Department of Rheumatology and Inflammation Research, Institute of Medicine, University of Gothenburg, Box 480, 405 30, Gothenburg, Sweden.
Department of Rheumatology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.
Arthritis Res Ther. 2023 Sep 26;25(1):182. doi: 10.1186/s13075-023-03173-w.
Physical function is an important determinant of health-related quality of life in radiographic axial spondyloarthritis patients (r-axSpA). To improve the basis of effective healthcare efforts, we aimed to investigate which demographic and disease-related factors that influence Bath Ankylosing Spondylitis Functional Index (BASFI) in r-axSpA patients overall and stratified by sex. Furthermore, we sought to explore differences between sexes regarding separate BASFI questions and also to explore which factors that may contribute to these differences.
This observational cross-sectional study included patients fulfilling the modified New York criteria for Ankylosing Spondylitis. Patients were assessed with 66/68 joint count and Bath Ankylosing Spondylitis Metrology Index (BASMI) measurements. Lateral X-rays were performed for Modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS). Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score (ASDAS)-C-Reactive Protein (CRP), and BASFI were registered. Multivariable linear regression analyses were used to investigate which factors that associate with BASFI.
A total of 353 r-axSpA patients were included, mean age 52.2 ± 12.7 years, 62.3% males. No significant sex difference was seen in BASFI scores (2.7 ± 2.0 in males vs 2.9 ± 2.1 in females). Age, body mass index, ASDAS-CRP, BASMI or mSASSS, fatigue, and tenderness were found to associate independently with BASFI in different models (R 0.53-0.63). Investigation of separate BASFI questions revealed that the ability to look over shoulder was worse in males than females (mean 4.43 ± 3.37 vs 3.74 ± 3.06, p = 0.05) and most strongly correlated with mSASSS and BASMI among separate BASFI questions (r = 0.53, p < 0.001; r = 0.62, p < 0.001). The ability to climb stairs was worse in females than males (mean 2.49 ± 2.77 vs 1.54 ± 2.32, p < 0.001).
No difference between male and female r-axSpA patients was seen in BASFI despite significant sex differences in BASMI, mSASSS, and CRP levels. Our results underline the impact of fatigue and tenderness on BASFI. The ability to climb stairs without a handrail was scored worse among females compared to males. Furthermore, the ability to look over the shoulder was worse in males than females and closely related to spinal mobility and structural spinal changes.
身体功能是影像学轴向脊柱关节炎（r-axSpA）患者健康相关生活质量的重要决定因素。为了改善有效的医疗保健工作基础，我们旨在研究哪些人口统计学和疾病相关因素会影响 r-axSpA 患者的 Bath 强直性脊柱炎功能指数（BASFI），并按性别进行分层。此外，我们还试图探讨男女之间在单独的 BASFI 问题上的差异，并探讨可能导致这些差异的因素。
这是一项观察性横断面研究，纳入符合改良纽约强直性脊柱炎标准的患者。患者接受 66/68 关节计数和 Bath 强直性脊柱炎计量指数（BASMI）测量。进行改良 Stoke 强直性脊柱炎脊柱评分（mSASSS）的侧位 X 射线检查。登记 Bath 强直性脊柱炎疾病活动指数（BASDAI）、强直性脊柱炎疾病活动评分（ASDAS-CRP）和 BASFI。使用多元线性回归分析来研究哪些因素与 BASFI 相关。
共纳入 353 例 r-axSpA 患者，平均年龄 52.2±12.7 岁，男性占 62.3%。男性和女性的 BASFI 评分无显著性别差异（男性 2.7±2.0，女性 2.9±2.1）。在不同模型中，年龄、体重指数、ASDAS-CRP、BASMI 或 mSASSS、疲劳和压痛均与 BASFI 独立相关（R 0.53-0.63）。对单独的 BASFI 问题进行调查显示，男性的肩部活动能力比女性差（平均 4.43±3.37 比 3.74±3.06，p=0.05），与单独的 BASFI 问题中的 mSASSS 和 BASMI 相关性最强（r=0.53，p<0.001；r=0.62，p<0.001）。女性爬楼梯的能力比男性差（平均 2.49±2.77 比 1.54±2.32，p<0.001）。
尽管男性和女性 r-axSpA 患者在 BASMI、mSASSS 和 CRP 水平方面存在显著性别差异，但在 BASFI 方面未见差异。我们的结果强调了疲劳和压痛对 BASFI 的影响。女性爬楼梯时没有扶手的能力比男性差。此外，男性的肩部活动能力比女性差，与脊柱活动度和结构性脊柱变化密切相关。
