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Is the whole-body cryotherapy a beneficial supplement to exercise therapy for patients with ankylosing spondylitis?
Abstract
Background:
The treatment of ankylosing spondylitis (AS) patients requires a combination of non-pharmacological (education, exercise and physical therapy), as well as pharmacological treatment modalities. The optimal management of AS still remains unresolved.
Objective:
The aim was to measure and compare the effects of whole-body cryotherapy (WBC) at -110∘C and at -60∘C and exercise therapy alone on disease activity and the functional parameters of patients with ankylosing spondylitis (AS).
Methods:
Ninety-two patients were allocated to three groups: with WBC at -110∘C or at -60∘C (each concurrent with exercise therapy), or exercise therapy alone. Disease activity and the functional parameters of the patients were measured at study entry and at the end of the 8-day treatment.
Results:
Supervised therapy, irrespective of the program, led to a significant reduction in disease activity (Bath Ankylosing Spondylitis Disease Activity Index: BASDAI, Ankylosing Spondylitis Disease Activity Score: ASDAS-CRP), disease-related back pain, fatigue, duration and intensity of morning stiffness and a significant improvement in the patient's functional capacity (Bath Ankylosing Spondylitis Functional Index: BASFI), spine mobility (Bath Ankylosing Spondylitis Metrology Index: BASMI) and chest expandability, with no changes in the levels of CRP. It has been demonstrated that following therapy, the group that underwent cryotherapy at -110∘C manifested significantly reduced disease activity (BASDAI) compared with exercise therapy only (p= 0.024).
Conclusion:
Adding cryotherapy at -110∘C to exercise therapy led to significantly reduced disease activity expressed in BASDAI, compared with exercise therapy alone.
... Increasing pain and subsequent stiffness as the patient mobilizes are warning signs that too much exercise is being provided [23]. Periods of activity lasting five or 10 minutes at one-or two-hourly intervals are likely to be better tolerated than more intensive sessions of exercise once or twice daily. ...
Rheumatism is a broad term for the painful afflictions of the musculoskeletal system, which include a variety of symptoms ranging from vague pain or aching to profound disability. This article explores the imperative role of physiotherapy in navigating pain within the field of rheumatology, providing a comprehensive review of non-pharmacological pain management strategies. A literature search of PubMed, Web of Science, Scopus, and Cochrane databases was conducted, employing keywords like "Pain," "Rheumatic disease," and "Physiotherapy," with the review emphasizing recent English studies, particularly randomized trials, meta-analyses, and systematic reviews over the last 10 years, to consolidate evidence on the efficacy of physiotherapy interventions for individuals with rheumatic disease. Pain, a significant challenge for individuals with rheumatic diseases, is often intense and persistent, associated with subsequent physical disability, but employing a holistic approach encompassing drugs, physical therapy, and patient education can yield substantial benefits in managing these painful conditions. In addition to pharmacological interventions, management strategies incorporate a non-pharmacological approach, encompassing rehabilitation and physical therapy in alignment with the International Classification of Functioning, Disability, and Health (ICF) model. The patient and physiotherapist collaborate to develop a goal-oriented treatment plan, utilizing modalities like heat, cold, electrotherapy, and hydrotherapy for pain management, progressing to mobility enhancement, posture re-education, and activities focused on a range of motion and muscle strengthening.
... Together with the latter, the increase in parasympathetic tone results in reduced fatigue, muscle tension and soreness, improved mood, and symptoms of depression, ultimately leading to a reduction in pain perception [12]. For all these reasons, cycles of WBC have led to improved rehabilitation outcomes in patients with conditions such as multiple sclerosis [13], post-COVID-19 condition [14], rheumatoid arthritis [15], ankylosing spondylitis [16], polymyalgia rheumatica [17], and fibromyalgia [18][19][20][21]. Despite its 40-year-long use worldwide, WBC is associated with rare and mostly transient adverse effects. ...
Functional neurological disorders (FNDs) are complex disabling conditions requiring a multiple rehabilitation intervention. Here, we propose a new use of whole-body cryostimulation (WBC) that was implemented in a multidisciplinary rehabilitation programme in a wheelchair-ridden woman diagnosed with FND and other comorbidities. WBC is a promising adjuvant treatment in various conditions of rehabilitation interest, mainly because of its wide range of rapid effects, from anti-inflammatory to pain and autonomic modulating effects. The 4-week program included physiotherapy, nutritional intervention, psychological support, and WBC (−110 °C for 2 min). Questionnaires to assess disease impact, pain level, fatigue and sleep quality were administered. At discharge, improvements in body composition, haematological biomarkers, physical performance, and questionnaire scores were observed. The patient was able to walk independently with a walker for medium distances and reported unprecedented improvements, particularly in functional parameters and questionnaire scores. Although the extent to which WBC per se contributed to the measured improvements cannot be ascertained, subjective reports and our clinical observations indicate that WBC, the only intervention not previously experienced by the patient, acted as a booster for the rehabilitation interventions. Further research will be necessary to rule out any possible placebo effect and to confirm the effects of WBC on FND.
