Which Factors Affect the Functional Situation and Quality of Life in Patients with Ankylosing Spondylitis?

Yıl 2017, Cilt: 17 Sayı: 4, 235 - 244, 20.12.2017

Gülcan Gürer Gülnur Taşçı Bozbaş , Ayşe İyiyapıcı Ünübol Tiraje Tuncer Bülent Bütün

https://doi.org/10.17098/amj.364155

Öz

Objectives: This study was performed to determine the possible predictive factors affecting the functional situation and quality of life in patients with ankylosing spondylitis (AS).

Materials and Methods: A total of 88 volunteer Turkish patients with AS were included in the study. We evaluated the Bath AS Functional Index (BASFI), Bath AS Disease Activity Index (BASDAI), Bath AS Metrology Index (BASMI) and AS Quality of Life Questionnaire (ASQoL) in patients. The ages, genders, levels of education, morning stiffness duration, smoking statuses, statues of doing the home exercises instructed were interrogated and mobility measurements of patients were performed and all of these values were recorded.

Results: BASFI was found to be correlated with smoking (p=0.019), morning stiffness (p=0.001), BMI (p=0.020), exercise (p=0.002), BASMI (p<0.001) and BASDAI (p<0.001). According to the categorical regression, BASDAI (Beta=0.574, p<0.001) was independently associated with the BASFI score.  ASQoL was found to have correlation with the level of education (p=0.030), smoking (p=0.049), morning stiffness (p=0.004) and exercise (p=0.007), BASDAI (p<0.001) and BASFI (p<0.001). It was found that the effect of BASFI was significant on the ASQoL(p=0.007).

Conclusion:  Even though the duration of the disease appears to be an unchangeable factor, smoking, duration of morning stiffness, the compliance with home-based exercise program and mobility measurements appear to be relatively changeable factors. Therefore, we believe that specialists who follow patients with AS can influence quality of life and functions of the patients by educating and inspiring them at every visit.    

Anahtar Kelimeler

Ankylosing spondylitis, Bath Ankylosing Spondylitis Metrology Index, Bath Ankylosing Spondylitis Functional Index, Bath Ankylosing Spondylitis Disease Activity Index, Ankylosing Spondylitis Quality of Life Questionnair

Ankilozan Spondilit Hastalarında Yaşam Kalitesini ve Fonksiyonel Durumu Hangi Faktörler Etkiler?

Öz

Giriş: Bu çalışma, Ankilozan spondilit (AS) hastalarında fonksiyonel durumu ve yaşam kalitesini etkileyen olası faktörleri belirlemek amacıyla yapıldı.

Materyal ve Metot: Çalışmaya AS'li toplam 88 adet gönüllü Türk hasta dahil edildi. Hastalarda Bath AS Fonksiyonel İndeks (BASFI), Bath AS Hastalık Aktivite İndeksi (BASDAI), Bath AS Metrology İndeksi (BASMI) ve AS Yaşam Kalitesi Anketi (ASQoL) değerlendirildi. Yaş, cinsiyet, eğitim düzeyi, sabah tutukluğu süresi, sigara içme durumu, evde egzersiz yapma durumları sorgulandı ve mobilite ölçümleri yapıldı ve bunlar kaydedildi. 

Bulgular: BASFI skoru sigara içme (p=0,019), egzersiz (p=0,002), sabah tutukluğu (p=0,001), vücud kütle indeksi (p=0,020), BASMI (p0,001) ve BASDAI (p0,001) ile korele bulundu. Kategorik regresyon analizine göre ise BASDAI BASFI skoru ile ilişkili bulundu (:0.574, p0,001). ASQoL ise sabah tutukluğu (p=0,004), eğitim durumu (p=0,030), sigara içme (p=0,049), egzersiz (p=0,007), BASDAI (p0,001) ve BASFI (p0,001) korele bulundu. ASQoL üzerinde BASFI’nin belirgin etkisi olduğu saptandı (p=0,007).

