Clinically Relevant Deficits in Performance Tests in Patients With Axial Spondyloarthritis

Abstract

Objective To assess the association between self-reported and performance-based physical functioning and to evaluate which performance tests are most frequently impaired in patients with axSpA. Methods Consecutive axSpA patients underwent standardized assessments including patient and disease characteristics, patient-reported outcomes for disease activity, functioning, depression, mobility and physical activity and performance tests. Patients were defined as being impaired if they were not able to perform ≥ 1 of the performance tests. Validated cut-offs were used to define impaired physical performance. Impairment of performance tests as well as discrimination between subgroups were analyzed. Results A total of 200 patients (r-axSpA 65.5%, nr-axSpA 34.5%) was included: 69% males, mean age 44.3 (SD 12.5) years and mean symptom duration 17.9 (12.6) years. The two most frequently impaired performance tests were the repeated chair stand test (n=75, 37.5%) and putting on socks (n=44, 22%). An impairment in ≥ 1 performance test was seen in 91 patients (45.5%). Patients with impairments were older (48.9 vs. 40.8 years), had a higher body mass index (28.7 vs. 26.1 kg/m2), a more active disease (ASDAS 3.0 vs. 2.1), higher BASFI (5.7 vs. 2.8), BASMI (4.3 vs. 2.8) and ASAS HI scores (9.6 vs. 5.0), and higher depression screen values (PHQ 12.1 vs. 6.3), all p<0.01. Conclusion Many patients with axSpA had impairments in physical performance tests. Importantly, this was frequently seen in tasks requiring coordination and muscle power of the lower extremity. Performance tests provide qualitatively different information than BASFI and BASMI assessments in patients with axSpA.

The influence of alexithymia on disease activity and quality of life in patients with axial spondyloarthritis: A cross‐sectional study

“…According to Assessment of Spondyloarthritis International Society 2009 classification criteria, axSpA was classified as ankylosing spondylitis (AS) and non‐radiographic axSpA (nr‐axSpA) 6 . Pain is a common complaint in axSpA patients and is usually caused by inflammation, structural damage, new bone formation, degenerative changes, and/or fractures due to osteoporosis 7–9 . Additionally, coexisting chronic widespread pain or chronic regional pain that is often linked to impaired quality of life and physical function is not uncommon in axSpA patients 7 .…”

“…Pain is a common complaint in axSpA patients and is usually caused by inflammation, structural damage, new bone formation, degenerative changes, and/or fractures due to osteoporosis 7–9 . Additionally, coexisting chronic widespread pain or chronic regional pain that is often linked to impaired quality of life and physical function is not uncommon in axSpA patients 7 . Psychological comorbidities are reported as being closely connected with potentially higher disease activity and poor outcomes in axSpA patients 10–12 …”

Does Gender Impact a Diagnosis of Ankylosing Spondylitis?

“…On average, patients experience symptoms for 5 to 14 years before receiving a diagnosis of axSpA (5–7). Diagnosis delay is partly attributed to the challenges in differentiating inflammatory back pain—a key clinical feature of axSpA affecting the spine and sacroiliac joints—from other forms of chronic back pain in the general population (8–10). An earlier diagnosis and the prompt treatment of disease may significantly ameliorate the burden of disease, resulting in better quality of life; nonetheless, misdiagnoses, delays in diagnosis, and underdiagnosis persist (3,11).…”

“…On average, patients experience symptoms for 5 to 14 years before receiving a diagnosis of axSpA (5)(6)(7). Diagnosis delay is partly attributed to the challenges in differentiating inflammatory back pain-a key clinical feature of axSpA affecting the spine and sacroiliac joints-from other forms of chronic back pain in the general population (8)(9)(10). An earlier diagnosis and the A portion of these data was presented as a poster presentation at the 2020 American College of Rheumatology Annual Meeting: Hwang M, Rozycki M, Arndt T, Yi E, Weisman M. Differences between men and women in the patient pathways to diagnosis of ankylosing spondylitis.…”

Quality of care, referral, and early diagnosis of axial spondyloarthritis

“…The diagnosis of axSpA should be made on the basis of history, clinical examination, laboratory findings, imaging, and consideration of differential diagnoses [26][27][28]. Overall, it is important that not a single symptom is indicative of the diagnosis of axSpA, this makes a simple pre-selection of patients difficult.…”