... [20][21][22][23][24][25][26] The few studies on joint pain management with cryotherapy showed encouraging results. [27][28][29][30][31][32][33] Gizinska et al reported a pain decrease using the Visual Analogue Scale, the Disease Activity Score-28 and interleukin-6 reduction in 25 patients with rheumatoid arthritis (−110°C for 3 min). 34 Jastrzabek et al described similar results in 40 patients with rheumatoid arthritis (20 cryotherapy sessions two times per day, at −160°C for 3 min). ...
Introduction
Hormone therapy (HT) is a major adjuvant treatment for breast cancer. Despite their effectiveness, aromatase inhibitors can cause several side effects, including arthralgia in 35%–50% of patients. These side effects frequently lead to the premature discontinuation of HT. Whole-body cryotherapy (WBC) can be used for managing arthritic pain. The primary objective of this study will be to evaluate the effect of WBC on aromatase-induced joint pain, compared with placebo cryotherapy, in patients with hormone-dependent breast cancer receiving adjuvant aromatase inhibitors. The secondary objectives will be to evaluate WBC safety and its effect on analgesic consumption, HT adherence and quality of life.
Methods and analysis
In this randomised, placebo-controlled, double-blinded clinical trial, 56 patients with aromatase inhibitor-induced joint pain and a Brief Pain Inventory-Short Form (BPI-SF) score ≥3 for the worst pain experienced in the previous week will be randomised into the WBC or placebo cryotherapy arm (10 sessions in each group). The primary outcome will be the BPI-SF score at week 6 post-treatment. The secondary outcomes will include the BPI-SF scores at months 3 and 6 post-treatment, the BPI-SF pain severity index and pain interference index, the Health Assessment Questionnaire score, the number of days of aromatase inhibitor treatment and analgesic consumption in the 15 days before the visits at week 6 and months 3 and 6 after cryotherapy. The incidence of adverse events will also be investigated.
Ethics and dissemination
Ethics approval was obtained from the Ethics Committee Est IV of Hospital Civil, Strasbourg, France. Protocol V.5 was approved in December 2022. The results will be disseminated in a peer-reviewed journal and presented at international congresses.
Trial registration number
NCT05315011 .
... Exposure to these temperatures can reduce pain and inflammatory status improving several metabolic parameters such as thermogenesis, lipid profile, insulin sensitivity, and glucose utilization [6,7], but also depression, anxiety [8], and sleep quality [9]. Moreover, cycles of WBC are able to reduce fatigue and disease activity in patients with several conditions, such as multiple sclerosis [10], post-COVID-19 condition (PCC) [11,12], rheumatoid arthritis [13], ankylosing spondylitis [14], and fibromyalgia [6,15,16]. ...
Polymyalgia rheumatica (PMR) is the most common inflammatory rheumatic disease among people over 50 and occurs with symptoms such as musculoskeletal pain and stiffness in the neck, shoulders, and hips. To date, corticosteroids represent the cornerstone of PMR treatment. However, it is well known that their prolonged use is associated with several adverse effects, making it crucial to find therapeutic alternatives. The purpose of this case report was to describe the effectiveness of 10 whole-body cryostimulation (WBC) sessions on a 74-year-old woman suffering from PMR. An improvement in disease impact, fatigue, pain, quality of sleep, and total physical activity was observed after WBC. Moreover, the patient reduced her daily drug intake by 67% following WBC treatments. Given the increasing prevalence of PMR and considering the side effects that drug treatments can lead to, WBC could represent a valuable adjuvant and well-tolerated alternative for treating PMR.
... Romanowski et al. showed that the group of subjects who participated in WBC at −110 • C achieved reduced disease activity compared to the group of patients without WBC therapy. 53 In a study by Stanek et al., it was assessed that WBC achieved significantly greater improvements in spinal mobility indices compared to a group who received kinesiotherapy alone. 54 In a subsequent study by Stanek et al., the effect of WBC on cardiovascular risk factors in patients with AS was investigated. ...
Introduction:
Whole-body cryotherapy (WBC) is a controlled exposure of the whole body to cold to gain health benefits. In recent years, data on potential applications of WBC in multiple clinical settings have emerged.
Sources of data:
PubMed, EBSCO and Clinical Key search using keywords including terms 'whole body', 'cryotherapy' and 'cryostimulation'.
Areas of agreement:
WBC could be applied as adjuvant therapy in multiple conditions involving chronic inflammation because of its potent anti-inflammatory effects. Those might include systemic inflammation as in rheumatoid arthritis. In addition, WBC could serve as adjuvant therapy for chronic inflammation in some patients with obesity.
Areas of controversy:
WBC probably might be applied as an adjuvant treatment in patients with chronic brain disorders including mild cognitive impairment and general anxiety disorder and in patients with depressive episodes and neuroinflammation reduction as in multiple sclerosis. WBC effects in metabolic disorder treatment are yet to be determined. WBC presumably exerts pleiotropic effects and therefore might serve as adjuvant therapy in multi-systemic disorders, including myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).
Growing points:
The quality of studies on the effects of WBC in the clinical setting is in general low; hence, randomized controlled trials with adequate sample size and longer follow-up periods are needed.
Areas are timely for developing research:
Further studies should examine the mechanism underlying the clinical efficacy of WBC. Multiple conditions might involve chronic inflammation, which in turn could be a potential target of WBC. Further research on the application of WBC in neurodegenerative disorders, neuropsychiatric disorders and ME/CFS should be conducted.