Sonuç: Hastalık süresi değiştirilemediği halde, sigara içme, sabah tutukluğunun süresi, evde egzersiz programına uyum ve hareketlilik ölçümleri nispeten değiştirilebilir faktörler gibi gözükmektedir. Bu nedenle, AS'li hastaları takip eden hekimlerin her ziyarette, bu konularda eğitim vererek ve bunu vurgulayarak hastaların yaşam kalitelerini ve fonksiyonlarını etkileyebileceklerine inanıyoruz.

Anahtar Kelimeler

Ankilozan spondilit, Bath Ankilozan Spondilit Metroloji Indeksi, Bath Ankilozan Spondilit Fonksiyonel İndeks, Bath Ankilozan Spondilit Hastalık Aktivite İndeksi, Ankilozan Spondilit Yaşam Kalitesi Anketi

Kaynakça

• 1. van Weely SF, Kneepkens EL, Nurmohamed MT, Dekker J, van der Horst-Bruinsma IE. Continuous improvement of physical functioning in Ankylosing Spondylitis patients by TNF inhibitors: 3-year follow-up and predictors. Arthritis Care Res (Hoboken) 2016;68:1522-9.
• 2. Dagfinrud H, Mengshoel AM, Hagan KB, Loge JH, Kvien TK. Health status of patients with ankylosing spondylitis: a comparison with the general population. Ann Rheum Dis; 2004;63:1605-10.
• 3. Bostan EE, Borman P, Bodur H. Functional disability and quality of life in patients with ankylosing spondylitis. Rheumatol Int 2003;23:121-6.
• 4. Zink A, Braun J, Listing J, Wollenhaupt J. Disability and handicap in rheumatoid arthritis and ankylosing spondylitis: Results from the German rheumatological database. J Rheumatol 2000;27:613-22.
• 5. Malinowski K, Kawalec P. The Association between Disease Activity and Quality of Life among Patients with Ankylosing Spondylitis in Polish Population. Value Health 2015;18(7):A653.
• 6. Ward MM. Predictors of the progression of functional disability in patients with ankylosing spondylitis J Rheumatol 2002;29(7):1420-5.
• 7. Ariza-Ariza R, Hernandez-Cruz B, Navarro-Sarabia F. Physical function and health-related quality of life of Spanish patients with ankylosing spondylitis Arthritis Rheum 2003;49:483-7.
• 8. Chung HY, Machado P, van der Heijde D, D'Agostino MA, Dougados M. Smokers in early axial spondyloarthritis have earlier disease onset, more disease activity, inflammation and damage, and poorer function and health-related quality of life: results from the DESIR cohort . Ann Rheum Dis 2012;71(6):809-16.
• 9. Ward MM, Weisman MH, Davis JC Jr, Reveille JD. Risk factors for functional limitations in patients with long-standing ankylosing spondylitis. Arthritis Rheum 2005;15(5):710-7.
• 10. Taylor AL, Balakrishnan C, Calin A. Reference centile charts for measures of disease activity, functional impairment, and metrology in ankylosing spondylitis. Arthritis Rheum 1998;41:1119-25.
• 11. Falkenbach A, Franke A, van Tubergen A, van der Linden S. Assessment of functional ability in younger and older patients with ankylosing spondylitis: performance of the Bath Ankylosing Spondylitis Functional Index. Am J Phys Med Rehabil 2002;81:416-20.
• 12. Falkenbach A, Franke A, van der Linden S. Factors associated with body function and disability in patients with ankylosing spondylitis: a cross-sectional study. J Rheumatol 2003;30:2186-92.
• 13. Bodur H, Ataman S, Rezvani A, et al. Quality of life and related variables in patients with ankylosing spondylitis. Qual Life Res 2011;20(4):543-9.
• 14. Fried LP, Guralnik JM. Disability in older adults: evidence regarding significance, etiology, and risk. J Am Geriatr Soc 1997;45:92-100.
• 15. Gabriel SE. The epidemiology of rheumatoid arthritis. Rheum Dis Clin North Am 2001;27:269-81.
