Objectives: This study aims to evaluate diagnostic delay, factors which are related to diagnostic delay, and the effect of diagnostic delay on prognostic outcomes in terms of spinal and hip mobility, functional status, disease activity, quality of life, cervical rotation, tragus to wall distance, and sacroiliitis severity in an Iranian population with ankylosing spondylitis (AS). Materials and methods: One hundred and sixty three patients (129 males, 34 females; mean age 37.74±9.88 years; range 18 to 65 years) with AS who met modified New York 1984 criteria were enrolled consecutively in a cross sectional survey. The main outcome variable (diagnostic delay) was defined as the interval between appearance of first symptoms and correct diagnosis of AS. Enthesitis, negative human leukocyte antigen B27 (HLA-B27), and educational level were among the factors of which their relationship to diagnostic delay were evaluated. The prognostic outcomes were measured using Bath ankylosing spondylitis functional index, Bath ankylosing spondylitis disease activity index, AS quality of life, Bath ankylosing spondylitis metrology index, chest expansion, and radiographic sacroiliitis severity. Results: Diagnostic delay was mean 7.88±7.17 years. Diagnostic delay was longer in patients with enthesitis (8.80±7.27) compared to patients without enthesitis (6.04±6.66) (p=0.007) and in HLA-B27 negative patients (10.10±7.44) compared to HLA-B27 positive patients (7.14±6.96) (p=0.013). Educational level was negatively correlated with diagnostic delay (p=0.002, r= -0.24). Diagnostic delay was correlated with Bath ankylosing spondylitis functional index (p=0.003, r=0.23), Bath ankylosing spondylitis disease activity index (p=0.026, r=0.18), AS quality of life (p=0.008, r=0.21), Bath ankylosing spondylitis metrology index (p<0.001, r=0.41), chest expansion (p<0.001, r= -0.38), and sacroiliitis grading (p=0.042, r=0.16). Conclusion: Negative HLA-B27, enthesitis, and low educational level are factors which affect diagnostic delay in AS. Individuals with enthesitis or low educational level should be evaluated accurately without causing delay in diagnosis since longer delay may lead to poorer prognostic outcomes.

Inequalities in features and severity of ankylosing spondylitis (AS) have been noticed between men and women, suggesting a possible influence of gender on disease phenotypes. Comparing disease features and characterization of gender differences in clinical features and medications could help elucidate the potential influence of gender on the severity of AS in patients. This study aims to assess the influence of gender on disease patterns in Iranian patients with AS. Three hundred and twenty patients diagnosed with primary AS were assessed for demographic variables, clinical manifestations, HLA status, disease severity, functional capacities, quality of life, and treatment status. Sixty-seven women and 253 men were included corresponding to a male to female ratio of 3.78:1. Both groups were similar regarding ethnicity, positive family history, and juvenile onset AS. HLA-B27 was more frequent among males (78.3 vs. 55.2%; p < 0.001). There was a higher proportion of female patients with overall enthesitis (p < 0.05). Extra-articular manifestations and treatment modalities presented similar frequencies in both genders. No difference in gender-associated diagnostic delays was observed. Female disease was at least as severe as male disease, and in some aspects, females presented with more severe disease. Despite a relatively similar disease profile, we observed a higher rate of enthesitis among women. Together with the equally high rate of disease activity indices in both genders, these findings indicate an overall longer delay to diagnosis in our country. Early detection and specialized care would be of great practical importance.

The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Bath Ankylosing Spondylitis Functional Index (BASFI) are widely used instruments in assessment of patients suffering from ankylosing spondylitis (AS). The Patient Acceptable Symptom State (PASS) is regarded as a target for patients' well-being. The aim of this study was to translate and adapt BASDAI, BASFI and PASS into the Iranian official language, Farsi, and evaluate their reliability and validity. Ninety patients with AS were included in this study. The questionnaires were translated into Farsi and back translated into English, modified until the final versions were approved with minor adaptations and the VAS was changed to numerical rating scales from 0 to 10. Forty-eight-hour test-retest agreement showed good reliability: interclass correlation coefficient (ICC) for BASDAI was 0.93 (CI at 95%, 0.90-0.95), for BASFI was 0.96 (CI at 95%, 0.94-0.97) and for PASS was 0.87 (CI at 95%, 0.79-0.92). Chronbach's alpha was 0.95, 0.96 and 0.87 for BASDAI, BASFI and PASS, respectively. BASDAI showed a significant correlation with patient global disease activity index, nocturnal back pain, total back pain, number of swollen joints, number of enthesites, morning stiffness, Bath Ankylosing Spondylitis Global Score (BAS-G), BASFI and BASMI. A significant correlation was also found between BASFI and occiput-to-wall distance, mentum-to-sternum distance, chest expansion, finger-to-floor distance, number of swollen joints, number of enthesites, nocturnal back pain, total back pain, BAS-G, BASDAI and BASMI. Patients who answered "no" to PASS (found their condition unsatisfactory) reported significantly increased pain scores, patient global disease activity scores, BAS-G, BASDAI and BASFI scores. The results showed that the Iranian versions of BASDAI, BASFI and PASS are adequately reliable and valid in patients with AS.

Amaç: Bu çalışmada İranlı ankilozan spondilit (AS) hastalarında sigara paket yılı ve hastalık aktivitesi, yaşam kalitesi, spinal mobilite ve sakroileit derecelendirmesi ve AS arasındaki ilişki araştırıldı. Sonuç: Bir grup İranlı AS hastasında sigara miktarı ve hastalık aktivitesi ve yaşam kalitesi arasında bağımsız bir ilişki olduğu doğrulandı. Ayrıca içilen sigara miktarı ve spinal mobilite arasında da bir ilişki vardı; ancak bu başka ilintili faktörlere bağlıydı. Sigara içen hastalara, daha iyi sonuçlar elde etmeleri için, sigarayı bırakmaları veya daha az içmeleri telkin edilmelidir. Hastalar ve yöntemler:Anahtar sözcükler: Ankilozan spondilit; mobilite kısıtlılığı; yaşam kalitesi; sakroileit; sigara kullanımı. Objectives:This study aims to investigate the correlation between the pack-years of smoking and disease activity, quality of life, spinal mobility, and sacroiliitis grading and ankylosing spondylitis (AS) in Iranian patients with AS. Patients and methods:A total of 160 AS patients were evaluated according to their smoking status and pack-years of smoking. The outcome measures were disease activity, quality of life, spinal mobility, and sacroiliitis grading, and these were assessed by the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Quality of Life (ASQoL), Bath Ankylosing Spondylitis Metrology Index (BASMI), and radiography, respectively. Results:The smoking quantity was significantly higher in the patients with severe sacroiliitis than those with mild or moderate disease (p=0.001). A univariate analysis revealed an association between the pack-years of smoking and the BASDAI [regression coefficient (B)=0.05, standard error (SE)=0.02, 95% CI: 0.006 to 0.10; p=0.03], ASQoL (B=0.15, SE=0.06, 95% CI: 0.04 to 0.26; p=0.007), and BASMI (B=0.05, SE=0.02, 95% CI: 0.006 to 0.08; p=0.03). A multivariate analysis revealed a significant association between the packyears of smoking and the BASDAI and ASQoL. Conclusion:An independent correlation between smoking quantity with disease activity and quality of life was confirmed in a group of Iranian AS patients. There was also a relationship between smoking quantity and spinal mobility, however, it was dependent on other related factors. Patients who smoke should be encouraged to quit or smoke less to achieve a better outcome.