The evaluation of enthesopathic involvement in ankylosing spondylitis and diffuse idiopathic skeletal hyperostosis

Aim: Ankylosing spondylitis (AS) and Diffuse idiopathic skeletal hyperostosis (DISH) are both of two diseases that characterized with enthesopathy. AS is an inflammatory disease in contrast to DISH which is a non-inflammatory disease. İnvolvement of the enthesis plays a key role in determining the disease activity in patients with AS. In this study, two different groups of disease in respect to enthesopathic involvement was investigated by using indexes defined in AS. In addition the effects of this involvement on clinical, laboratory and functional parameters were searched.Materials and Methods: 30 adult patients diagnosed with AS according to Modified Newyork criteria and 18 adult patients diagnosed with DISH corresponds to Utsinger and Resnick?s radiological diagnostic criteria were enrolled in the study. Patients who have an inflammatory rheumatic disease except to AS and DİSH and other serious systemic illness disrupts the general status were excluded. All patients' demographic, clinical, functional, and laboratory findings were evaluated once time in cross-sectionally. Pain in resting and during the activity was evaluated with visual analog scale (VAS). MASES (Maastricht Ankylosing Spondylitis Enthesitis Score) and MEI (Mander Enthesitis Index) indexes were performed for evaluation of the enthesopathic involvement all of the patients. SF 36 (Short Form-36) questionnaire were asked for pain and physical function. Disease activity index BASDAI (Bath AS Disease Activity Index), the functional index BASFI (Bath AS Functional Index) and ASQOL (AS Quality of Life Questionnaire) were used to assess quality of life solely in patients with AS.Results: In our study, there were no statistically significant differences between the patients with AS and DISH in respect to enthesis assessment indices (MEI, MASES), pain (VAS) and SF-36 physical function and pain subscales. Patients with AS showed a significant limitation in the measured parameters of the physical examination compared with the DISH patients. Most effected enthesitis region was found lumbar 5 vertebral spinous proces in both of group patients of MASES index. MASES and MEI scores in patients with AS were showed significant correlations with duration of disease, physical examination findings, BASMI, BASDAI, the question of enthesis in BASDAI, BASFI, ASQoL and SF-36 scores. The rest pain was found more statistically than pain during the activity correlated with the MASES and MEI scores in AS. MEI and MASES indexes were showed significant associations with disease duration, fasting blood glucose, pain (VAS) and SF-36 pain and physical function subscales in patients with DISH.Conclusion: Entesopathic involvement in the DISH is an important issue as much as AS regarding with pain and impairment in the functional status. DISH was considered a non-inflammatory and non-deforming disease. We think this is a reason of neglect entesopathic involvement in this disease. Advanced radiological imaging techniques to assess enthesitis could be depicted pathology more clearly and objectively in cases with DISH and AS. The indexes are necessary to evaluate functional status, entesopathic involvement and pain in cases with DISH similar to AS.Key words: Ankylosing spondylitis, diffuse idiopathic skeletal hyperostosis, enthesopathy.