OCJENA AKTIVNOSTI ANKILOZANTNOG SPONDILITISA PRIMJENOM BASDAI I ASDAS INSTRUMENTA

Dubravka Bobek, Iva Žagar, Kristina Kovač-Durmiš, Porin Perić, Božidar Ćurković, Đurđica Babić-Naglić

Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) is the most frequently used ankylosing spondylitis activity assesment by which through 6 questions 5 basic diseases symptoms (fatigue, back pain, joint pain/swelling, enthesitic points, intensity and duration of morning stiffness) are being evaluated. In distinction from mentioned, Ankylosing Spondylitis Disease Activity Score (ASDAS) is the first validated index for the AS activity assessment with the patient’s assessments of the disease symptoms (back pain, duration of the morning stiffness, activity of the disease, pains and swelling of the peripheral joints) includes the acute phase reactants (SE or CRP). We compared BASDAI and ASDAS indexes to the group of patients with the AS, in order to evaluate their congruence and to evaluate the infl uence of SE, fatigue and back pain at obtained values. The cross-sectional study was performed in a group of 36 patients with the AS whose disease activity levels were evaluated by the BASDAI and ASDAS (SE) index. Statistical data analysis was performed by Student t-test and frequency tables for non-parameter data. As it has been expected the significant correlation between BASDAI and ASDAS indexes has been confirmed (r=0.796; p=0.00). BASDAI/ASDAS average value of all of the patients was 4.2/2.8. From 36 patients with the AS according to the BASDAI index 42% had mild active disease (BASDAI <4), while according to ASDAS index 44% patients had very active disease (ASDAS 2.1- 3.5). Higher activity of the disease according to ASDAS index is the result of the elevated sedimentation which is assessed only in ASDAS index. Patients with higher BASDAI index statistically have more significantly expressed fatigue and spinal pain without statistically significant difference in sedimentation (p=0.120). Examinees with higher ASDAS index have also significantly more expressed fatigue and back pain, but unlike BASDAI they have sedimentation (p=0.001). ASDAS is more recent clinical indicator of the AS activities which could be compared to BASDAI instrument. In this group of patients ASDAS seems to be more sensitive index because it discriminates more patients with the active disease.

Za procjenu aktivnosti ankilozantnog spondilitisa (AS) najčešće se koristi Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) kojim se kroz 6 pitanja evaluira 5 osnovnih simptoma bolesti (umor, bol u kralježnici, bol i oteklina zglobova, osjetljivost enteza, intenzitet i trajanje jutarnje zakočenosti). Za razliku od navedenog, Ankylosing Spondylitis Disease Activity Score (ASDAS) je indeks za procjenu aktivnosti AS koji uz bolesnikovu procjenu simptoma bolesti (bolova u kralježnici, trajanja jutarnje zakočenosti, aktivnosti bolesti, bolova i otekline perifernih zglobova) uključuje reaktante akutne faze (SE ili CRP). Cilj rada bio je usporediti BASDAI i ASDAS indekse na skupini bolesnika s AS, procijeniti njihovu sukladnost i utjecaj SE, umora i boli u kralježnici na dobivene vrijednosti. Istraživanje je provedeno po tipu presječne studije u skupini od 36 bolesnika s AS kojima je procijenjena razina aktivnosti bolesti BASDAI i ASDAS (SE) indeksom. Statistička analiza podataka učinjena je Student t-testom te tablicama frekvencije za neparametrijske podatke. Kao što je i očekivano potvrđena je značajna korelacija između BASDAI i ASDAS indeksa (r=0,796; p=0,00). Prosječna vrijednost BASDAI/ASDAS svih bolesnika iznosila je 4,2/2,8. Od 36 bolesnika s AS prema BASDAI indeksu 42% je imalo blago aktivnu bolest (BASDAI <4), dok je prema ASDAS indeksu 44% bolesnika imalo jako aktivnu bolest (ASDAS 2,1-3,5). Bolesnici s višim BASDAI indeksom imaju statistički značajno izraženiji umor i bol u kralježnici bez statistički značajne razlike u sedimentaciji (p=0,120). Ispitanici s višim ASDAS indeksom imaju također značajno izraženiji umor i bol u kralježnici, ali za razliku od BASDAI-a i sedimentaciju (p=0,001). ASDAS je noviji klinički indikator aktivnosti AS koji je usporediv s BASDAI instrumentom. U ovoj skupini bolesnika ASDAS se čini osjetljivijim upitnikom jer diskriminira više bolesnika s aktivnom bolešću.