Adequately dosed aerobic physical activity in people with axial spondyloarthritis: associations with physical therapy.

INTRODUCTION: This study aimed to compare the engagement in moderate- and vigorous-intensity PA in axSpA patients with and without current physical therapy (PT). METHODS: In this cross-sectional study, a survey, including current PT treatment (yes/no) and PA, using the 'Short QUestionnaire to ASsess Health-enhancing PA' (SQUASH), was sent to 458 axSpA patients from three Dutch hospitals. From the SQUASH, the proportions meeting aerobic PA recommendations (≥ 150 min/week moderate-, ≥ 75 min/week vigorous-intensity PA or equivalent combination; yes/no) were calculated. To investigate the association between PT treatment and meeting the PA recommendations, odds ratios (OR) with 95% confidence intervals (95% CI) were estimated using logistic regression models, adjusting for sex, age, health status and hospital. RESULTS: The questionnaire was completed by 200 patients, of whom 68%, 50% and 82% met the moderate-, vigorous- or combined-intensity PA recommendations, respectively. Ninety-nine patients (50%) had PT treatment, and those patients were more likely to meet the moderate- (OR 2.09 [95% CI 1.09-3.99]) or combined-intensity (OR 3.35 [95% CI 1.38-8.13]) PA recommendations, but not the vigorous-intensity PA recommendation (OR 1.53 [95% CI 0.80-2.93]). Aerobic exercise was executed in 19% of individual PT programs. CONCLUSION: AxSpA patients with PT were more likely to meet the moderate- and combined-intensity PA recommendations, whereas there was no difference in meeting the vigorous-intensity PA recommendation. Irrespective of having PT treatment, recommendations for vigorous-intensity PA are met by only half of the patients. Implementation should thus focus on aerobic PA in patients without PT and on vigorous-intensity PA in PT programs.

Responsiveness and Interpretability of 2 Measures of Physical Function in Patients With Spondyloarthritis.

BACKGROUND: Maintenance or improvement of physical function is an important treatment target in the management of patients with axial spondyloarthritis (axSpA); measurement tools that can detect changes in physical function are therefore important. OBJECTIVES: The objective of this study was to compare responsiveness and interpretability of the patient-reported Bath Ankylosing Spondylitis Functional Index (BASFI) and the Ankylosing Spondylitis Performed-Based Improvement (ASPI) in measuring change in physical function after exercise in patients with axSpA. DESIGN: This was a sub-study of 58 patients nested within a randomized controlled trial comparing the effect of 12 weeks of exercise with usual care. METHODS: Responsiveness and interpretability were assessed according to the Consensus-based Standards for the selection of health status Measurement Instrument. Responsiveness was assessed by testing 8 predefined hypotheses for ASPI and BASFI. Interpretability was assessed by: (1) using patients' reported change as an anchor ("a little better" = minimal important change) and (2) by categorizing patients with a 20% improvement as responders. RESULTS: For ASPI and BASFI, 5 of 8 (63%) versus 2 of 8 (25%) of the predefined hypotheses for responsiveness were confirmed. The minimal important change values for improvement in physical function were 3.7 seconds in ASPI and 0.8 points (on a scale from 0 to 10) for BASFI. In the intervention group, 21 of 30 (70%) and 13 of 30 (43%) of the patients were categorized as responders measured with ASPI and BASFI, respectively. There was a tendency towards a floor effect in BASFI, as 8 of 58 (14%) patients scored the lowest value at baseline. LIMITATIONS: This study was limited by its moderate sample size. CONCLUSIONS: Our findings suggest that ASPI is preferable over BASFI when evaluating physical function after exercise interventions in patients with axSpA.

Supervised Group Exercise in Axial Spondyloarthritis: Patients' Satisfaction and Perspective on Evidence-Based Enhancements.

