Functional Limitations Due to Axial and Peripheral Joint Impairments in Patients With Ankylosing Spondylitis: Are Focused Measures More Informative?

Abstract

Objective Functional limitations in ankylosing spondylitis (AS) may be due to peripheral joint or axial involvement. To determine if the Bath AS Functional Index (BASFI), an axial-focused measure, can detect limitations related to peripheral joint involvement equally well as the Health Assessment Questionnaire modified for the Spondyloarthropathies (HAQ-S), a peripheral arthritis-focused measure, and vice versa, we compared associations of each questionnaire with spinal and hip range of motion, peripheral arthritis, and enthesitis in patients with AS. Methods We examined patients every 4 to 6 months in this prospective longitudinal study. We used mixed linear models to examine associations between ten physical examination measures and the BASFI and HAQ-S. Results We studied 411 patients for a median of 1.5 years (3 visits). In multivariate analyses, cervical rotation, chest expansion, lateral thoracolumbar flexion, hip motion, tender joint count, and tender enthesis count were equally strongly associated with the BASFI and HAQ-S. Peripheral joint swelling was more strongly associated with the HAQ-S. Individual items of the BASFI were more likely than items of the HAQ-S to be associated with unrelated physical exam measures (e.g. association between difficulty rising from a chair and cervical rotation), which may have diminished the axial/peripheral distinction for the BASFI. Conclusions The BASFI and HAQ-S had similar associations with impairments in axial measures, while the HAQ-S had stronger associations with the number of swollen peripheral joints. The HAQ-S should be considered for use in studies focused on spondyloarthritis with peripheral joint involvement.

Repeated Spinal Mobility Measures and Their Association With Radiographic Damage in Ankylosing Spondylitis

“…Spinal mobility measures were performed at each study visit by the study visit investigators. Of the measurements of physical impairment recorded in the PSOAS (20), the following individual mobility tests were selected for study given their hypothesized relationship with regional cervical or lumbar mSASSS: cervical rotation, cervical lateral flexion, occiput‐to‐wall (OTW) distance, lumbar flexion (eg, Schöber’s test), and lateral lumbar bending. Cervical rotation and cervical lateral flexion were recorded as the sum of maximal right and left movements, using a protractor.…”

Langfassung zur S3-Leitlinie Axiale Spondyloarthritis inklusive Morbus Bechterew und Frühformen, Update 2019

“…7.2). Patienten mit peripherer Beteiligung weisen eine Einschränkung der körperlichen Funktionsfähigkeit auf, die sich auch in dem auf die Achsenskelettmanifestation fokussierten Fragebogen Bath Ankylosing Spondylitis Functioning Index (BASFI) niederschlägt [33].…”

The Clinical and MRI Effect of TNF-α Inhibitors in Spondyloarthritis Patients With Hip Involvement: A Real-World Observational Clinical Study

“…Hip involvement is an important cause of disability and poor prognosis in approximately 10%-50% of patients with spondyloarthritis (SpA) (1,2), and 47%-90% of those patients with hip involvement have it bilaterally (3). Progression of hip involvement is reported to be associated with more severe spinal involvement (4,5) and seriously affects joint function and life quality. In addition, nearly 8% of patients with hip involvement have intractable pain and disability.…”