments in Ankylosing Spondylitis. J Rheumatol. 1999;26:951–954.
• Jenkinson TR, Mallorie PA, Whitelock HC, et al. Defining spinal mobility in ankylosing spondylitis (AS): the Bath AS Metrology Index. J Rheumatol. 1994;21:1694–1698.
• Jones SD, Porter J, Garrett SL, et al. A new scoring system for the Bath Ankylosing Spondylitis Metrology Index (BASMI). J Rheumatol. 1995;22:1609.
• Van der Heijde D, Landewe R, Feldtkeller E. Proposal of a linear definition of the Bath Ankylosing Spondylitis Metrology Index (BASMI) and comparison with the 2-step and 10- step definitions. Ann Rheum Dis. 2008;67:489–493.
• Carvalho PD, Ruyssen-Witrand A, Fonseca J, et al. Determining factors related to impaired spinal and hip mobility in patients with axial spondyloarthritis: longitudinal results from the DESIR cohort. RMD Open. 2020;6(3):e001356.
• Machado P, Landewe R, Braun J, et al. Both structural damage and inflammation of the spine contribute to impairment of spinal mobility in patients with ankylosing spondylitis. Ann Rheum Dis. 2010;69:1465–1470.
• Calvo-Gutierrez J, Garrido-Castro JL, Gil-Cabezas J, et al. Is spinal mobility in patients with spondylitis determined by age, structural damage, and inflammation? Arthritis Care Res (Hoboken). 2015;67(1):74-79.
• Cohen J, Cohen P, West SG, et al. Applied multiple regression/ correlation analysis for the behavioral sciences. Routledge 2013.
• Jung YO, Kim I, Kim S, et al. Clinical and radiographic features of adult-onset ankylosing spondylitis in Korean patients: comparisons between males and females. J Korean Med Sci 2010;25(4):532–535.
• Yacoub YI, Amine B, Laatiris A, et al. Gender and disease features in Moroccan patients with ankylosing spondylitis. Clin Rheumatol. 2012;31(2):293-297.
• Deminger A, Klingberg E, Geijer M, et al. A five-year prospective study of spinal radiographic progression and its predictors in men and women with ankylosing spondylitis. Arthritis Res Ther. 2018;20:162.
• Poddubnyy D, Haibel H, Listing J, et al. Baseline radiographic damage, elevated acute-phase reactant levels, and cigarette smoking status predict spinal radiographic progression in early axial spondylarthritis. Arthritis Rheum. 2012;64(5):1388–1398.
• Poddubnyy D, Haibel H, Listing J, et al. Cigarette smoking has a dose-dependent impact on progression of structural damage in the spine in patients with axial spondyloarthritis: results from the GErman SPondyloarthritis inception cohort (GESPIC). Ann Rheum Dis. 2013;72(8):1430–1432.
• Sağ S, Nas K, Sağ MS, et al. Relationship of work disability between the disease activity, depression and quality of life in patients with ankylosing spondylitis. J Back Musculoskelet; 2018;1–7.
• Donath J, Miller A. Restrictive chest wall disorders. Semin Respir Crit Care Med. 2009; 30:275-292.
• Heeneman S, Daemen MJ. Cardiovascular risks in spondyloarthritides. Curr Opin Rheumatol. 2007;19:358-362.
• Berdal G, Halvorsen S, van der Heijde D, et al. Restrictive pulmonary function is more prevalent- in patients with ankylosing spondylitis than in matched population controls and is associated with impaired spinal mobility: a comparative study. Arthritis Res Ther. 2012;14:R19.
• Chen CH, Chen HA, Liao HT, et al. The clinical usefulness of ESR, CRP, and disease duration in ankylosing spondylitis: the product of these acute‑phase reactants and disease duration is associated with patient’s poor physical mobility. Rheumatol Int. 2015;35(7):1263-1267.
• Vliet Vlieland TP, Buitenhuis NA, Van Zeben D, et al. Sociodemographic factors and the outcome of rheumatoid arthritis in young women. Ann Rheum Dis. 1994;53(12):803–906.
• Salaffi F, Carotti M, Gasparini S, et al. The health-related quality of life in rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis: a comparison with a selected sample of healthy people. Health Qual Life Outcomes. 2009;7:25.
• Coulter EH, McDonald MT, Cameron S, et al. Physical activity and sedentary behaviour and their associations with clinical measures in axial spondyloarthritis. Rheumatol Int. 2020;40:375–381.
• Zhang S, Li Y, Xu X, et al. Effect of cigarette smoking and alcohol consumption on disease activity and physical functioning in ankylosing spondylitis: a cross-sectional study. Int J Clin Exp Med. 2015;8(8):13919-13927.
• Chen CH, Chen HA, Lu CL, et al. Association of cigarette smoking with Chinese ankylosing spondylitis patients in Taiwan: a poor disease outcome in systemic inflammation, functional ability, and physical mobility. Clin Rheumatol. 2013;32:659-663.