Pulmonary involvement in ankylosing spondylitis.

Abstract

SUMMARY Thirty two patients with ankylosing spondylitis were investigated with a set of pulmonary function tests and the results compared with those for a control population. The patients had no complaints about lung symptoms and their chest radiographs were normal. The main pathological findings were reduced lung volumes, a raised closing volume/vital capacity ratio, and a decreased volumic airway conductance. The lung volume reduction correlated with disease duration, thoracic mobility, and degree of acute phase reaction. The stiff spondylitic thorax probably makes the main contribution to the impairment of lung function in these patients, but the findings in this study also suggest an involvement of the small airways. This type of pulmonary function testing seems valuable even in patients with ankylosing spondylitis without lung symptoms and it might be used as a tool in the staging of the disease, to evaluate treatment and to differentiate from fibrosis.

Treatment of ankylosing spondylitis with biologics and targeted physical therapy

“…Normal chest expansion requires normal costovertebral, costosternal, manubriosternal, and sternoclavicular joints. If any of these joints are involved, chest expansion is diminished [7,10,19]. Our results also showed associations of pain, numbers of tender points, chest expansion, and thoracolumbar lateral flexion.…”

“…The restrictive pattern characterized by low FVC is frequently associated with a decreased thoracic expansion [7,10]. After 12 weeks of targeted physical therapy, respiratory function improved slightly, but not significantly-probably because this program did not contain direct cardiopulmonary exercises.…”

“…Physical therapy included manual mobilization and breathing exercise, and so these techniques could not ameliorate breathing muscle endurance. The muscles' endurance and response to differenct exercises decrease in AS, which correlated significantly with age, disease duration, chest expansion, modified Shober Index, and vital capacity [35,36,37]. __Karapolat et al [38] found that swimming, walking, and conventional exercise (CE) had beneficial effects on quality of life and pulmonary function.…”

“…__Progressive ankylosis of the thoracic spine in AS will eventually lead to restrictive pulmonary function impairment, characterized by reduced vital capacity (VC), increased ratio of forced 1-s expiratory volume (FEV1) and forced vital capacity (FVC). Respiratory function in AS shows a typical restrictive pattern, which is characterized by decrease of FVC <80% and FEV1 with normal FEV1/FVC ratio [1,7,10]. __Both pharmacological treatment with primarily tumor necrosis factor-α (TNF-α) inhibitors and complex physical exercise are effective and important [11,12,13].…”

The Pulmonary Involvement in Rheumatic Diseases: Pulmonary Effects of Ankylosing Spondylitis and Its Impact on Functionality and Quality of Life

“…The pulmonary function tests in AS had shown previously that the typical pattern was restrictive, characterized by a low thoracic expansion, but pulmonary compliance, diffusion capacity and arterial blood gases were normal (Fisher et al 1990). The restrictive pattern characterized by low FVC is frequently associated with low thoracic expansibility (Feltelius et al 1986;Franssen et al 1986;Vanderschueren et al 1989). The normal chest expansion requires normal costovertebral, costosternal, manubriosternal and sternoclavicular joints.…”