Correlation Between Global Sagittal Alignment And Health Related Quality Of Life In Ankylosing Spondylitis Patients With Thoracolumbar Kyphosis

Part one:Correlation between global sagittal alignment and health related quality of life in ankylosing spondylitis patients with thoracolumbar kyphosisAbstractObjective:To identify the relationship between global sagittal alignment and health-related quality of life (HRQoL) in ankylosing spondylitis (AS) patients with thoracolumbar kyphosis.Methods:A total of 107 AS patients (99 male and 8 female), with a mean age of 35.5 ±11.4 years (range,15-65 years), were included in this study. The radiographic parameters were measured on lateral radiographs of the whole spine, including sagittal vertical axias (SVA), spino-sacral angle (SSA), spino-pelvic angle (SPA) and T1 pelvic angle (TPA). HRQoL was assessed using the oswestry disability index (ODI) questionnaire, the bath ankylosing spondylitis diseaseactivity index (BASDAI), the bath ankylosing spondylitis functional index (BASFI) and short form-36 questionnaire (SF-36). The patients were divided into two groups:Group A (n= 76, GK?70°), Group B (n= 31, GK> 70°). Statistical analysis was performed to identify significant differences between these two groups. In addition, correlation analysis and multiple regression analysis between radiological parameters and clinical questionnaires were conducted.Results:With respect to SVA, SSA, SPA, TPA and HRQoL scores, significant differences were observed between two groups (p< 0.05). Also, SVA, SSA, SPA and TPA were significantly related to HRQoL. Multiple regression analysis revealed that SVA, SSA, SPA and TPA were significant parameters in the prediction of HRQoL in AS patients with thoracolumbar kyphosis. Of note, HRQoL related much more to SSA and SPA than SVA and TPA. SSA significantly predicted physical function domain and total score of SF-36, and SPA was noted to be a significant parameter in prediction of ODI and bodily pain domain of SF-36.Conclusion:AS patients with moderate and severe deformity were demonstrated to be significantly different in terms of SVA, SSA, SPA, TPA and HRQoL. In addition, SVA, SSA, SPA and TPA correlated with HRQoL significantly. SVA, SSA, SPA and TPA were found to be significant independent predictors of HRQoL in AS patients with thoracolumbar kyphosis. In particular, SSA and SPA could better predict HRQoL than SVA and TPA in AS patients with thoracolumbar kyphosis.Part two:Influence factors and clinical significance of digestive disturbance in ankylosing spondylitis patientsAbstractObjective:To investigate the digestive disturbance in ankylosing spondylitis (AS) patients, and to analyze its influeflee factors and clinical significance.Methods:From July 2014 to Apill 2015,101 AS patients were included in this study, consisting of 84 outpatients and 17 inpatients. The parameters of patients, including age, disease duration, history of taking non steroidal anti inflammatory drugs (NSAIDs) and disease modifying anti rheumatic drugs (DMARDs), smoking and alcohol history, comorbidities, erythroeyte sedimentationrate (ESR), C reactive protein (CRP) and global kyphosis (GK) were collected. Digestive function was assessed by the Food and Benefits Assessment (FBA) and Functional Digestive Disorders Quality of Life (FDDQL) questionnaires. The patients were divided into mild kyphosis group (GK<60°, n=67) and severekyphosis group (GK?60°, n=34). Correlations of FBA, FDDQL with the influencing factors were calculated by the Spearman coefficients of correlations. Multiple regression analysis was used to investigate the influence factors which impaireddigestive function of AS patients.Results:The score of FBA and FDDQL was 63.2±13.5 and 77.4±13.1. The average GK of patients was 52.1°±23.5°. Additionally, the ESR and CRP were 26.6±20.2 mm/h and 32.0±22.7 mg/L. History of smoking, alcohol, taking NSAIDs and DMARDs were found in 52,40,48 and 23 patients, respectively. Among them,3 patients were companied with anemia. There was no significant difference between two groups in questionnaire scores except for the score of coping with disease domain of FDDQL questionnaire. Spearman correlation analysis revealed that FBA was significantly correlated with age, CRP and alcohol (P<0.05), while FDDQL was significantly related to anemia (P<0.05) in mild kyphosis group. Moreover, in severe kyphosis group, no significant correlation was found between FBA and influence factors, and FDDQL was significantly associated with GK and anemia (P<0.05). For all 101 AS patients, significant correlations were observed between FBA and age, NSAIDs as well as alcohol history (P<0.05). Similarly, FDDQL significantly correlated with GK, NSAIDs, DMARDs, and anemia (P<0.05). Multiple regression analysis revealed that NSAIDs and alcohol history resulted in lower FBA score, while NSAIDs and anenlia leaded to lower FDDQL score.Conclusion:There is no significant difference between AS patients with mild and severe kyphosis in digestive function. The digestive function of AS patients is impaired, which is related to age, GK, NSAIDs, DMARDs, alcohol and anemia. Digestive disturbance is not correlated with disease duration, ESR, CRP and smoking. Among them, NSAIDs, alcohol and anemia are the most important factors impairing the digestive function in AS paticnts.