Loss of balance and fall risk, and their relationship with disease activity, functional status, spinal mobility, quality of life and enthesitis score in patients with ankylosing spondylitis: A cross-sectional study

Yıl 2020, Cilt: 42 Sayı: 4, 441 - 448, 31.12.2020

Mehmet Bingöl Ahmet Karadağ

https://doi.org/10.7197/cmj.819210

Öz

Objective: This study evaluates the loss of balance and fall risk in patients with Ankylosing Spondylitis (AS), and assesses their relationship with disease activity, functional status, spinal mobility, quality of life and enthesitis score.

Method: Included in the study were 50 AS patients who were diagnosed in accordance with the modified New York criteria, and 50 healthy volunteers of similar age and gender. For the AS patients, disease activity was assessed using the Bath Ankylosing Spondylitis Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score (ASDAS) C-reactive protein/Erythrocyte sedimentation rate (CRP/ESR); functional status was assessed using the Bath Ankylosing Spondylitis Functional Index (BASFI); spinal mobility was assessed using the Bath Ankylosing Spondylitis Metrology Index (BASMI); and quality of life was assessed using the Ankylosing Spondylitis Quality of Life Questionnaire (ASQoL). Additionally, a Short form-36 (SF-36) was used to assess quality of life in both the AS patients and the healthy control group; while a Timed Up and Go-test (TUG), Functional Reach Test (FRT), Berg Balance Scale (BBS) and Tinnetti’s Falls Efficacy Scale (TFES) were used to assess balance and fall risk. Enthesitis in the AS patients was evaluated using Maastricht Ankylosing Spondylitis Enthesitis Score (MASES). 

Results: A comparison of the AS patients and the healthy controls in terms of BBS, FRT, TUG and TFES revealed balance loss and fall risk to be higher in the AS patient group, to a statistically significant degree (p<0.001). BBS, FRT, TUG and TFES were statistically significantly correlated with BASDAI, BASMI, BASFI, ASDAS-ESR, ASDAS-CRP and ASQoL in AS patients (p<0.05), while no statistically significant correlation was identified between BBS, FRT, TUG, TFES and MASES (p>0.05).

Conclusions: Loss of balance and fall risk are higher in AS patients than in healthy individuals. Loss of balance and fall risk is associated with disease activity, poor functional status, limited spinal mobility and quality of life in AS patients. That said, there is no association between enthesitis score and loss of balance and fall risk in AS patients. These findings suggest that loss of balance loss and fall risk should be assessed in patients with AS.