OBJECTIVE: Supervised group exercise (SGE) has been proven effective in patients with axial spondyloarthritis (SpA), but its contents and dosage do not always comply with current scientific insight. This aim of this study was to describe axial SpA patients' satisfaction with current SGE and perspective on potential evidence-based SGE enhancements. METHODS: Patients with axial SpA who participated in SGE in 4 regions in The Netherlands (n = 118) completed a cross-sectional survey on their satisfaction with features of their current SGE (8 questions scored on a 3-point Likert scale; 1 overall grade, scored according to an 11-point scale) and their perspective on the introduction of appropriately dosed cardiorespiratory and strengthening exercise, monitoring of exercise intensity, periodic reassessments, patient education, and supervision by physical therapists with specific expertise (4 dichotomous questions and one 5-point Likert scale). RESULTS: Most patients were satisfied with the current total intensity (84 of 112 patients [75%]), duration (93 of 111 patients [84%]), and load (89 of 117 patients [76%]) of the program and the proportion of mobility (102 of 114 patients [90%]), strengthening (90 of 115 patients [78%]), and cardiorespiratory exercise (82 of 114 patients [72%]). The median overall grade of the program was a 7 (interquartile range 7-8). Most patients agreed with the implementation of more frequent (home) exercise (73 of 117 patients [62%]), heart-rate monitoring (97 of 117 patients [83%]), and annual reassessments (97 of 118 patients [82%]), whereas 50% agreed with the introduction of patient education (37 of 74 patients). The majority found supervision by therapists specializing in axial SpA to be of high importance (105 of 118 patients [89%]). CONCLUSION: The majority of SGE participants with axial SpA were satisfied with current SGE but also agreed with enhancements in line with scientific evidence. Current satisfaction levels indicate that a planned implementation strategy, including education and addressing potential barriers and facilitators for the uptake of enhancements, is warranted.

High intensity exercise for 3 months reduces disease activity in axial spondyloarthritis (axSpA): a multicentre randomised trial of 100 patients.

BACKGROUND: Exercise is considered important in the management of patients with rheumatic diseases, but the effect of high intensity exercises on disease activity is unknown. OBJECTIVE: To investigate the effectiveness of high intensity exercises on disease activity in patients with axial spondyloarthritis (axSpA). METHOD: Assessor blinded multicentre randomised controlled trial. 100 patients (aged from their 20s to their 60s) with axSpA were randomly assigned to an exercise group or to a no-intervention control group. The exercise group performed cardiorespiratory and muscular strength exercises at high intensity over 3 months. The control group received standard care and was instructed to maintain their usual physical activity level. Primary outcome was disease activity measured with the Ankylosing Spondylitis (AS) Disease Activity Scale (ASDAS, higher score=worst) and the Bath AS Disease Activity Index (BASDAI, 0-10, 10=worst). Secondary outcomes were inflammatory markers, physical function and cardiovascular (CV)-health. There was patient involvement in the design and reporting of this study. RESULTS: 97 of the 100 (97%) randomised patients completed the measurements after the intervention. There was a significant treatment effect of the intervention on the primary outcome (ASDAS: -0.6 [-0.8 to -0.3], p<0.001 and BASDAI: -1.2 [-1.8 to -0.7], p<0.001). Significant treatment effects were also seen for inflammation, physical function and CV-health. CONCLUSION: High intensity exercises reduced disease symptoms (pain, fatigue, stiffness) and also inflammation in patients with axSpA. It improves patients' function and CV health. This debunks concerns that high intensity exercise might exacerbate disease activity in patients with axSpA. TRIAL REGISTRATION NUMBER: NCT02356874.

The mediating role of pain and function in the association between stiffness and quality of life in patients with axial spondyloarthritis.

OBJECTIVE: The relationship between stiffness and quality of life (QoL) remains unclear. We therefore aimed to examine the role of pain and function in linking stiffness and QoL in patients with axSpA. METHODS: We used cross-sectional data from a registry of axSpA patients in a tertiary referral centre to assess the links among stiffness, pain and function on QoL. Path analysis was used to analyse the associations between these domains, pursuing four hypotheses: H1 - More stiffness is associated with poor QoL; H2 - More pain and decreased function are associated with poor QoL; H3 - More stiffness is associated with more pain and decreased function; H4 - The linkage between stiffness and QoL is mediated by function and pain. RESULTS: Data from 221 patients (Mean age 38.5, 79.0% males and 83.1% Chinese) were analyzed. Our mediation model achieved good fit (χ2 (10) = 7.06, p = 0.719, CFI= 1.00 TLI = 1.00, RMSEA < 0.001). Results supported all 4 hypotheses (p < 0.001): More stiffness, more pain, decreased function were associated with poor QoL. Function was associated directly with QoL. Stiffness was associated with QoL through both pain and function. CONCLUSION: Optimization of QoL in patients with stiffness in axSpA requires effective control of both function and pain. Physiotherapy, exercises and medications may improve the QoL in these patients.

