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region, etc.
The main advantage and the main distinctive feature of long-term crediting is a credit term of payments. At the expense of the long temporary period for which it is necessary to repay completely the loan it is possible to make small monthly payment or to take the credit for a large sum. An opportunity to solve important problems, for example, to get the real estate, - important advantage of this type of crediting. It is possible to take the huge sum of money and buy the apartment, pay expensive, buy the car etc. As sources of financing of the long-term credits distinguish: authorized capital, funds of bank and retained earnings; long-term loans; deposits for the term of higher than one year.
List of used literature: 1. G.N. Gamidov "Banking and credit business" - UNITY, 2001 - 678 pages.
УДК 616.721-002.77:616.24-073.96
Khan T. Junior researcher, Department of Rheumatology, Republican Specialized Scientific-practical Medical Centre of Therapy and Medical
Rehabilitation, Tashkent, Uzbekistan Khakimova R. PhD, Department of Rheumatology, Republican Specialized Scientific-practical Medical Centre of Therapy and Medical
Rehabilitation, Tashkent, Uzbekistan Nuritdiniva S. PhD, Department of Rheumatology, Republican Specialized Scientific-practical Medical Centre of Therapy and Medical
Rehabilitation, Tashkent, Uzbekistan Islamova D. Junior researcher, Department of Rheumatology, Republican Specialized Scientific-practical Medical Centre of Therapy and Medical
Rehabilitation, Tashkent, Uzbekistan Aliakhunova M. ScD, professor, Head of the Department of Rheumatology, Republican Specialized Scientific-practical Medical Centre of Therapy and Medical Rehabilitation, Tashkent, Uzbekistan
Хан Т.А., м.н.с. отделение Ревматологии Хакимова Р.А., к.м.н. отделение Ревматологии Нуритдинова С.К., к.м.н. отделение Ревматологии Исламова Д.Н., м.н.с. отделение Ревматологии Алиахунова М.Ю., д.м.н. профессор, заведующая отделением Ревматологии Республиканский специализированный научно-практический медицинский центр терапии и медицинской реабилитации
Узбекистан, г. Ташкент INTERACTION OF QUALITATIVE AND QUANTITATIVE CHARACTERISTICS IN ANKYLOSING SPONDYLITIS
Abstract: Thirty-six adult patients with AS were observed in the center. All participants were tested by the SF-36 Health Survey, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Functional Index (BASFI), and the Multidimensional Assessment of Fatigue (MAF) Pulmonary Function Test (PFT). Participants showed reduced spinal mobility, which was negatively correlated with mSASSS. PFT results showed reduced forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) and increased FEV1/FVC. Reduced FEV1 and FVC showed positive correlations with reduced spinal mobility. Perceived physical condition and degree of pain were both significantly related to the SF-36, BASDAI, BASFI, and MAF scores. This study shows that spinal mobility may have a predictive value for pulmonary impairment in patients with AS, and can be applied to predict pulmonary function in clinical settings.
Keywords: Ankylosing spondylitis, Pulmonary function tests, Quality of life
ВЗАИМОДЕЙСТВИЕ КОЛИЧЕСТВЕННЫХ И КАЧЕСТВЕННЫХ ХАРАКТЕРИСТИК ПРИ АНКИЛОЗИРУЮЩЕМ
СПОНДИЛИТЕ
Аннотация: В центре наблюдалось 36 взрослых пациентов с анкилозирующим спондилитом (АС). Все участники были опробованы обследованием здоровья SF-36, индексом активности болезни анкилозирующего спондилоартрита (BASDAI), функциональным индексом анкилозирующего спондилоартрита (BASFI) и многоплановой опросника слабости (MAF). В ходе исследования у пациентов выявили снижение подвижности позвоночника, что отрицательно коррелировало с mSASSS. Результаты пикфлоуметрии показали снижение объема форсированного выдоха за одну секунду (FEV1) и форсированную жизненную емкость (FVC) и увеличение FEV1 / FVC. Сниженные FEV1 и FVC показали положительные корреляции с уменьшенной подвижностью позвоночника.
