[Validation of the Ankylosing Spondylitis Quality of Life questionnaire in Tunisian language]. / Validation de la version dialectale tunisienne de l'ankylosing spondylitis quality of life (ASQoL).

BACKGROUND: The Ankylosing Spondylitis Quality of Life (ASQoL) questionnaire is a Wide-world used, unidimensional, disease-specific measure of quality of life. Arabic or Tunisian versions of ASQoL or any other quality of life index are not provided. AIM: To adapt the Ankylosing Spondylitis Quality of life Questionnaire (ASQoL) for use in Tunisian and to test its reliability and validity. METHODS: 99 patients who fulfilled the modified New York criteria for ankylosing spondylitis (AS) were included in this study (84 male and 15 female). The translation process included the recent guidelines for cross-cultural adaptation. Reliability of the Tunisian version of the ASQoL was assessed by test-retest method (day 1 and day 10) and internal consistency using Cronbach's alpha coefficient. For construct validity, ASQoL scores were correlated with specific instruments of AS. RESULTS: The mean age of patients was 38.35 years ± 12.26 (18- 73) and the mean disease duration was 11.3 years ± 9.4 (0.6 - 40). The mean time to complete the questionnaire was 5 minutes. Reproducibility was good with no significant difference between ASQoL0 (mean score = 9.8 ± 5.04) and ASQoL10 (mean score = 9.46 ± 5.89) as well as the statically significant positive correlation intra-class coefficient: 0.87 (IC 95%: 0.79-0.92). Internal consistency was good (Cronbach: 0.933; IC95%=0.86-0.95). ASQoL was significantly correlated with BASDAI (p<0.001), BASFI (p<0.001), BASG-s (p<0.001), BASMI (p=0.026), MASES (p=0.024) and all items of SF-36. CONCLUSION: Validation of the ASQoL for use in Tunisia was successful. The results of the present study indicate that the Tunisian version for ASQoL is reliable and valid.

Health-related Quality of Life Assessment on 100 Tunisian Patients with Ankylosing Spondylitis using the SF-36 Survey.

OBJECTIVES: The main objective of the study was to examine the self reported health status in patients with ankylosing spondylitis (AS) compared with the general population and the secondary objective (in the AS group) was to study the association between health status, demographic parameters, and specific disease instruments in AS. METHODS: A cross sectional study of 100 AS patients recruited between 2006 and 2009 at the Department of Rheumatology. Health status was assessed by using the SF-36 health questionnaire in patients with AS. Demographic characteristics and disease-specific instruments were also examined by the questionnaire. A sample of 112 healthy individuals was also surveyed using the SF-36 health questionnaire. RESULTS: This study showed a great impairment in the quality of life of patients with AS involving all scales. All male patients with AS reported significantly impaired health-related quality of life on all items of the SF-36 compared with the general population whereas female patients reported poorer health on three items only, namely physical functioning, general health and bodily pain. Mental health was mostly affected than physical role. The physical role was significantly higher in patients with high education level than in patients with low education level (p=0.01). Physical functioning was better in employed patients. All scales of SF-36 were correlated with BASFI, BASDAI and BAS-G. Only physical functioning and general health were correlated with BASMI. CONCLUSION: Impairment in the quality of life can be significant when suffering from AS, affecting mental health more than physical health. Among disease parameters, functional impairment, disease activity, mobility limitation, and spinal pain were the most associated factors resulting to the deterioration of quality of life.

Assessment of preclinical atherosclerosis in patients with ankylosing spondylitis.

OBJECTIVE: Epidemiological studies recently confirmed the increased risk of vascular morbidity and mortality during ankylosing spondylitis (AS). Increase of intima-media thickness (IMT) of the common carotid artery is a useful and noninvasive marker of preclinical atherosclerosis. The aim of our study was to compare IMT in patients with AS with matched controls and to determine risk factors of atherosclerosis related to AS. METHODS: We performed a prospective study of 60 consecutive patients meeting modified New York criteria for AS, compared to 60 controls matched for age and sex. Disease-specific measures were determined. Measurement of IMT was performed by the same radiologist using the same machine and probe in right and left common carotid arteries, and the average of the 2 measurements was considered. RESULTS: In total 48 male and 12 female patients were recruited, and 60 corresponding controls; mean age was 36 ± 11 years. We found significantly increased IMT in the AS group (0.51 ± 0.12 mm) compared with controls (0.39 ± 0.09 mm; p = 0.001). After adjustment for confounding factors, increased IMT was still present (p = 0.003). Age at onset of AS (p = 0.001), Bath AS Disease Activity Index (p = 0.002), AS Disease Activity Score (ASDAS) erythrocyte sedimentation rate (ESR; p = 0.047), ASDAS C-reactive protein (CRP; p = 0.012), Bath AS Functional Index (p = 0.008), global spine visual analog scale for pain (p = 0.000), Schober index (p = 0.039), Bath AS Metrology Index (p = 0.028), modified Stoke Ankylosing Spondylitis Spine Score (p = 0.035), and high ESR (p = 0.001) and CRP (p = 0.000) were correlated with high IMT in patients with AS. Otherwise, status of arthritis (p = 0.442), enthesitis (p = 0.482), and HLA-B27 (p = 0.528) seemed to have no effect on IMT. CONCLUSION: AS is associated with an increased risk of atherosclerosis independent of traditional risk factors. Disease activity, functional and mobility limitations, structural damage, and inflammation are the most incriminated risk factors.