Recommendations for the prescription of physical exercise for patients with spondyloarthritis. / Recomendaciones para la prescripción de ejercicio físico en pacientes con espondiloartritis.

OBJECTIVE: To develop expert-based recommendations on physical activity and exercise for patients with spondyloarthritis (SpA). METHODS: Two discussion groups, one of physical therapists, rehabilitation physicians, and professionals of physical activity and sports, and another of rheumatologists interested in SpA, were held to discuss the results of a survey of rheumatologists on exercise and two focus groups with patients on barriers to exercise. Preliminary recommendations were drafted. These were submitted to the opinion of the experts in both groups according to a two round Delphi methodology. RESULTS: Twenty one recommendations covering general aspects of exercise, adaptation to patient, how to deliver messages, pain management, and type of exercise and monitoring were issued. The level of agreement varied slightly between expert groups but it was high overall. Items with poor agreement were removed from the consensus. CONCLUSIONS: We present recommendations on when and how to prescribe and monitor exercise in patients with SpA based on the opinion of experts in exercise and in SpA. We must now test whether these recommendations are useful for clinical practice and have an effect on patients with SpA seen by rheumatologists.

Changes of patient-reported outcomes and protein fingerprint biomarkers after exercise therapy for axial spondyloarthritis.

The objective of this study was to investigate the patient-reported outcomes (PROs) and matrix metalloproteinase (MMP) derived extracellular matrix (ECM) biomarkers in non-radiographic (nr)-axial spondyloarthritis (axSpA) and radiographic (r)-axSpA after exercise intervention. Forty-six axSpA patients with stable disease and treatment underwent 24 weeks long exercise intervention. The clinical and laboratory assessments were performed at baseline and at follow-up. The PROs included evaluation of patient's global disease activity (PGDA), disease activity (DA7), pain (PAIN7) and fatigue during last week and quality of life questionnaires. ELISAs for MMP-degraded collagen type II, C-reactive protein (CRPM) and citrullinated vimentin were used. The data of 23 r-axSpA and 19 nr-axSpA were analysed. The PDGA was similar for nr-axSpA (35.2 ± 18.9) and r-axSpA (33.4 ± 22.3) at baseline, improved significantly after intervention (p < 0.01) and the change of PDGA was almost identical for nr-axSpA (- 10.0 ± 15.4) and r-axSpA (- 9.8 ± 11.9). Evaluations of DA7 and PAIN7 were significantly improved only in nr-axSpA (3.5 ± 2.3 and 34.7 ± 25.6 at baseline vs. 2.1 ± 1.9 and 21.0 ± 20.5, respectively, p < 0.01). The decline of DA7 and PAIN7 was more profound, but not significantly in nr-axSpA than in r-axSpA (- 1.4 ± 1.6 and - 13.7 ± 17.4 vs. - 0.5 ± 3.1 and - 3.7 ± 3.3, respectively). The quality of life was not changed. At baseline, increased levels of CRPM were found in r-axSpA (14.85 ± 4.10) compared to nr-axSpA (11.83 ± 3.20), p < 0.05, but all three biomarkers were not influenced by exercise therapy. We found that exercise therapy mainly in the nr-axSpA improves PROs, but not ECM turnover biomarkers. This indicates that exercise therapy is important for patients' health but does not affect ECM turnover.

Impact of biological therapy on work outcomes in patients with axial spondyloarthritis: results from the British Society for Rheumatology Biologics Register (BSRBR-AS) and meta-analysis.