• 16. Mikuls TR, Saag KG. Comorbidity in rheumatoid arthritis. Rheum Dis Clin North Am 2001;27:283-303.
• 17. Garrett S, Jenkinson T, Kennedy LG, Whitelock H, Gaisford P, Calin A. A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol 1994;21(12):2286-91.
• 18. Calin A, Garrett S, Whitelock H, et al. A new approach to defining functional ability in ankylosing spondylitis: the development of the Bath Ankylosing Spondylitis Functional Index. J Rheumatol 1994;21(12):2281-85.
• 19. Jenkinson TR, Mallorie PA, Whitelock HC, Kennedy LG, Garrett SL, Calin A. Defining spinal mobility in ankylosing spondylitis (AS). The Bath AS Metrology Index. J Rheumatol 1994;21(9):1694-8.
• 20. Doward LC, Spoorenberg A, Cook SA, et al. Development of the ASQoL: a quality of life instrument specific to ankylosing spondylitis. Ann Rheum Dis 2003;62(1):20-6.
• 21. Akkoc Y, Karatepe AG, Akar S, Kirazli Y, Akkoc N. A Turkish version of the Bath Ankylosing Spondylitis Disease Activity Index: reliability and validity. Rheumatol Int 2005;25(4):280-4.
• 22. Karatepe AG, Akkoc Y, Akar S, Kirazli Y, Akkoc N. The Turkish versions of the Bath Ankylosing Spondylitis and Dougados Functional Indices: reliability and validity. Rheumatol Int 2005;25:612-8.
• 23. Yanik B, Gursel YK, Kutlay S, Ay S, Elhan AH. Adaptation of the Bath Ankylosing Spondylitis Functional Index to the Turkish population, its reliability and validity: functional assessment in AS. Clin Rheumatol 2005;24(1):41-7.
• 24. Duruöz T, Doward L, Cerrahoglu L, et al. Translation and validation of the Turkısh version of the Ankylosıng Spondylıtıs Qualıty Of Lıfe (ASQoL) Questionnaire. Rheumatol Int 201;33(11):2717-22.
• 25. Yılmaz O, Tutoğlu A, Garip Y, Ozcan E, Bodur H. 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. Rheumatol Int 2013;33(5):1159-63.
• 26. Averns HL, Oxtoby J, Taylor HG. Smoking and outcome in ankylosing spondylitis. Scand J Rheumatol 1996;25(3):138-42.
• 27. Ward MM, Weisman MH, Davis JC Jr. Risk factors for functional limitations in patients with long-standing ankylosing spondylitis. Arthritis Rheum 2005;53(5):710-7.
• 28. Dagfinrud H, Kvien TK, Hagen KB. The Cochrane review of physiotherapy interventions for ankylosing spondylitis. J Rheumatol 2005;32:1899-906.
• 29. Analay Y, Ozcan E, Karan A, Diracoglu D, Aydin R. The effectiveness of intensive group exercise on patients with ankylosing spondylitis. Clin Rehabil 2003;17:631-6.
• 30. Ince G, Sarpel T, Durgun B, Erdogan S. Effects of multimodal exercise program for people with ankylosing spondylitis. Phys Ther 2006;86:924-35.
• 31. Karapolat H, Akkoc Y, Sari I, et al. 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. Clin Rheumatol 2008;27(6):695-700.
• 32. Analay Y, Ozcan E, Karan A, Diracoglu D, Aydin R. The effectiveness of intensive group exercise on patients with ankylosing spondylitis. Clin Rehabil 2003;17(6):631-6.
• 33. Durmus D, Alayli G, Cil E, Canturk F. Effects of a home-based exercise program on quality of life, fatigue, and depression in patients with ankylosing spondylitis. Rheumatol Int 2009;29(6):673-7.
• 34. Haywood KL, Garratt AM, Jordan K, Dziedzic K, Dawes PT. Spinal mobility in ankylosing spondylitis: reliability, validity and responsiveness. Rheumatology (Oxford) 2004;43(6):750-7.
• 35. Fallahi S, Jamshidi AR, Bidad K, Qorbani M, Mahmoudi M. Evaluating the reliability of Persian version of ankylosing spondylitis quality of life (ASQoL) questionnaire and related clinical and demographic parameters in patients with ankylosing spondylitis. Rheumatol Int 2014;34(6):803-9.