Воспринимаемое физическое состояние и степень боли были в значительной степени связаны с оценками SF-36, BASDAI, BASFI и MAF. Это исследование показывает, что подвижность позвоночника может иметь прогнозирующее значение для легочной недостаточности у пациентов с АС и может применяться для прогнозирования легочной функции в клинических условиях.
Ключевые слова: анкилозирующий спондилит, функция внешнего дыхания, качество жизни.
INTRODUCTION
Ankylosing spondylitis (AS) is a common inflammatory rheumatic disease that affects the axial skeleton, causing characteristic inflammatory back pain, which can lead to structural and functional impairments and a decrease in quality of life [1]. Thereby, the aim of our investigation become the interaction of qualitative and quantitative characteristics in participants with AS.
MATERIALS AND METHODS
Thirty-six adult patients with AS were observed in the center. All participants were diagnosed by using the modified New York criteria. The exclusion criteria were: 1) other musculoskeletal problems in the spine or thoracic cage, 2) cardiopulmonary disease.
The SF-36 Health Survey (SF-36) was employed to evaluate the QOL of participants. This measure consists of 36 items, and answers are scored and summed to produce a value from 0 to 100 for each of the eight domains (physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional, and mental health) as well as to give an overall score [5]. The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Functional Index (BASFI), and the Multidimensional Assessment of Fatigue (MAF) scale were used to assess participants' disease activity, functional impairment and degree of fatigue, respectively. The BASDAI has six questions related to fatigue, back pain, peripheral pain, peripheral swelling, local tenderness, and morning stiffness (severity and duration). Other than the item relating to morning stiffness, all questions are scored from 0 (none) to 10 (very severe) using a visual analogue scale (VAS). The BASFI is comprised of ten questions assessing functional limitations and the level of physical activity at home and work. VAS is used to score each question from 0 (easy) to 10 (impossible), and the average value over the 10 questions is the BASFI score. Participants' perceived physical condition and degree of pain (pain in any joint, back pain, and nocturnal back pain) during the last week were assessed by using a 10 cm VAS. Such characteristics including their sex, age, weight, height, and the date of onset and diagnosis were also collected.
Participants' spinal mobility was also examined through seven physical tests: 1) modified Schober test, 2) lateral bending, 3) chest expansion, 4) occiput to wall, 5) finger to ground, 6) bimalleolar distance, and 7) the range of motion (ROM) for the cervical and thoracolumbar spine, as measured by inclinometer. Vertebral squaring was also evaluated through the mSASSS of the cervical and
lumbar spine. Plain radiographs of the cervical and lumbar spine were obtained, and the anterior angles of the cervical vertebra (lower C2 to upper T1) and lumbar vertebra (lower T12 to upper S1) were scored. Each anterior vertebral angle was scored at 0 (normal), 1 (erosion, squaring, or sclerosis), 2 (syndesmophyte) or 3 (bridging), with total scores ranging from 0 to 72 [7]. The mSASSS was scored by a musculoskeletal radiologist.
Pulmonary Function Test (PFT) was performed using a SPIROST FI SP-5000 FUKUDA DENSHI, and the forced expiratory volume in one second (FEV1), forced vital capacity (FVC) and FEV1/FVC values were obtained. The PFT was performed three times for each participant, so that the best result could be obtained. The Spearman coefficient was used to see the correlation among variables. A p-value of less than 0.05 was considered to be significant in all analyses. Data analyses were performed using SPSS ver. 17.0 (SPSS Inc., Chicago, IL, USA) for Windows.
RESULTS
Of thirty-six participants, thirty-one were males (86.1%) and five were females (13.9%). Their mean age was 37.5±9.6 years (ranging from 27 to 55 years) and the mean duration from the onset was 11.3±8.6 years (ranging from 7 to 26 years). The mean mSASSS of participants was 21.4±22.0. When we analyzed their PFT results, a restrictive pattern was revealed with reduced FEV1 (85.0%±13.7% of predicted value) and FVC (80.2%±15.4% of predicted value) and increased FEV1/FVC (109.1%±11.3% of predicted value). Only twenty-six participants replied to the questionnaire items, including SF-36, BASDAI, BASFI, and MAF, and their mean age and duration from onset were 34.7±9.7 and 13.2±8.8 years, respectively. Relationship between spinal mobility and structural changes of the spine The mSASSS score was negatively correlated with modified Schober test, chest expansion, and ROM of the spine, whereas it was positively correlated with lateral bending.