OBJECTIVES: To quantify, among patients with axial spondyloarthritis (axSpA), the benefit on work outcomes associated with commencing biologic therapy. METHODS: The British Society for Rheumatology Biologics Register in Axial Spondyloarthritis (BSRBRAS) recruited patients meeting Assessment of SpondyloArthritis International Society criteria for axSpA naïve to biological therapy across 83 centres in Great Britain. Work outcomes (measured using the Work Productivity and Activity Impairment Index) were compared between those starting biological therapy at the time of recruitment and those not. Differences between treatment groups were adjusted using propensity score matching. Results from BSRBR-AS were combined with other studies in a meta-analysis to calculate pooled estimates. RESULTS: Of the 577 participants in this analysis who were in employment, 27.9% were starting biological therapy at the time of recruitment. After propensity score adjustment, patients undergoing biological therapy, at 12-month follow-up, experienced significantly greater improvements (relative to non-biological therapy) in presenteeism (-9.4%, 95% CI -15.3% to -3.5%), overall work impairment (-13.9%, 95% CI -21.1% to -6.7%) and overall activity impairment (-19.2%, 95% CI -26.3% to -12.2%). There was no difference in absenteeism (-1.5%, 95% CI -8.0 to 4.9). Despite these improvements, impact on work was still greater in the biological treated cohort at follow-up. In the meta-analysis including 1109 subjects across observational studies and trials, treatment with biological therapy was associated with significantly greater improvements in presenteeism, work impairment and activity impairment, but there was no difference in absenteeism. CONCLUSIONS: There is consistent evidence that treatment with biological therapy significantly improves work productivity and activity impairment in people with axSpA. However, there remain substantial unmet needs in relation to work.

2018 EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis.

Regular physical activity (PA) is increasingly promoted for people with rheumatic and musculoskeletal diseases as well as the general population. We evaluated if the public health recommendations for PA are applicable for people with inflammatory arthritis (iA; Rheumatoid Arthritis and Spondyloarthritis) and osteoarthritis (hip/knee OA) in order to develop evidence-based recommendations for advice and guidance on PA in clinical practice. The EULAR standardised operating procedures for the development of recommendations were followed. A task force (TF) (including rheumatologists, other medical specialists and physicians, health professionals, patient-representatives, methodologists) from 16 countries met twice. In the first TF meeting, 13 research questions to support a systematic literature review (SLR) were identified and defined. In the second meeting, the SLR evidence was presented and discussed before the recommendations, research agenda and education agenda were formulated. The TF developed and agreed on four overarching principles and 10 recommendations for PA in people with iA and OA. The mean level of agreement between the TF members ranged between 9.8 and 8.8. Given the evidence for its effectiveness, feasibility and safety, PA is advocated as integral part of standard care throughout the course of these diseases. Finally, the TF agreed on related research and education agendas. Evidence and expert opinion inform these recommendations to provide guidance in the development, conduct and evaluation of PA-interventions and promotion in people with iA and OA. It is advised that these recommendations should be implemented considering individual needs and national health systems.

Measurement properties of the ASAS Health Index: results of a global study in patients with axial and peripheral spondyloarthritis.

OBJECTIVES: To evaluate construct validity, interpretability, reliability and responsiveness as well as determination of cut-off points for good and poor health within the original English version and the 18 translations of the disease-specific Assessment of Spondyloarthritis international Society Health Index (ASAS HI) in 23 countries worldwide in patients with spondyloarthritis (SpA). METHODS: A representative sample of patients with SpA fulfilling the ASAS classification criteria for axial (axSpA) or peripheral SpA was used. The construct validity of the ASAS HI was tested using Spearman correlation with several standard health outcomes for axSpA. Test-retest reliability was assessed by intraclass correlation coefficients (ICCs) in patients with stable disease (interval 4-7 days). In patients who required an escalation of therapy because of high disease activity, responsiveness was tested after 2-24weeks using standardised response mean (SRM). RESULTS: Among the 1548 patients, 64.9% were men, with a mean (SD) age 42.0 (13.4) years. Construct validity ranged from low (age: 0.10) to high (Bath AnkylosingSpondylitisFunctioning Index: 0.71). Internal consistency was high (Cronbach's α of 0.93). The reliability among 578 patients was good (ICC=0.87 (95% CI 0.84 to 0.89)). Responsiveness among 246 patients was moderate-large (SRM=-0.44 for non-steroidal anti-inflammatory drugs, -0.69 for conventional synthetic disease-modifying antirheumatic drug and -0.85 for tumour necrosis factor inhibitor). The smallest detectable change was 3.0. Values ≤5.0 have balanced specificity to distinguish good health as opposed to moderate health, and values ≥12.0 are specific to represent poor health as opposed to moderate health. CONCLUSIONS: The ASAS HI proved to be valid, reliable and responsive. It can be used to evaluate the impact of SpA and its treatment on functioning and health. Furthermore, comparison of disease impact between populations is possible.

