AB0882 Achilles enthesitis in the patients with spondyloarthritis: relationship with muscle strength, activities of daily living and quality of life
Authors: Ö. Kuru, B. Farisoğulları, G. Alayli, A. Bilgici, D. Durmuş
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Enthesitis is a central feature of spondyloarthritis (SpA). In SpA, the entheses of the lower extremities are more commonly involved than those of the upper limbs, and the heel is the most frequent site. Investigation of peripheral enthesitis in SpA is based on clinical findings and/or imaging findings. The involvement of Achilles tendon may lead to pain, movement restrictions, decrease in muscle strength, and eventually a diminished quality of life (QoL). <h3>Objectives</h3> In the present study, we aimed to evaluate clinical enthesopathy and relation with ankle muscle strength, activities of daily living (ADLs) and foot and ankle related QoL in the patients with SpA. <h3>Methods</h3> Sixty SpA patients fulfilling the Assessment of SpondyloArthritis International Society (ASAS) classification criteria for SpA (M/F=39/21) (35.61±9.85 years) and 50 healthy controls (M/F=32/18) (35.40±10.62 years) were enrolled in the study. Clinical enthesopathy was defined by the presence of at least one of the spontaneous pain, tenderness elicited by pressure, mobilisation and contraction against resistance of the corresponding tendons and local swelling of the enthesis. Pain by visual analogue scale (VAS), disease activity by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), functional capacity by Bath Ankylosing Spondylitis Functional Index (BASFI), enthesitis severity by SPARCC index was assessed in the patients. Isokinetic measurements of ankle dorsiflexion and plantarflexion were performed by the isokinetic dynamometer. The participants were tested at 30<sup>0</sup> and 120<sup>0</sup>/sec angular velocities. Pain, other symptoms (stiffness, swelling, range of motion), ADLs, sport and recreational activities, and foot and ankle-related QoL were evaluated by the Foot and Ankle Outcome Score (FAOS) in which higher scores indicate lesser problems and/or functional limitations. <h3>Results</h3> There was no significant difference between the patients and controls regarding age, sex, and body mass index. Clinical enthesopathy was detected in 36.7% of the SpA patients. Although ankle plantarflexion and dorsiflexion muscle strength in all angular velocities were lower in the SpA patients, the difference did not reach statistical significance (p&gt;0.05). All of the FAOS subscales were found to be significantly lower in the patients with SpA than in the controls (p&lt;0.001). When the SpA patients were divided into two groups as with clinical enthesopathy (n=22) and without clinical enthesopathy (n=38), there were significant differences between the groups regarding VAS pain, BASDAI, BASFI and SPARCC scores whereas there was no significant difference in muscle strength. Also, all FAOS subscale scores were significantly lower in the patients with clinical enthesopathy. Additionally, in the patients with SpA, while there were negative correlations between VAS pain, BASDAI, BASFI, SPARCC and FAOS subscale scores, there was a positive correlation between ankle muscle strength and FAOS scores (p&lt;0.05). <h3>Conclusions</h3> We found that all the FAOS subscale scores were lower in the SpA patients and they were correlated with clinical findings. The results of our study indicate that even though there was not a significant decrease in the muscle strength, ADLs, sport and recreation activities, foot-related QoL are poorly affected in the SpA patients with Achill enthesitis. <h3>Disclosure of Interest</h3> None declared