ACR：HAQ-S可用于AS患者外周关节受累的评价

强直性脊柱炎（AS）患者的功能受限可能是由于外周或者中轴关节受累。针对这一情况，来自美国国立卫生研究院，国立关节炎及肌肉骨骼及皮肤疾病的SIDDHARTH BETHI等人进行了一项研究，研究目的是明确Bath强直性脊柱炎功能指数（BASFI，一项基于中轴的评级方法）是否能检测出周围关节受累相关的功能受限；及修订的脊柱关节炎健康评估调查问卷（HAQ-S，一种基于周围关节的评价方法）是否能检测出中轴关节相关的功能受限。研究者对AS患者脊柱及腰骶部活动范围、周围关节炎、附着点炎与相关的每种调查问卷的关系进行了比较。研究结果在线发布在2013年4月的《关节炎护理及研究》（Arthritis Care & Research）杂志上。作者发现，BASFI和HAQ-S与中轴关节损伤评价的相关性相似，但是HAQ-S与外周关节肿胀数相关性更强。HAQ-S可被应用于AS患者外周关节受累的研究。

这是一项前瞻性纵向研究，研究者每4-6个月对受试者进行一次评价。研究者采用混合线性模型来评价10项躯体检查措施和BASFI和HAQ-S之间的关系。该研究共纳入411位受试者，中位时间1.5年（中位访视：3次）。在多因素分析中，颈椎活动、胸廓运动、胸腰椎侧弯、髋关节活动、压痛关节数、压痛附着点数与BASFI和HAQ-S相关性一致。周围关节肿胀数与HAQ-S相关性更大。BASFI个别项目似乎比HAQ-S个别项目与其他体格检查的相关性更大（例如：从椅子上站起的困难度和颈椎活动的关系），这一结果可能减少BASFI对外周和中轴关节评价的差异。

BASFI和HAQ-S与中轴关节损伤评价的相关性相似，但是HAQ-S与外周关节肿胀数相关性更强。HAQ-S能被应用于AS患者外周关节受累的研究。

Functional limitations due to axial and peripheral joint impairments in patients with ankylosing spondylitis: are focused measures more informative?
OBJECTIVE
Functional limitations in ankylosing spondylitis (AS) may be due to peripheral joint or axial involvement. To determine if the Bath Ankylosing Spondylitis Functional Index (BASFI), an axial-focused measure, can detect limitations related to peripheral joint involvement equally as well as the Health Assessment Questionnaire modified for the spondyloarthropathies (HAQ-S), a peripheral arthritis-focused measure, and vice versa, we compared associations of each questionnaire with spinal and hip range of motion, peripheral arthritis, and enthesitis in patients with AS.
METHODS
We examined patients every 4-6 months in this prospective longitudinal study. We used mixed linear models to analyze the associations between 10 physical examination measures and the BASFI and HAQ-S.
RESULTS
We studied 411 patients for a median of 1.5 years (median 3 visits). In multivariate analyses, cervical rotation, chest expansion, lateral thoracolumbar flexion, hip motion, tender joint count, and tender enthesis count were equally strongly associated with the BASFI and HAQ-S. Peripheral joint swelling was more strongly associated with the HAQ-S. Individual items of the BASFI were more likely than items of the HAQ-S to be associated with unrelated physical examination measures (e.g., the association between difficulty rising from a chair and cervical rotation), which may have diminished the axial/peripheral distinction for the BASFI.
CONCLUSION
The BASFI and HAQ-S had similar associations with impairments in axial measures, while the HAQ-S had stronger associations with the number of swollen peripheral joints. The HAQ-S should be considered for use in studies focused on spondyloarthritis with peripheral joint involvement.