Work participation in spondyloarthritis across countries: analysis from the ASAS-COMOSPA study.

OBJECTIVES: To explore the role of individual and country level socioeconomic (SE) factors on employment, absenteeism and presenteeism in patients with spondyloarthritis (SpA) across 22 countries worldwide. METHODS: Patients with a clinical diagnosis of SpA fulfilling the ASAS classification criteria and in working age (≤65 years) from COMOSPA were included. Outcomes of interest were employment status, absenteeism and presenteeism, assessed by the Work Productivity and Activity Impairment Specific General Health questionnaire. Three multivariable models were built (one per outcome) using mixed-effects binomial (for work status) or ordinal regressions (for absenteeism and presenteeism), with country as random effect. The contribution of SE factors at the individual-level (eg, gender, education, marital status) and country-level (healthcare expenditure (HCE) per capita, Human Development Index (HDI) and gross domestic product per capita) SE factors, independent of clinical factors, was assessed. RESULTS: In total, 3114 patients with SpA were included of which 1943 (62%) were employed. Physical function and comorbidities were related to all work outcomes in expected directions and disease activity also with absenteeism and presenteeism. Higher education (OR 4.2 (95% CI 3.1 to 5.6)) or living in a country with higher HCE (OR 2.3 (1.5 to 3.6)) or HDI (OR 1.9 (1.2 to 3.3)) was positively associated with being employed. Higher disease activity was associated with higher odds for absenteeism (OR 1.5 (1.3 to 1.7)) and presenteeism (OR 2.1 (1.8 to 2.4)). No significant association between individual-level and country-level SE factors and absenteeism or presenteeism was found. CONCLUSIONS: Higher education level and higher country SE welfare are associated with a higher likelihood of keeping patients with SpA employed. Absenteeism and presenteeism are only associated with clinical but not with individual-level or country-level SE factors.

Patients with spondyloarthritis are equally satisfied with follow-up by physiotherapist and rheumatologist.

OBJECTIVE: International guidelines recommend that patients with spondyloarthritis (SpA) have lifelong physiotherapy, as physical activity and exercise are essential for optimizing health throughout the course of the disease. The aim of the present study was to investigate if a physiotherapy-led outpatient clinic specializing in SpA could provide satisfactory follow-up as an alternative to standard visits with a rheumatologist (RT). We hypothesized that satisfaction would be similar in patients followed by a physiotherapist (PT) or an RT. METHODS: A total of 68 patients were randomized to follow-up every fourth month by a PT or RT, for three visits in total. Patient satisfaction was evaluated using the Leeds Satisfaction Questionnaire (LSQ). Function, mobility and disease activity were rated using the Bath Ankylosing Spondylitis Functional Index (BASFI), Mobility Index (BASMI) and Ankylosing Spondylitis Disease Activity Score (ASDAS). RESULTS: Patients were equally satisfied with PT and RT follow-up at the first (p = 0.062) and last (p = 0.710) visit. At the second visit, the RT group was seen by a nurse, and was more satisfied than the PT group (p = 0.015). Function deteriorated in both the PT (p = 0.014) and RT (p = 0.007) groups. Mobility increased in the PT group (p = 0.020). Disease activity was not affected. CONCLUSIONS: Patients seem to be equally satisfied with either of the follow-up regimes. The PT-led follow-up did not seem to affect the patients' course of disease negatively. The results indicate that it would be safe to implement a PT-led clinic for patients with SpA in specialist health services, but longer-term follow-up is necessary to support the findings of this study.