... Exposure to these temperatures is able to reduce pain and inflammatory status improving several metabolic parameters such as thermogenesis, lipid profile, insulin sensitivity and glucose utilisation [6,7], but also depression, anxiety [8] and sleep quality [9]. Moreover, cycles of WBC are able to reduce fatigue and disease activity in patients with several conditions such as multiple sclerosis [10], post-COVID-19 condition (PCC) [11,12], rheumatoid arthritis [13], ankylosing spondylitis [14] and fibromyalgia [6,15,16]. To the best of our knowledge, no studies have so far investigated the effects of WBC on PMR. ...
Polymyalgia rheumatica (PMR) is the most common inflammatory rheumatic disease among people over the age of 50 and occurs with symptoms such as musculoskeletal pain and stiffness in the neck, shoulders and hips. To date, corticosteroids represent the cornerstone of PMR treatment, although it is well known that their prolonged use is associated with several adverse effects, making it crucial to find therapeutic alternatives to their use. The purpose of this case report was to describe the effectiveness of 10 whole-body cryostimulation (WBC) sessions on a 74-year-old woman suffering from PMR. An improvement in disease impact, fatigue, pain, quality of sleep and total physical activity was observed after WBC. Moreover, the patient reduced her daily drug intake by 67% following WBC treatments. Given the increasing prevalence of PMR and considering the side effects that drug treatments can lead to, WBC could represent a valuable adjuvant and well-tolerated alternative for the treatment of PMR.
... Therefore, albumin is a negative acute-phase protein [49,50]. Therefore, the increased albumin levels after WBC treatments in our study may be related to decreased inflammation and oxidative stress, which was also observed in this study and reported in the previous ones [17,[20][21][22][51][52][53][54]. Furthermore, albumin is the main plasma protein rich in sulfhydryl groups and provides nonenzymatic antioxidant defense outside the cells. ...
Background:
The aim of the study was to assess the effect of whole-body cryotherapy (WBC) with subsequent exercise training (WBC group) or exercise-only training (ET group) on endothelium inflammation parameters in patients with ankylosing spondylitis (AS).
Methods:
The WBC procedure lasted 3 min, and exercise training consisted of one 60 min session a day, which was the same in each group. The ET group was compared to the WBC group. Endothelium (high-sensitivity C-reactive protein (hsCRP), soluble P-Selectin, soluble vascular cell adhesion molecule-1 (sVCAM-1), neopterin), and oxidative stress (lipid hydroperoxide (LHP), protein sulfhydryl (PSH), lipofuscin, paraoxonase-1(PON-1), and albumin) parameters were estimated 1 day before and 1 day after the completion of the study.
Results:
A significant decrease in hsCRP, sP-Selectin, sVCAM-1, and neopterin concentrations was observed in the WBC group after the treatment. After the treatment, in both groups, LHP and lipofuscin levels and PON-1 activity decreased significantly. The observed drop in these parameters was higher in the WBC group compared to the ET group. Albumin concentration increased in the WBC group after treatment.
Conclusion:
Procedures of WBC have a beneficial effect on endothelium parameters in AS patients; therefore, this method can be applied in the treatment of this group of patients.
... As reported by Stanek et al. [25], whole-body crostimulation (W-BC) seems to be a safe method leading to an improvement of rheologic properties of bloodand is recommended for patients with ankylosing spondylitis. Romanowski and Straburzynska-Lupa [24] also confirmed the effectiveness of W-BC in the therapy of patients with ankylosing spondylitis. ...
Whole-body cryostimulation (W-BC) is commonly used following exercise to accelerate recovery or as a form of therapy to prevent and cure sports injuries. This study aimed to investigate the effect of a series of 24 W-BC sessions on morphological and rheological blood indicators in physically active men. Eighteen physically active men participated in the study (mean age 22.1 ± 0.07). They were divided into two groups depending on their self-reported levels of physical activity: moderate or high physical activity. The participants completed a total of 24 W-BC sessions every second day, over a span of two months. Blood was collected at baseline, immediately after and 24 h after the first treatment, before and after the 12th treatment, before, immediately after, and 24 h after the 24th treatment, and one, two, three, and four weeks after the 24th treatment. Rheological and morphological indicators of blood were examined. The number of leukocytes was decreased in the moderate activity group (p < 0.05) but not in the high intensity group, following the first W-BC session. There were no significant changes in elongation index (EI) at a shear stress of 2.19–31.04 (Pa) in both groups as well as at the following values: aggregation index (AI), the half time (T½) and the amplitude of aggregation (AMP) in both studied groups. Differences between the first and the 12th or the 24th session became apparent in some morphological indices in one or both groups. Changes in the morphological properties were not observed after the first exposure but became evident following repeated W-BC sessions.
... Recent findings have shed light on the potential benefits of WBC on musculoskeletal disorders (Romanowski et al., 2020;Straburzyńska-Lupa et al., 2018) and mental wellbeing (Pawik et al., 2019), whilst its use in sport and exercise recovery has become more documented (Lombardi et al., 2017;Partridge et al., 2019). Sports personnel are familiar with the practice of ice baths or cold water immersions, the use of which has been extensively reviewed (Ihsan et al., 2016;Leeder et al., 2012;Machado et al., 2016). ...
