Uses, definition, and additional insights into ASQOL explained
Ankylosing spondylitis (AS) is a chronic inflammatory condition that can impact various aspects of a person's life, including physical and mental health, lifestyle, and employment choices. To assess the impact of AS on a person's quality of life, the AS Quality of Life (ASQoL) scale is often used.
The ASQoL scale consists of 18 questions that ask about different symptoms and effects on daily routine. A score of 0 or a low score indicates less impact on a person's quality of life, while higher scores suggest a greater impact. Each affirmative response to a question receives a score of 1, indicating a negative impact on quality of life. Each negative response receives a score of 0.
The ASQoL scale covers various aspects of life with AS, including questions about specific symptoms such as unbearable pain, feeling tired all the time, difficulty sleeping, and feeling like crying. It also includes questions about how AS affects daily life, such as limiting places a person can go, difficulty dressing, and difficulty doing jobs around the house.
A study showed a roughly even split between those who reported low, medium, and high impact on their quality of life due to AS. However, if a person notices their symptoms worsen, they should consider speaking with a healthcare professional. Factors that could cause worsening symptoms include smoking, getting limited sleep, lack of movement or exercise, and not responding well to or sticking with treatment.
Living with AS can be debilitating for some and more of a nuisance for others. However, there are strategies for managing symptoms and improving quality of life.
Medications
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are fundamental for reducing pain, inflammation, and helping prevent AS-related bone changes over time. For patients not sufficiently helped by NSAIDs, biologic therapies like tumor necrosis factor (TNF) inhibitors (e.g., infliximab, etanercept) and Janus kinase (JAK) inhibitors are used to calm the immune system and control inflammation. Disease-modifying drugs such as sulfasalazine may be used off-label if peripheral joints are affected. Steroids may be injected or given orally for quick relief during flare-ups but are generally temporary.
Physical Therapy and Exercise
Regular physical therapy is crucial to maintain mobility, reduce stiffness, and strengthen muscles supporting affected joints. Low-impact activities such as swimming or water therapy reduce joint stress and improve function without exacerbating pain.
Self-Care and Symptom Relief
Heat therapy helps reduce muscle tension, alleviate morning stiffness, and improve general pain. Cold therapy is recommended for acute flare-ups and inflammation, particularly in enthesitis and peripheral joints, helping to reduce swelling and pain. Sleep position adjustments, establishing regular pre-bedtime routines, and gentle stretching can improve sleep quality and reduce symptom flares during the night.
Additional Supportive Measures
Mindfulness and relaxation techniques can help manage chronic pain and improve quality of life. In rare, severe cases, surgical interventions may be considered to improve spinal alignment or relieve nerve pressure.
Together, these approaches form a comprehensive management plan aimed at reducing pain and inflammation, maintaining mobility, minimizing structural damage, and enhancing overall wellbeing for individuals living with ankylosing spondylitis. Regular monitoring and coordination with healthcare providers are essential to tailor treatments and adjust strategies as the condition evolves.
Life expectancy can vary based on the severity of the condition, with some evidence suggesting it can increase the risk of death due to complications such as cardiovascular disease. However, with proper treatment, it may not affect life expectancy at all. The person with AS answers the questions, and a healthcare professional or the person themselves can then provide a score for the assessment. Evidence suggests that the ASQoL scale is a reliable assessment tool for healthcare professionals to use.