Fiabilidad y validez de la medida de la movilidad cervical en pacientes con espondiloartritis axial utilizando un sensor inercial / Reliability and validity of cervical mobility analysis measurement using an inertial sensor in patients with axial spondyloarthritis

Introducción. La espondiloartritis axial (EA) produce una reducción de la movilidad debido a la inflamación y el daño estructural a nivel vertebral. El análisis de la movilidad cervical es un componente fundamental en la evaluación de pacientes con EA. Diversos índices y herramientas se han propuesto para analizar la movilidad cervical en estos pacientes, si bien, algunos de ellos carecen de precisión y sensibilidad y otros necesitan amplios recursos para ser usados. Los sensores de movimiento inerciales (IMU) podrían ser útiles para este cometido, pero se necesitan procesos de validación. Material y método. Se evaluó el movimiento cervical en tres planos (flexión frontal, lateral y rotación cervical) utilizando un IMU y un sistema de captura de movimiento de forma sincronizada. Se hizo una prueba test/retest del sensor. Se tomaron otras medidas habitualmente usadas para monitorizar a los pacientes con EA. Resultados. El análisis de fiabilidad según el índice de correlación intraclase fue muy bueno (0,99) para el test/retest del sensor IMU y para la comparación con el sistema de captura de movimiento. Las diferencias en grados fueron pequeñas (2-9°). Discusión. La tecnología IMU proporciona una forma flexible y económica de medir la movilidad en este tipo de patologías. Según nuestros resultados, la comparativa con respecto a la captura de movimiento como «gold standard», ha sido satisfactoria. Es por esto que esta tecnología puede ser útil para analizar la movilidad cervical en la EA (AU)

Introduction. Axial spondyloarthritis (AS) reduces mobility due to inflammation and structural damage in the vertebra. Analysis of cervical mobility is a key component of the assessment of patients with AS. Several indices and tools have been proposed to analyse cervical mobility in these patients, but some of them lack accuracy and sensitivity and others require extensive resources for their use. Inertial motion sensors (IMU) might be useful for this purpose, but require validation. Material and method. Cervical movement was assessed synchronously in three planes (frontal flexion, lateral flexion and cervical rotation) by using an inertial sensor (IMU) and a motion capture system. A test/retest with the sensor was also performed. Other measurements commonly used to monitor AS patients were taken. Results. The reliability analysis using the intraclass correlation index was very good (0.99) for the test/retest with the IMU sensor and for the comparison with the motion capture system. Differences in degrees were small (2-9°). Discussion. IMU technology provides a flexible and economic way to measure mobility in this type of disease. In this study, the results of IMU versus motion capture as the gold standard were satisfactory. This technology can be useful for analysing cervical mobility in AS (AU)

Born to run: The paradox of biomechanical force in spondyloarthritis from an evolutionary perspective.

Spondyloarthritis (SpA) refers to a group of chronic inflammatory arthritic diseases that can be severely debilitating. The most common form of SpA affecting the peripheral skeleton is psoriatic arthritis, while that affecting the axial skeleton is ankylosing spondylitis. SpA has a multifactorial nature, with both genetic and environmental factors initiating and maintaining the disease. Recently, the role of biomechanical stress as an initiator of disease has gained much attention, with efforts focusing on the underlying cellular and molecular mechanisms. In this review, we provide a different view, with emphasis on the apparently contradictory role of physical therapy in SpA owing to the impact of biomechanical stress and put this in an evolutionary context due to changes in environment and lifestyle across time.

Clinical improvement and reduction in serum calprotectin levels after an intensive exercise programme for patients with ankylosing spondylitis and non-radiographic axial spondyloarthritis.