Whilst Whole Body Cryotherapy (WBC) has become an emerging tool for sport and exercise recovery, its overall efficacy remains contentious. This thesis addressed a variety of issues concerning the practice.
Firstly, the impact of single WBC interventions for treating exercise-induced muscle damage (EIMD) is unclear. Secondly, the influence of inter-individual factors on WBC outcomes post-exercise remains an under-investigated area. Therefore the first main study explored the effects of age and body fat content on responses to WBC following downhill running, a commonly utilised eccentric exercise model for inducing muscle damage. WBC participants underwent cryotherapy (3 minutes, −120°C) one hour post- downhill run and control (CON) participants passively recovered (20°C). Despite the presence of EIMD, WBC significantly blunted (p=0.04) the decrease in muscle torque 24 hours after the downhill run. This response was significantly influenced by age, with young participants (<40 years) retaining their muscle strength more than older participants (≥45 years). WBC may therefore attenuate EIMD and benefit muscle strength recovery following eccentrically biased exercise, particularly for young males.
A subsequent downhill run study investigated the influence of WBC timing post-exercise, a factor that could clarify optimal treatment usage. An additional objective was to compare the effects of WBC with cold water immersions (CWI) since the verdict regarding which cold modality is superior for recovery remains an on-going area of controversy. It was revealed that WBC 4 hours post-exercise was ineffective in treating EIMD markers, so applying WBC within one hour after exercise may be preferable to delaying by several hours. However, WBC was no more effective than CWI, meaning that the cost vs. reward implications of WBC treatments would need further reviewing.
Finally, the implications of repetitive WBC during training programmes require further evaluation due to the possibility of repetitive cold interfering with long term adaptations. The final study investigated the impact of two weekly WBC treatments on adaptations to a 6 week strength and endurance training programme. It was found that WBC participants significantly improved their muscle strength comparatively to the CON group. However WBC did not improve their jump height (p=0.23) in contrast to the CON group (p=0.01). In conclusion, repetitive WBC does not appear to blunt strength training adaptations, although there may be an interference effect in the development of explosive power.
... A variety of studies (Ma et al., 2013;Giemza et al., 2015;Romanowski and Straburzynska-Lupa, 2020) have found favorable outcomes in the improvement of range of motion (ROM) and flexibility after one or multiple cryo-exposures. Ma et al. (2013) studied the effects of a cycle of 24 WBC sessions (3 min, −110 • C) on the active ROM of flexion, abduction, internal, and external rotation of the shoulder in subjects suffering from adhesive capsulitis of the shoulder. ...
... A variety of studies (Ma et al., 2013;Giemza et al., 2015;Romanowski and Straburzynska-Lupa, 2020) have found favorable outcomes in the improvement of range of motion (ROM) and flexibility after one or multiple cryo-exposures. Ma et al. (2013) studied the effects of a cycle of 24 WBC sessions (3 min, −110 • C) on the active ROM of flexion, abduction, internal, and external rotation of the shoulder in subjects suffering from adhesive capsulitis of the shoulder. ...
... A variety of studies (Ma et al., 2013;Giemza et al., 2015;Romanowski and Straburzynska-Lupa, 2020) have found favorable outcomes in the improvement of range of motion (ROM) and flexibility after one or multiple cryo-exposures. Ma et al. (2013) studied the effects of a cycle of 24 WBC sessions (3 min, −110 • C) on the active ROM of flexion, abduction, internal, and external rotation of the shoulder in subjects suffering from adhesive capsulitis of the shoulder. ...
Recovery after exercise is a crucial key in preventing muscle injures and in speeding up processes to return at the homeostasis level. There are several ways of developing a recovery strategy with the use of different kinds of traditional and up-to date techniques. The use of cold has traditionally been used after physical exercise for recovery purposes. In the recent years, the use of whole-body cryotherapy/cryostimulation (an extreme cold stimulation lasting 1-4 min and given in a cold room at a temperature comprised from -60 to -195°C) has tremendously increased for such purposes. However, there are controversies about the benefits that the use of this technique may provide. Therefore, this paper describes what is whole body cryotherapy/cryostimulation, reviews and debates the benefits that its use may provide, presents practical considerations and applications, and emphasizes the need of customization depending on the context, the purpose, and the subject characteristics.
This review is written by international experts from the working group on whole body cryotherapy/cryostimulation from the International Institute of Refrigeration.
Objectives
Fatigue is frequent in axial spondyloarthritis (axSpA) and is difficult to improve. This systematic review aimed to assess the effects of axSpA treatment on fatigue.
Methods
A systematic review following the PRISMA recommendations was performed on PubMed, Cochrane and Embase databases. We included controlled interventional studies, cohort studies conducted in patients with axSpA meeting the ASAS 2009 criteria and measuring fatigue between 12–156 weeks of treatment. We excluded studies not written in English, case reports, abstracts, systematic reviews, meta-analysis and studies with missing data. A meta-analysis was performed for anti-TNF/anti-IL17/JAK inhibitors randomized controlled trials evaluating fatigue at week 12–16.