Pulmonary function: the relationships with spinal mobility and structural changes of the spine Both FEV1 and FVC showed positive correlations with modified Schober test, chest expansion, bimalleolar distance, and ROM of the spine and showed negative correlations with finger to ground. FEV1 was also negatively correlated with mSASSS (p<0.01).
There was also a negative correlation between FVC and mSASSS, but this was not statistically correlated (p=0.06). However, all variables related to spinal mobility or mSASSS were not correlated with FEV1/FVC. The body mass index did not show any significant correlations with FEV1, FVC, or FEV1/FVC.
The relationships among QOL, disease activity, functional level, fatigue, and pain MAF had a negative correlation with SF-36 and positive correlations with BASDAI and BASFI. Perceived physical condition, pain in any joint, and back pain were all negatively correlated with SF-36, whereas they were positively correlated with BASDAI, BASFI. Nocturnal back pain also showed a negative correlation with SF-36 and a positive correlation with BASDAI and BASFI.
However SF-36, BASDAI, BASFI did not show any consistent relationships
with modified Schober test, lateral bending, chest expansion, occiput to wall, finger to ground, bimalleolar distance, or ROM of the spine. SF-36, BASFI were not significantly correlated with pulmonary function, and only BASDAI showed a positive correlation with FEV1/FVC (p=0.038). Perceived physical condition, pain in any joint, and nocturnal back pain were all positively correlated with FEV1/FVC, but there were no other correlations found between the patient's perceived physical condition and pain and other variables, including ROM, mSASSS, FEV1 and FVC.
DISCUSSION
This study was conducted in patients with AS to evaluate their spinal mobility, the spinal radiographic findings, pulmonary function, QOL, pain and fatigue, and to assess the relationships among these outcomes. Our results suggest that more severe radiographic changes in the spine are related with reduced spinal mobility and chest wall motion, which was confirmed in the ROM of the spine as assessed by inclinometer and the results of three physical examinations (modified Schober, lateral bending, and chest expansion tests).
The pulmonary function of patients with AS is known to show a restrictive pattern caused by stiffness and interstitial lung disease [2,3,8-11], and patients in this study also showed some restrictive patterns in PFT with increased FEV1/FVC and reduced lung capacity. Reduced FEV1 was another result indicated by our study. These findings may reinforce previous reports that there is small airway involvement in the reduced volume airway conductance seen in patient with AS [2,3]. Both reduced FEV1 and FVC were related to reduced spinal mobility and spinal radiographic changes. This result implies that spinal mobility assessment, as well as radiographic changes in the vertebral body, may have a predictive value for the respiratory vital capacity of patients with AS, and this finding can be applied to predict pulmonary function and to provide appropriate rehabilitative interventions in clinical settings. However, FEV1/FVC showed no relationship with either spinal mobility or radiographic changes, which may be explained by the fact that both FEV1 and FVC were reduced simultaneously.
This study also shows that there are significant relationships among decreased QOL, more severe disease activity, greater impairments in functionality and a higher degree of fatigue, results which correspond with the findings of earlier study [4].
Previous research has reported that pulmonary impairments can reduce exercise capacity [12], and may also affect functional level and QOL [10]. Spinal mobility is also known to impair the QOL in patients with AS [5,9].
In conclusion, this study shows that both spinal mobility and radiographic changes in the vertebral body may have a predictive value for pulmonary impairment in patients with AS, and can be applied to predict pulmonary function in clinical settings. We also suggest that providing appropriate pain management and recommending the maintenance of a good physical activity level may be important in improving the QOL and functional capability of patients with AS.
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