BACKGROUND: The efficacy of exercise therapy for ankylosing spondylitis (AS) is well-documented, but dearth of information is for non-radiographic axial spondyloarthritis (nr-axSpA). Biomarkers like serum calprotectin, interleukins IL-6, IL-17 and tumour necrosis factor (TNF)-α may reflect the disease activity of axial spondyloarthritis (axSpA). In this study, we investigated clinical and laboratory parameters of both axSpA subgroups in response to intensive physical exercise. METHODS: Altogether, 46 patients with axSpA, characterised according to the Assessment of SpondyloArthritis International Society criteria as having nr-axSpA or AS underwent 6-month exercise programme. Clinical outcomes of disease activity, Bath AS Disease Activity Index (BASDAI), AS Disease Activity Index (ASDAS-CRP), mobility, Bath AS Metrology Index (BASMI) and function, Bath AS Functional Index (BASFI) were evaluated at baseline and at the end of the exercise programme. Serum IL-6 and IL-17, TNF-α and calprotectin were measured via ELISA. The clinical and laboratory data of 29 control axSpA patients were used for the evaluation of the results. RESULTS: In all axSpA patients, the ASDAS-CRP (2.10 ± 0.12 to 1.84 ± 0.11, p <0.01) and BASMI (1.28 ± 0.14 to 0.66 ± 0.84, p <0.0001) improved after 6 months of exercise therapy. There was a significant improvement in the ASDAS-CRP in the nr-axSpA subgroup (2.01 ± 0.19 to 1.73 ± 0.16, p <0.05) and in the BASMI in both, the nr-axSpA and the AS subgroups (1.09 ± 0.12 to 0.47 ± 0.08, p <0.0001 and 1.43 ± 0.24 to 0.82 ± 0.23, p <0.0001, respectively). Both, ASDAS-CRP and BASDAI, were significantly improved in the exercise axSpA group compared to the control axSpA group (mean -0.26 vs. -0.13 and -0.49 vs. 0.12, respectively, all p <0.05). Only calprotectin was significantly reduced after the exercise programme in nr-axSpA and AS patients (from 2379.0 ± 243.20 to 1779.0 ± 138.30 µg/mL and from 2430.0 ± 269.70 to 1816.0 ± 148.20 µg/mL, respectively, all p <0.01). The change in calprotectin was more profound in the axSpA intervention group (mean -604.56) than in the control axSpA (mean -149.28, p <0.05). CONCLUSION: This study demonstrated similar efficacy for an intensive exercise programme in both nr-axSpA and AS patients. A significant decrease in serum calprotectin levels in both subgroups of axSpA patients after the exercise programme reflected an improvement in the disease activity and spinal mobility.

Efectos de un programa de ejercicio físico y relajación en el medio acuático en pacientes con espondiloartritis: ensayo clínico aleatorizado / Effects of an exercise and relaxation aquatic program in patients with spondyloarthritis: A randomized trial

Fundamento y objetivo: La espondiloartritis hace referencia a un conjunto de enfermedades reumáticas crónicas que comparten diversas características clínicas, genéticas, radiológicas y epidemiológicas. La presentación clínica de las espondiloartritis se caracteriza por compromiso del esqueleto axial y articular periférico. El objetivo de este estudio fue evaluar la eficacia de un programa de entrenamiento físico más relajación en el medio acuático en personas con espondiloartritis. Pacientes y método: Estudio clínico aleatorizado de simple ciego en el que 30 personas con espondiloartritis fueron asignadas al azar a un grupo experimental o control. Durante 2 meses al grupo experimental se le aplicó un programa de entrenamiento físico en el medio acuático más relajación (3 sesiones por semana), y al grupo control se le realizaron las evaluaciones los mismos días que al experimental sin que participaran en ningún programa de ejercicio físico supervisado. Los datos obtenidos al inicio del estudio e inmediatamente después de la aplicación de la última sesión fueron: Bath Ankylosing Spondylitis Functional Index («Índice de funcionalidad para las espondiloartritis»), Bath Ankylosing Spondylitis Disease Activity Index («Índice de actividad de la enfermedad del grupo de Bath»), Cuestionario de Salud SF-12 y pulsómetro Sigma PC3® (Sigma-Elektro GmbH, Neustadt, Aemania). Resultados: La prueba U de Mann-Whitney mostró diferencias estadísticamente significativas para la calidad de vida (función física [p = 0,05]), Bath Ankylosing Spondylitis Functional Index (p = 0,015), Bath Ankylosing Spondylitis Disease Activity Index (fatiga [p = 0,032], dolor de cuello, espalda y caderas [p = 0,045], dolor o inflamación en otras articulaciones [p = 0,032] y rigidez matutina la despertar [p = 0,019]). Conclusiones: Los resultados del presente estudio muestran que los tratamientos de ejercicio físico unidos a la relajación aportan beneficios a los pacientes con espondiloartritis y son recomendables como parte del tratamiento de la enfermedad (AU)