Results
1672 studies were identified, of which 34 were selected for analysis. Twelve studies evaluated anti-TNF with a significant reduction in fatigue measured by various scores (FACIT, MFI, NRS, VAS, FSS) in 11 studies. Among the four studies evaluating anti-IL17, three showed a reduction in fatigue, with a dose effect for secukinumab. Two studies evaluated JAK inhibitors and showed a reduction in fatigue. The meta-analysis showed no differences between the DMARDs. Concerning non-pharmacological treatments, 12 of 16 studies showed a reduction in fatigue using physical activity, cryotherapy, and magnetotherapy. Two studies showed that the addition of physical activity to anti-TNF reduced fatigue more significantly. Finally, one study showed a greater efficacy in men, and two studies suggested it as in non-radiographic form.
Conclusion
This review shows a beneficial effect of DMARD and non-pharmacological treatment on fatigue in axSpA in short and medium terms with a greater effect when combining them.
Whole-body cryostimulation (WBC) is known to be effective in reducing pain and inflammatory status, improving several metabolic parameters such as thermogenesis, lipid profile, insulin sensitivity and glucose utilisation but also depression, anxiety and sleep quality. Cycles of WBC have been shown to reduce fatigue, disease activity and pain in patients with rheumatic, metabolic, neurological and post-coronavirus disease 2019 (COVID-19) conditions. Despite important limitations of the available studies, growing scientific evidence indicates that WBC effectively reduces fibromyalgia (FM) symptoms, particularly due to its rapid anti-inflammatory effect. In addition, preliminary data seems to suggest that the positive effects of WBC on pain, fatigue, sleep and psychological aspects (mood and anxiety) may last on average 3–4 months after treatment discontinuation.
For this reason, WBC has the potential to boost rehabilitation programmes in achieving functional outcomes in FM patients, which seems attractive in terms of the cost-effectiveness of rehabilitation. Moreover, the high compliance and highly positive perception of the treatment reported by FM patients in most studies seem to make WBC a preferred component of the rehabilitation programme, which appears crucial in the long-term management of this chronic condition.
Skeletal muscle contractions during cold exposure are stimulated by muscle shivering and enhance the endocrine function by releasing certain muscle-derived peptides: myokines and exerkines, which may prevent or even reverse negative effects of different health conditions. At the same time, shivering induced by cold exposure is the most important means to maintain body temperature. The effects of whole-body cryostimulation (WBC) on muscle damage secondary to eccentric contractions, its impact on aerobic or anaerobic capacity and exercise capacity are reviewed in this chapter. Exercise and cold exposure activate the same pathways in myokines released by the muscle: changes in myokines during shivering or in response to exercise alone or together with WBC are described. WBC can be a practical tool to support the effects of regular training workouts, especially among those subjects who are beginning to be active. WBC alone is not able to significantly modify physical performance or body composition, but by improving muscle regeneration and flexibility and endocrine function it may have beneficial effects on health.
Objective
To update the evidence of non-biological treatments for axial spondyloarthritis (axSpA), as a basis for the 2022 Assessment of SpondyloArthritis international Society-European Alliance of Associations for Rheumatology (ASAS-EULAR) recommendations for the management of axSpA.
Methods
A systematic literature review (2016–2021) on efficacy and safety of non-pharmacological and non-biological pharmacological treatments was performed, up to 1 January 2022. The research question was formulated according to the PICO format: Population: adult patients with r-axSpA and nr-axSpA; Intervention: non-pharmacological and non-biological pharmacological treatments; Comparator: active comparator or placebo; Outcomes: all relevant efficacy and safety outcomes. Type of studies included were: randomised controlled trials (RCTs), observational studies (for efficacy of non-pharmacological treatments, and safety), qualitative studies. Cohen’s effect size (ES) was calculated for non-pharmacological and risk ratio (RR) for pharmacological treatments.
Results
Of 107 publications included, 63 addressed non-pharmacological interventions, including education (n=8) and exercise (n=20). The ES for education on disease activity, function, mobility was small to moderate (eg. Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), ES: 0.06–0.59). Exercise had moderate to high ES on these outcomes (eg. BASDAI, ES: 0.14–1.43). Six RCTs on targeted synthetic disease-modifying antirheumatic drugs (DMARDs) showed efficacy of tofacitinib, upadacitinib and filgotinib (phase 2 only) in r-axSpA (range RR vs placebo for ASAS20: 1.91–3.10), while apremilast and nilotinib were not efficacious. Studies on conventional synthetic DMARDs (n=3), non-steroidal anti-inflammatory drugs (NSAIDs, n=8) and other drugs (n=12) did not provide new evidence on efficacy/safety (efficacy of NSAIDs confirmed; limited efficacy of short-term glucocorticoids in one RCT).
Conclusions
Education, exercise and NSAIDs confirmed to be efficacious in axSpA. JAKi were proved efficacious in r-axSpA.
Currently, all available therapies for the control and management of fibromyalgia (FM) are mostly focused on relieving patients’ symptoms and improving their quality of life. The purpose of this review is to provide an up-to-date overview of the evidence supporting the beneficial effects of whole-body cryostimulation (WBC) in patients with FM and evidence-based guidance on the possible adjuvant use of WBC in the treatment of FM. We searched the most recent literature by retrieving 10 eligible studies, 4 of which were abstracts only, from a total of 263 records. Thermal stress caused by cryostimulation induces an analgesic effect, improving pain, redox balance, and inflammatory symptoms in an exercise-mimicking fashion. In addition, it reduces the feeling of fatigue, improves mood, and reduces mental health deterioration with positive consequences on depressive states and improved sleep quality. Although the studies included in this review are not of sufficient quality and quantity to draw definitive conclusions about the effectiveness of WBC in FM, initial evidence indicates WBC as a promising add-on option in the multidisciplinary treatment of FM, due to its rapid action and high patients’ compliance. The application of WBC protocols has the potential to expand therapeutic options for the treatment of FM and related disorders; however, larger, high-quality primary studies are still needed.
