Background/Purpose: In this study, we assessed the impact of postural deformities caused by ankylosing spondylitis (AS) on balance.

Methods: 29 AS patients and 21 healthy controls were enrolled. Control group consisted of healthy hospital staff. Demographic data (age, sex, body mass index, treatment regimes, comorbidities, symptom and disease durations,  smoking and alcohol use) were recorded. Physical examination, timed up-and-go test, 5 times sit-to-stand test, gait speed, functional reach test, 6 minute walk test, Romberg tests (eyes open and closed- feet together , tandem and on a soft surface ), Dynamic Gait Index (DGI), Functional Gait Assessment (FGA), Berg Balance Scale (BBS) and for the AS group Bath Ankylosing Spondylitis Metrology Index (BASMI) were scored. Subjects were asked to fill out questionnaires for Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Back Depression Inventory (BDI),Activity Specific Balance Confidence Scale (ABC) and Dizziness Handicap Inventory (DHI).BASDAI, BASFI , and BASMI were only used in the AS group. The AS patients were then subgrouped according to their BASMI scores. Patients with scores ranging between 0-4 were assigned to subgroup AS1 while those with scores between 5-10 were assigned to subgroup AS2. These two subgroups were then compared with each other and with healthy controls.

Results:

AS1 patients had higher Berg Balance Scores compared to AS2 patients(p<0.05), while no significant difference was found between AS1 and AS2 groups in 5 times sit-to-stand test, timed up and go test, gait speed, Romberg tests, 6 min. walk test ,functional reach test, DGI, FGA, BDI or ABC scales (p>0.05). 

AS and control subjects were found to have significant differences in 5 times sit-to-stand test, tandem Romberg test with eyes closed, BDI, BBS and ABC scores (p<0.05).

The control and the AS2 group differed significantly in 5 times sit-to-stand test, timed up and go test, tandem romberg with eyes closed, 6 min. walk test, functional reach test, FGA, BBS, BDI, DHI and ABC scores (p<0.05), these differences were not observed in the AS1 group.

Conclusion: Our study results support the concept that ankylosing spondylitis patients have poorer static and dynamic balance compared to healthy subjects.  Poor balance and resulting falls may increase disease morbidity and  should be assessed in patients with AS.The chronic nature of the disease and slow progression of postural deformities may explain why poor balance is not a more common symptom of  AS. Still, especially in patients with fracture risk factors such as osteoporosis and immobilisation, it is important to assess balance and take the necessary precautions.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/do-postural-deformities-in-patients-with-ankylosing-spondylitis-cause-balance-problems/