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Vergleich der Atemmuskelkraft, Lungenfunktionstests und Ausdauer bei Patienten mit ankylosierender Spondylitis im Früh- bzw. Spätstadium

A comparison of respiratory muscle strength, pulmonary function tests and endurance in patients with early and late stage ankylosing spodylitis

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Zusammenfassung

Hintergrund:

Ankylosierende Spondylitis (AS) ist eine multisystemische Erkrankung, bei der die Lungenfunktion hauptsächlich durch die Restriktion der Brustwandbeteiligung beeinträchtigt wird. Vielfach wurde über einen restriktiven ventilatorischen Defekt berichtet, der vermutlich die Folge einer reduzierten Beweglichkeit des Brustkorbs ist. Bei AS zeigt die Atemfunktion ein typisch restriktives Muster, wobei die Dehnbarkeit der Lunge, die Diffusionskapazität und die arteriellen Blutgase unauffällig sind.

Ziel:

Ziel der Studie war ein Vergleich der Lungenfunktionstests (PFT), Atemmuskelkraft (MIP, MEP) und Ausdauer (MVV) bei AS im Früh- und Spätstadium.

Methode:n

In die Studie wurden 35 Patienten aufgenommen (30 Männer, 5 Frauen). Alle Patienten erfüllten die New Yorker Kriterien für AS. Sie wurden je nach Dauer der Erkrankung (<10 Jahre: Frühstadium, 20 Patienten; >10 Jahre: Spätstadium, 15 Patienten) eingeteilt und dann hinsichtlich PFT, MIP, MEP und MVV, Atemnot-Score, Erweiterung des Brustumfangs und BASFI-Score verglichen.

Zusätzlich wurden 21 gesunde Probanden mit den AS-Patienten verglichen. Bei allen wurde die Erweiterung des Brustkorbs gemessen. Die Lungenfunktion wurde durch Spirometrie untersucht. Die Messung der Atemmuskelkraft erfolgte durch ein Munddruckmessgerät (MPM). Bei allen AS-Patienten wurde der funktionale Status durch BASFI erhoben.

Ergebnisse:

Der Body Mass Index (BMI) unterschied sich bei allen Gruppen nicht signifikant. FVC und FEV1 waren bei AS im Spätstadium signifikant niedriger (p=0,003, p=0,03, restriktiver ventilatorischer Defekt). Die Erweiterung des Brustkorbs war bei AS im Spätstadium signifikant geringer (p<0,05). Kein statistisch signifikanter Unterschied bestand bei MIP- und MEP-Werten zwischen AS im Spätstadium, AS im Frühstadium und gesunden Probanden (p>0,05). Die MVV war bei langjährigen AS-Patienten (p=0,05) signifikant vermindert. Obwohl BASFI und Atemnotwerte bei AS-Patienten im Spätstadium erhöht waren, erreichten sie keine statistische Signifikanz. Das Alter korrelierte negativ mit MIP- und MEP-Werten bei Patienten im Spätstadium (r=−0,733; p=0,02, r=−0,667; p=0,05).

Schlussfolgerung:

Unsere Studie zeigt, dass FVC, FEV1 (als Kennzeichen eines restriktiven Musters), MVV und Erweiterung des Brustumfangs bei langjähriger AS besonderes beeinträchtigt sind. Daher sollte man besonders bei Patienten im Frühstadium vor allem bestrebt sein, den Status des Brustkorbs zu verbessern. Diese Patienten sollten zu regelmäßigen Atemübungen angeregt werden, um die Einschränkung der Brustkorberweiterung zu verhindern und die kardiorespiratorische Fitness und Atemausdauer zu verbessern.

Abstract

Background:

Ankylosing spondylitis (AS) is a multisystemic disease in which pulmonary function is altered owing mainly to the restriction of chest wall involvement. A restrictive ventilatory defect has been extensively reported. This has been suggested to be a consequence of reduced mobility of the thoracic cage. Respiratory function in AS shows a typical restrictive pattern but pulmonary compliance, diffusion capacity, and arterial blood gases are normal.

Objective:

The objective of the present study was to compare pulmonary function tests (PFT), respiratory muscle strength (MIP, MEP) and endurance (MVV) in early and late AS.

Methods:

A total of 35 patients (30 males, 5 females) took part, all of whom met the New York criteria for AS. Patients were divided into two groups for the comparison of early (disease duration <10 years, 20 patients) and late (disease duration >10 years, 15 patients) manifestations in pulmonary function tests, respiratory muscle strength and endurance, dyspnea score, chest expansion, and BASFI score.

In addition, 21 healthy controls were compared with the AS patients. Measurement of chest expansion was performed in all subjects. Pulmonary function tests were performed by spirometry. Respiratory muscle strength was evaluated by a mouth pressure meter (MPM). Functional status was assessed by BASFI in all AS patients.

Results:

There was no significant difference in body mass index between the groups. The FVC and FEV1 were significantly lower in late AS (p=0.003, p=0.03, restrictive ventilatory defect ). Chest expansion was significantly lower in late AS (p<0.05). There was no significant difference for MIP or MEP values between late AS, early AS and the controls (p>0.05). Endurance (MVV) was significantly lower in late AS patients (p=0.05). Although the BASFI and dyspnea scores were higher in late AS, they did not reach significant levels. In addition, age was negatively correlated with MIP and MEP in late AS (r=−0.733; p=0.02, r=−0.667; p=0.05).

Conclusion:

This study demonstrates that FVC and FEV1 (hallmarks of a restrictive pattern), MVV (endurance) and chest expansion are especially involved in long-standing AS. Therefore, improvement of the thoracic cage should be taken into consideration, especially in early AS. These patients should be encouraged to make regular respiratory exercises for preventing the limitation of chest expansion and also improving cardiopulmonary fitness and respiratory endurance.

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Authors and Affiliations

  1. Department of Physical Medicine and Rehabilitation, Mersin University Faculty of Medicine, Kat 1/1 Mezitli , 33170, Mersin, Turkey

    G. Şahin & M. Sezgin

  2. Department of PMR, Faculty of Medicine, Mustafa Kemal University, Turkey

    H. Guler

  3. Department of Chest Disease, Mersin University Faculty of Medicine, Turkey

    M. Çalikoglu

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  1. G. Şahin
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  2. H. Guler
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  3. M. Çalikoglu
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  4. M. Sezgin
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Correspondence to G. Şahin.

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Übersetzung: Lothar Thöne, Heidelberg.

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Şahin, G., Guler, H., Çalikoglu, M. et al. Vergleich der Atemmuskelkraft, Lungenfunktionstests und Ausdauer bei Patienten mit ankylosierender Spondylitis im Früh- bzw. Spätstadium. Z. Rheumatol. 65, 535–540 (2006). https://doi.org/10.1007/s00393-006-0080-1

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  • DOI: https://doi.org/10.1007/s00393-006-0080-1

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