Seronegative spondyloarthritis is a progressive inflammatory disease with a wide and varied range of symptoms. Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease characterized by pain and structural changes. Ankylosing spondylitis is characterized by functional disorders such as reduced mobility and axial deformity, leading to a decrease in patient quality of life. The purpose of this article is to provide basic information on therapeutic options for exercise in the treatment of ankylosing spondylitis. Therapeutic exercise is the most important non-pharmacological intervention in patients. In addition to positive metabolic effects, exercise also plays an important role in improving spinal mobility and muscle strength. Maintaining proper postural posture appears to play a key role in patients with ankylosing spondylitis. Muscle contraction stimulates and promotes the secretion of cytokines called myokines. The best known is interleukin-6 (IL-6). This myokine also acts indirectly in the expression of tumor necrosis factor alpha (TNF-α). Exercise improves quality of life, physical condition, and symptoms associated with ankylosing spondylitis.
Purpose:
Patients with ankylosing spondylitis (AS) have increased production of proinflammatory cytokines, increased oxidants, and decreased antioxidant capacity. The aim of this study was to determine the effect of whole-body cryotherapy (WBC) at -110°C and -60°C, on disease activity, selected proinflammatory cytokines, and oxidative stress in patients with AS.
Methods:
Sixty-five patients with AS were recruited to one of three study procedures: WBC at -110°C, -60°C, or exercise therapy (non-WBC). The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score (ASDAS-CRP), concentration of C-reactive protein (CRP), and the concentrations of interleukin 8 and 17 (IL-8, IL-17) were measured at the beginning of the study and at the end of the intervention. The concentration of thiobarbituric acid reactive substances (TBARS), as a lipid peroxidation result, and total antioxidant status, an antioxidant organism potential, were measured.
Results:
All the studied groups showed significantly decreased posttherapy disease activity expressed as a function of the BASDAI, ASDAS-CRP, and the IL-8 concentration. We found that the TBARS concentration after therapy was significantly increased in the WBC at -110°C group. A comparison of the therapeutic effects between the treatment groups showed a significantly lower BASDAI after therapy in the WBC at -110°C group compared to the non-WBC group.
Conclusion:
WBC at -110°C had a positive effect on lowering AS clinical activity as measured by the BASDAI.
Objective
The aim of the study was to estimate the impact of whole-body cryotherapy (WBC) on cardiovascular risk factors in patients with ankylosing spondylitis (AS).
Material and Methods
We investigated the effect of WBC with subsequent kinesiotherapy on markers of inflammation, oxidative stress, lipid profile, and atherosclerosis plaque in male AS patients (WBC group). To assess the disease activity, the BASDAI and BASFI were also calculated. The results from the WBC group were compared with results from the kinesiotherapy (KT) group.
Results
The results showed that in the WBC group, the plasma hsCRP level decreased without change to the IL-6 level. The ICAM-1 level showed a decreasing tendency. The CER concentration, as well as the BASDAI and BASFI, decreased in both groups, but the index changes of disease activity were higher in the WBC than KT patients. Additionally, in the WBC group, we observed a decrease in oxidative stress markers, changes in the activity of some antioxidant enzymes and nonenzymatic antioxidant parameters. In both groups, the total cholesterol and LDL cholesterol, triglycerides, sCD40L, PAPP-A, and PLGF levels decreased, but the parameter changes were higher in the WBC group.
Conclusion
WBC appears to be a useful method of atherosclerosis prevention in AS patients.
Background:
Cryotherapy is a physiotherapy method used to treat back pain in older persons.
Objective:
This study aims to evaluate the changes in the rheological parameters of blood in older women with spondyloarthrosis, who underwent whole-body cryotherapy.
Methods:
The experimental group comprised 69 older women with lumbar spondyloarthrosis, aged between 65 and 70 years. Due to the methodology of the procedure, the experimental group was randomly divided into three groups. Each group underwent two weeks of different types of physiotherapy: only whole-body cryotherapy (22 women); only kinesitherapy (23 women); and both cryotherapy and kinesitherapy (24 women). The control group comprised 25 women who did not undergo any form of therapy. The evaluation of the rheological properties of the blood encompassed measurements of the plasma viscosity, the erythrocyte elongation and aggregation indices, and the level of fibrinogen.
Results:
The conducted rheological tests revealed a significant decrease in the erythrocyte elasticity and aggregation indices only in the group of women who had undergone both whole-body cryotherapy and kinesitherapy.
Conclusions:
Applying whole-body cryotherapy to older women with spondyloarthrosis decreases the elasticity of erythrocytes and, despite favourable changes in the aggregation parameters, problems with perfusion may still appear. For this reason, the benefit of using whole-body cryotherapy in these persons is debatable.