Anahtar Kelimeler

Enthesitis, fall, balance, ankylosing spondylitis

Kaynakça

• Hayta E, Karadağ A, Gumus C. Tetraplegia developing with skull traction in patients with ankylosing spondylitis (AS): A case report. Int J Case Rep Images 2016;7:111–114.
• Koca TT, Göğebakan H, Koçyiğit BF, Nacitarhan V, Yildir CZ. Foot functions in ankylosing spondylitis. Clin Rheumatol 2019;38:1083-1088.
• Acar Y, Ilçin N, Gürpinar B, Can G. Core stability and balance in patients with ankylosing spondylitis. Rheumatol Int 2019;39:1389-1396.
• Sawacha Z, Carraro E, Del Din S, Guiotto A, Bonaldo L, Punzi L, et al. Biomechanical assessment of balance and posture in subjects with ankylosing spondylitis. J Neuroeng Rehabil 2012;9:63.
• Dursun N, Sarkaya S, Ozdolap S, Dursun E, Zateri C, Altan L, et al. Risk of falls in patients with ankylosing spondylitis. J Clin Rheumatol 2015;21:76-80.
• Inanır A, Okan S, Filiz B. Evaluation of postural stability and fall risk in patients with ankylosing spondylitis. Cukurova Med J 2013,38: 86-91.
• D’Agostino MA, Olivieri I. Enthesitis. Best Pract Res Clin Rheumatol 2006;20:473-86.
• Tolu S, Rezvani A, Hindioglu N, Kirez IE, Korkmaz M. Postural stability and the relationship with enthesitis in ankylosing spondylitis: A cross-sectional study. Medicine Science 2019;8:613-9.
• van der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum 1984;27:361-8.
• Garrett S, Jenkinson T, Kennedy LG, Whitelock H, Gaisford P, Calin P. A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol 1994;21:2286–91.
• 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;25:280–84.
• Machado P, Landewe R, Lie E, Kvien TK, Braun J, Baker D, et al. Assessment of SpondyloArthritis international Society. Ankylosing Spondylitis Disease Activity Score (ASDAS): defining cut-off values for disease activity states and improvement scores. Ann Rheum Dis 2011;70: 47-53.
• Calin A, Garrett S, Whitelock H, Kennedy LG, O'Hea J, Mallorie P, 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: 2281–05.
• Ozer HT, Sarpel T, Gulek B, Alparslan ZN. The Turkish version of the Bath Ankylosing Spondylitis Functional Index: reliability and validity. Clin Rheumatol 2005;24: 123–28.
• 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 2004;21:1694-8.
• Doward LC, Spoorenberg A, Cook SA, Whalley D, Helliwell PS, Kay LJ, et al. Development of the ASQoL: a quality of life instrument specific to ankylosing spondylitis. Ann Rheum Dis 2003;2:20–26.
• Duruöz MT, Doward L, Turan Y, Cerrahoglu L, Yurtkuran M, Calis M, et al. Translation and validation of the Turkish version of the Ankylosing Spondylitis Quality of Life (ASQOL) questionnaire. Rheumatol Int 2013;33:2717-22.
• Ware JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 1992;30: 473-83.
• Kocyigit H, Aydemir O, Olmez N, N Olmez, A Kısa Memis. Reliability and validity of the Turkish version of short-form-36 (SF-36). Turkish J Drugs Therap 1999;12:102-6.
• Kornetti DL, Fritz SL, Chiu Y-P, Light KE, Velozo CA. Rating scale analysis of the Berg Balance Scale. Arch Phys Med Rehabil 2004;85:1128–35.
• Duncan PW, Weiner DK, Chandler J, Studenski S. Functional reach: a new clinical measure of balance. J Gerontol 1990;45:192-7.
• Podsiadlo D, Richardson S. The timed ‘’Up & Go’’: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 1991;39:142–148.
• Tinetti ME, Richman D, Powell L. Falls efficacy as a measure of fear of falling. J Gerontol1990;45:234-43. 24. Dorenbosch LH, Spoorenberg A, Van Tubergen A. Assessment of enthesitis in ankylosing spondylitis. Ann Rheum Dis 2003;62:127-32.
• Onen F, Akar S, Birlik M, et al. Prevalence of Ankylosing spondylitis and related spondyloarthritides in an urban area of Izmir, Turkey. J Rheumatol. 2008;35:305-9.
• Elolemy G, Aboughanima A, Ganeb S, Elziat H. Health-Related Quality of Life in Patients with Ankylosing Spondylitis: Relationship with Disease-Related Variables. Curr Rheumatol Rev 2019
• Laatiris A, Amine B, Ibn Yacoub Y, Hajjaj-Hassouni N. Enthesitis and its relationships with disease parameters in Moroccan patients with ankylosing spondylitis. Rheumatol Int 2012;32:723-7.
• Murray HC, Elliott C, Barton SE, Murray A. Do patients with ankylosing spondylitis have poorer balance than normal subjects? Rheumatology 2000;39:497-500.
• Gündüz OH, Özcan-Ekşi EE, Giray E, Yağci İ. What Impairs Balance in Ankylosing Spondylitis? Posture or Disease Activity? Arch Rheumatol 2017;32:221-226.
• Batur BE, Karataş KG. Do Postural Changes Affect Balance in Patients with Ankylosing Spondylitis? J Rehabil Med 2017;49:437–440.
• Lee JS, Suh KT, Kim JI, Goh TS. Analysis of sagittal balance of ankylosing spondylitis using spinopelvic parameters. J Spinal Disord Tech 2014;27:94-8.
• Alkan H, Yıldız N, Sarsan A, Atalay Simsir N, Sevinc HO, Topuz O, et al. Fall risk in patients with Ankylosing Spondylitis. Turk J Rheumatol 2013;28:109–116.
• Demontis A, Trainito S, Del Felice A, Masiero S. Favorable effect of rehabilitation on balance in ankylosing spondylitis: a quasi-randomized controlled clinical trial. Rheumatol Int 2016;36:333-9.
• Sivas F, Baskan BM, Inal E, Aktekin LA, Barça N, Özoran K, et al. The relationship between enthesitis indices and disease activity parameters in patients with ankylosing spondylitis. Clin Rheumatol 2009;28:259–264.
• Heuft-Dorenbosch L, Spoorenberg A, van Tubergen A, Landewé R, van ver Tempel H, Mielants H, et al. Assessment of enthesitis in ankylosing spondylitis. Ann Rheum Dis 2003;62:127-32.