The relationship between clinical and ultrasonographically measured enthesitis scores and balance and kinesiophobia in patients with ankylosing spondylitis

Background: This study investigates the clinical and ultrasonographic evaluation of enthesial regions in patients with Ankylosing Spondylitis (AS) and explores the association of these findings with kinesiophobia and balance Material and Methods : A total of 46 individuals aged between 18 and 65 years, diagnosed with AS according to the Modified New York criteria, were included in the study, along with a control group of 40 individuals matched for age and gender. Sociodemographic characteristics were recorded for both groups, and disease activity in AS patients was assessed using the BASDAI (Bath Ankylosing Spondylitis Disease Activity Index), functional status in daily living activities with the BASFI (Bath Ankylosing Spondylitis Functional Index), and mobility levels with the BASMI (Bath Ankylosing Spondylitis Metrology Index). Kinesiophobia levels were measured using the Tampa Scale for Kinesiophobia (TSK), while balance was evaluated using the Berg Balance Scale (BBS). Enthesitis assessment included the MASES (Maastricht Ankylosing Spondylitis Enthesitis Score) and ultrasonographic evaluation with the GUESS (Glasgow Ultrasound Enthesitis Scoring System). Results : When the two groups were compared, they were found to have similar characteristics in terms of age, gender, BMI, occupation, and education level. Significant differences were observed between the groups regarding BASDAI, BASFI, BASMI, BBS, TSK, MASES, and GUESS scores. A negative correlation was identified between the Berg Balance Scale and both GUESS and MASES enthesitis scores, whereas a positive correlation was noted between kinesiophobia and the GUESS and MASES enthesitis scores. Additionally, kinesiophobia showed a positive correlation with age, CRP, BASMI, and BASFI scores, while it was negatively correlated with balance. Furthermore, a positive relationship was detected between the two enthesitis scoring systems (MASES and GUESS). Conclusions : Enthesitis is one of the key characteristic findings of AS. It is believed that due to the inflammation in the enthesial regions, structural changes occur, and proprioceptive feedback is affected, potentially leading to disturbances in balance. In our study, based on this premise, we found a significant relationship between enthesitis scores, kinesiophobia, and balance. Considering that exercise is a cornerstone in AS treatment, it is inevitable that balance disorders and kinesiophobia in patients will negatively impact the AS rehabilitation process. We propose that the use of ultrasound (USG), which is both readily accessible and practical, in conjunction with enthesitis assessment, will be valuable in the early identification of patients at high risk for kinesiophobia and balance disturbances. Key words: Ankylosing spondylitis, Enthesitis , Balance