Objectives: The aim of this study was to investigate the effects of breathing and posture exercises on pain, functional status as well as respiratory function and health related quality of life in patients with Ankylosing Spondylitis (AS).
Materials and Methods: Forty patients with AS were included in the study. Pain levels were recorded by Visual Analog Scale (VAS). Disease activity levels were determined by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), functional status was determined by Bath Ankylosing Spondylitis Functional Index (BASFI) and spinal measurements were determined by the Bath Ankylosing Spondylitis Metrology Index (BASMI) criteria. Ankylosing Spondylitis Quality of Life (ASQol) was used as the disease-related quality of life scale. Pulmonary functions were tested with the Zan spirometry device. The first group was given a home exercise program including breathing and posture exercises and the second group was given a program with only posture exercises. However, the control group was not given a home exercise program. Patients in all groups were evaluated again after three months.
Results: The VAS, BASDAI, BASFI, BASMI, chest expansion, pulmonary function test results and ASQol values showed a significant improvement in the group with breathing and posture exercises. There was no significant change in the control group. Chest expansion, forced vital capacity (FVC), forced expiratory volume in the first second (FEV1)/FVC ratio in the first group had improved more significantly than group 2 and the control group. Also, BASFI, BASMI, BASDAI, ASQol, VAS scores in group 1 had improved more significantly when compared to group 2 and the control group.
Conclusion: Breathing exercises show a positive effect on the pain level, clinical status and respiratory function and provides improved functional status and quality of life in patients with AS. [Med-Science 2012; 1(2.000): 103-117]
Background
Several measurements are often used in daily clinical practice in the assessment of Ankylosing Spondylitis (AS) patients. The Assessment in SpondyloArthiritis International Society (ASAS) recommend in its core set: chest expansion modified Schöber test, Occiput to wall distance, lateral lumbar flexion, cervical rotation and The Bath Ankylosing Spondylitis Metrology Index (BASMI). BASMI also includes five measurements, some of them recommended by ASAS. Three versions of BASMI have been published with different scales and intervals for each component of the index. Though studies about reliability of these measurements are needed. The aim of this study was to analyze inter-rater reliability of recommended spinal mobility measures in AS. Methods
We examined reproducibility of spinal mobility measurements on 33 AS patients performed by two experienced rheumatologists in the same day. Descriptive statistics, Intraclass Correlation Coefficients (ICC), and Smallest Detectable Difference (SDD) using the Bland-Altman criteria were obtained for all the measurements. ResultsChest expansion showed the lowest value of ICC (0.66) and occiput-wall the highest (0.97). SDD was 2.43 units for BASMI2 and 1.27 units for BASMI10. Conclusions
Reliability according to ICC was moderate to high in all measurements. BASMI10, instead BASMI2, must be used: measurements used to calculate are the same but there is better reliability. Inter-rater variation, expressed as SDD, must be taken in account: smaller improvements do not demonstrate the efficacy of treatment because they can be due to experimental error and not to the treatment itself.
Whole-body cryotherapy (WBC) has been frequently used to supplement the rehabilitation of patients with rheumatoid arthritis (RA). The aim of this study was to compare the effect of WBC and traditional rehabilitation (TR) on clinical parameters and systemic levels of IL-6, TNF-
α
in patients with RA. The study group comprised 25 patients who were subjected to WBC (−110°C) and 19 patients who underwent a traditional rehabilitation program. Some clinical variables and levels of interleukin-6 (IL-6) and tumor necrosis factor-
α
(TNF-
α
) were used to assess the outcomes. After therapy both groups exhibited similar improvement in pain, disease activity, fatigue, time of walking, and the number of steps over a distance of 50 m. Only significantly better results were observed in HAQ in TR group (
p
< 0.05). However, similar significant reduction in IL-6 and TNF-
α
level was observed. The results showed positive effects of a 2-week rehabilitation program for patients with RA regardless of the kind of the applied physical procedure.
The present study investigated whether whole-body cryotherapy (WBC) procedures could potentially have more beneficial effects
on index of BASDAI and BASFI, pain intensity, and spine mobility parameters: Ott test, modified Schober test, chest expansion
in ankylosing spondylitis (AS) patients, than kinesiotherapy procedures used separately. AS patients were exposed to a cycle of
WBC procedures lasting 3 minutes a day, with a subsequent 60 minutes of kinesiotherapy or 60 minutes of kinesiotherapy only,
for 10 consecutive days excluding weekend. After the completion of the cycle of WBC procedures with subsequent kinesiotherapy
in the AS patients, BASDAI index decreased about 40% in comparison with the input value, whereas in the group of patients who
received only kinesiotherapy it decreased only about 15% in comparison with the input value. After the completion of the treatment
in theWBC group, BASFI index decreased about 30% in comparison with the input value, whereas in the kinesiotherapy group it
only decreased about 16% in comparison with the input value.The important conclusion was that, inWBC group with subsequent
kinesiotherapy, we observed on average about twice better results than in the group treated only by kinesiotherapy.
