A comparison of BASDAI, BASFI and ASQoL in smoker versus non smokers and in male versus female in a West of Ireland cohort
Larkin MA, Curran AM, Sullivan C, Lynch, B
Rheumatology Department, Galway University Hospital
Ankylosing spondylitis (AS) is a chronic inflammatory disorder with an estimated prevalence of 0.2–0.8% in the adult Caucasian population of Western Europe. Numerous studies have shown that there is a long delay in diagnosing AS, with a mean delay of approximately 7 years.
Subjective measures of symptom severity, functional ability and quality of life are determined using various tools; Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI) and Ankylosing Spondylitis Quality of Life (ASQoL) respectively.
Lifestyle factors have been shown to influence BASDAI, BASFI and ASQoL scores. Cigarette smoking has been linked to worse functional, clinical and radiological outcome in AS.
A previous study examined the difference in severity of AS between genders; radiographic spinal changes are more severe in men. The same study showed self-reported functional limitations were worse in women than men.
To analyse the AS cohort attending Galway University Hospital (GUH). To compare the BASDAI, BASFI and ASQoL in smokers vs non smokers and in males vs females.
Data was initially gathered prospectively using a web based data system; Ankylosing Spondylitis Registry of Ireland. Patients who attended GUH submitted their data over 3 years. Their data was then collated retrospectively.
There were 43 patients; 5 female (11.6%), 38 males (88.4%). The median age was 42 years (21-82) with the median age at diagnosis, 35 years (17-72). 17 years (2-56) was the median duration of symptoms. In keeping with previous studies the average delay in diagnosis was 6.7 years. 55.8% have extra spinal manifestations; 60% of the female cohort and 55% of the male.
At diagnosis, 25.6% of the cohort were current smokers, 74.4% non smokers. ASQoL, BASDAI and BASFI scores for current smokers were higher than the same median values in non smokers. However, when compared using the Mann-Whitney U test this difference was not statistically significant; as demonstrated in table 1.
ASQoL, BASDAI and BASFI were also compared in males vs females using Mann-Whitney U test. Despite a higher median value of ASQoL in females it did not reach statistical significance.
Although this is a small cohort of patients from the West of Ireland it could be deemed to be representative of a larger population with a mean delay in diagnosis of 6.7 years in keeping with international trends. Although the median scores were not statistically significant in terms of smokers vs non-smokers, a significant difference in ASQoL scores were noted. Similarly BASDAI and BASFI scores were higher in smokers vs non-smokers and would suggest the trend is in keeping with international norms. Although the study does not definitively prove adverse effects of smoking in AS we should continue to recommend smoking cessation in every AS patient as part of their treatment plan.