Background and objective: Spondyloarthritis is a general term referring to a group of chronic rheumatic illnesses that share clinical, genetic, radiological and epidemiological features. The clinical presentation of spondyloarthritis is characterized by the compromise of both the axial and peripheral articular skeleton. We aimed to evaluate the efficacy of an aquatic exercise plus relaxation program in patients with spondyloarthritis. Patients and method: This was a randomized single blind study including 30 patients with spondylitis who were randomly assigned to an experimental or control group. For 2 months, the experimental group underwent an aquatic fitness plus relaxation program (3 sessions per week). Evaluations were also performed in the control group the same days as the experimental group but they did not participate in any supervised exercise program. The following data were obtained at baseline and immediately after application of the last session: Bath Ankylosing Spondylitis Functional Index, Bath Ankylosing Spondylitis Disease Activity Index, Health Questionnaire SF-12 and Sigma PC3® (Sigma-Elektro GmbH, Neustadt, Germany) Heart Rate Monitor. Results: The Mann-Whitney test showed statistically significant differences in the quality of life (physical function [P = .05]), Bath Ankylosing Spondylitis Functional Index (P = .015), Bath Ankylosing Spondylitis Disease Activity Index (fatigue [P = .032], neck pain, back and hips [P = .045], pain or swelling in other joints [P = .032] and in waking morning stiffness [P = .019]). Conclusions: The results of the present study suggest that therapy with physical exercise plus relaxation provides benefits to spondyloarthritis patients and these are advised as a part of their usual treatment (AU)

Measuring participation in people with spondyloarthritis using the social role participation questionnaire.

OBJECTIVES: People with spondyloarthritis (SpA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) have identified the importance of understanding how their disease and its treatment impacts on their social roles. This requires a reliable and valid standardised measure, and this study evaluates these measurement properties of the Social Role Participation Questionnaire (SRPQ). METHODS: 109 participants (44 with AS, 65 with PsA) completed questionnaires on demographics, participation measures (SRPQ, Keele Assessment of Participation (KAP), Late Life Disability Instrument (LLDI)), disease severity (physician global) and activity (pain, fatigue, Bath Ankylosing Spondylitis Disease Activity Index), psychological measures (depressive symptoms (Hospital Anxiety and Depression Scale), Illness Intrusiveness)) and function (Health Assessment Questionnaire, Bath Ankylosing Spondylitis Functional Index). After testing scaling properties, test-retest reliability of the SRPQ was evaluated using intraclass correlation coefficients (ICC) and hypotheses of construct validity were evaluated using correlation coefficients. RESULTS: Patients with AS had a mean age of 40 years and 65% were male, whereas patients with PsA had a mean age of 53 years and 63% were male. Although there were some differences between AS and PsA participants in their social role participation, scaling properties were good for both groups. ICCs were >0.90 for the satisfaction subscales of the SRPQ. For construct validity, SRPQ satisfaction subscales were moderately correlated with the KAP and LLDI (0.64-0.78), and less satisfaction was associated with higher disease severity and activity, more depressive symptoms, more illness intrusiveness and more disability (coefficients -0.67 to -0.88). CONCLUSION: Social role participation is an important concept for people with SpA, and the SRPQ is a reliable and valid measure for use with people with AS and PsA.

[Nonpharmacological treatment of patients with spondyloarthritides]. / Nefarmakolosko lijecenje bolesnika sa spondiloartropatijama.

Despite the advances in the pharmacological therapy non-pharmacologic methods and especially therapeutic exercise are a cornerstone in management of spondyloarthritides. In this review studies of various physical therapy programs in ankylosing spondylitis and other spondyloarthritides are addressed with emphasis on their benefits and potential indications as well as on limitations in clinical practice and in studying these treatments. Formal physical therapy under the supervision of a physical therapist has been shown to diminish pain and stiffness and to improve posture, mobility, function and quality of life. Apart form land exercises water therapy (including balneotherapy) may be beneficial and in most severe cases, inpatient rehabilitation may be indicated, too. Physicians should implement such non-pharmacological therapy as a part of a comprehensive management strategy. Even though data are not sufficient to determine which specific physical therapy programme should be recommended this review demonstrates that physical therapy is an effective form of intervention and remains an essential part of the management with the importance of emphasis on continued and regular exercise therapy.