Background Some functional limitations caused by axial spondyloarthritis (aSpa) are difficult to assess. The most widely used function and activity scores (BASFI and BASDAI, respectively) include some questions related to neck pain and disability; nevertheless, they are far from specific to assess this peculiar aspect. In literature, references concerning evaluation of neck symptoms and their potential functional impact in Spa are scarce. Neck Disability Index (NDI) is a questionnaire that targets functional assessment of patients with neck pain and, so far, it has not been applied to Spa patients in any study.
Objectives To evaluate, in a cohort of patients with aSpa, the functional impact of neck pain, and its relation with disease duration and activity and function indexes.
Methods Cross sectional study. Analyzed variables: gender, age, disease duration. BASDAI, BASFI and NDI were assessed in all patients, as well as mSASSS and tragus-to-wall distance. Statistical analysis performed with SPSS® version 18.0.
Results Sixty six patients were enrolled (48 males, 18 females); mean age was 45±15.2 years old and mean disease duration was 9.92±10. Mean BASDAI and BASFI were, respectively, 3.53±2.53 and 3.22±2.6. Mean mSASSS was 11.65±16.34 and mean trags-to-wall distance was 12.96±4.66cm. Mean NDI value was 20.41±12.65; according to severity classification, 5 patients (7.57%) presented “no disability”, 23 patients (34.85%) had a “mild disability”, 14 patients (21.21%) had “moderate disability”, “severe disability” was noted in 14 patients (21.21%) and 10 patients were classified as having “complete disability”.
Although a tendency to higher values of NDI in patients with higher values of BASDAI and BASFI was observed, those correlations were not statistically significant. On the other hand, a statistically significant positive correlation between disease duration and NDI value was identified (p=0,011), and also – as expected - between tragus-to-wall distance and NDI value (p=0.02). No relation was found between NDI value and radiological damage (assessed by mSASSS) and there was no significant difference in both genders.
Conclusions In this study, we found that the majority of patients presented some degree of disability related to neck pain, which was moderate to total in more than half of them. We also concluded that this functional impairment increases with disease duration (as suggested by previous literature data) and is also more prominent in patients with greater tragus-to-wall distance. The fact that the usually assessed disease activity and function indexes include few questions regarding cervical spine, therefore diluting its impact in total index score, might explain why no correlation was found between them and NDI.
Holden W, Taylor S, Stevens H, Wordsworth P, Bowness P. Neck pain is a major clinical problem in ankylosing spondylitis, and impacts on driving and safety. Scand J Rheumatol. 2005;34(2): 159-60
Disclosure of Interest None declared