Introduction: Exposure to cold is one of the strongest physiological and psychological environmental stressors and induces an array of significant functional responses. Objective: To analyze the changes in morphological and rheological parameters of blood in regular winter swimmers and individuals exposed to whole-body cryotherapy. Methods: The study covered a period of two months (February and March) and included two groups of healthy males: 1) 10 winter swimmers who immersed in cold waters (3 min at 2°C to 7.2°C) once a week, and 2) 10 healthy volunteers who were exposed to cryotherapy (3 min at -110°C) on a weekly basis. Venous blood for morphological, biochemical (glu¬cose, fibrinogen) and rheological analysis (aggregation index, the amplitude and total extent of aggregation, the half time of the aggregation) was sampled prior to the experiment, as well as after one and two months of regular exposure to cold. Results: After two months of winter swimming, significant reduction of plasma fibrinogen was documented as compared to the baseline level. In contrast to winter swimmers, after two months of cryotherapy plasma concentration of fibrinogen was significantly higher than prior to the experiment. Moreover, significant increase in platelet count and the reduction in glucose concentration were documented after two months as compared the first month of cryotherapy.Conclusions: This study confirmed that exposure to cold can modulate morphological and biochemical parameters of blood. Despite the lack of unfavorable changes in hemorheological indices of both studied groups, an increase in fibrinogen concentration documented in cryotherapy group points to potential risk associated with this form of cold exposure.
Abstract:
The aim of this study was to estimate the influence of whole-body cryotherapy on blood morphology parameters in patients with ankylosing spondylitis and healthy volunteers exposed to cryotherapy as a method of biological restitution. Subjects from both groups were exposed to a cycle of 10 daily, 2 minute-lasting whole-body cryotherapy procedures (at a temperature of -120ºC) with subsequent 60 minute-lasting kinesitherapy. A day before the beginning of cryotherapy procedures and once more after the end therapeutic cycle the following parameters of blood cell count were estimated: leukocytes count with differential cell count, erythrocytes count, platelets count, hemoglobin concentration, hematocrit value and erythrocyte indexes (MCV, MCH, MCHC). In patients with ankylosing spondylitis after the end of a cycle of whole-body cryotherapy a significant decrease in hematocrit value and MCV as well as an increase in MCHC were observed. On the other hand in healthy volunteers a significant increase in erythrocytes, hemoglobin concentration, hematocrit value and MCV, decrease in MCHC as well as an increase in platelets count and proportion of monocytes in differential cell count. On the basis of obtained results it was concluded that whole-body cryotherapy evokes only a slight changes in blood morphology parameters within the range of reference values, different in patients with ankylosing spondylitis and healthy volunteers. In patients with ankylosing spondylitis it seems to be a safe method leading to improvement of rheologic properties of blood.
OBJECTIVE:
To examine the level of evidence for criterion-concurrent validity of spinal mobility assessments in patients with ankylosing spondylitis (AS).
METHODS:
Guidelines proposed in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses were used to undertake a search strategy involving 3 sets of keywords: accura*, truth, valid*; ankylosing spondylitis, spondyloarthritis, spondyloarthropathy, spondylarthritis; mobility, spinal measure*, (a further 16 keywords with similar meaning were used). Seven databases were searched from their inception to February 2014: AMED, Embase, ProQuest, PubMed, Science Direct, Scopus, and Web of Science. The Quality Assessment of Diagnostic Accuracy Studies (with modifications) was used to assess the quality of articles reviewed. An article was considered high quality when it received "yes" in at least 9 of the 13 items.
RESULTS:
From the 741 records initially identified, 10 articles were retained for our systematic review. Only 1 article was classified as high quality, and this article suggests that 3 variants of the Schober test (original, modified, and modified-modified) poorly reflect lumbar range of motion where radiographs were used as the reference standard.
CONCLUSION:
The level of evidence considering criterion-concurrent validity of clinical tests used to assess spinal mobility in patients with AS is low. Clinicians should be aware that current practice when measuring spinal mobility in AS may not accurately reflect true spinal mobility.
The aim of this article was to review current evidence about cryotherapy in inflammatory rheumatic diseases (therapeutic and biological effects). For therapeutic effects, we performed a systematic review (PubMed, EMBASE, Cochrane Library, LILACS databases, unpublished data) and selected studies including non-operated and non-infected arthritic patients treated with local cryotherapy or whole-body cryotherapy. By pooling 6 studies including 257 rheumatoid arthritis (RA) patients, we showed a significant decrease in pain visual analogic scale (mm) and 28-joint disease activity score after chronic cryotherapy in RA patients. For molecular pathways, local cryotherapy induces an intrajoint temperature decrease, which might downregulate several mediators involved in joint inflammation and destruction (cytokines, cartilage-degrading enzymes, proangiogenic factors), but studies in RA are rare. Cryotherapy should be included in RA therapeutic strategies as an adjunct therapy, with potential corticosteroid and nonsteroidal anti-inflammatory drug dose-sparing effects. However, techniques and protocols should be more precisely defined in randomized controlled trials with stronger methodology.
Background
From a health service perspective, society, with its limited resources, needs to be reassured that evidence-based medicine is also effective when carried out in the frame of ordinary clinical practice. The effectiveness of rehabilitation programs in ankylosing spondylitis (AS) has been proven to be effective in clinical trials. However, less is known when this is carried out in clinical practice. The aim of this study was to evaluate the effect of a 2-weeks rehabilitation program on self-reported outcome and physical function in patients with axial spondyloarthritis (ax-SpA) including AS patients carried out in ordinary clinical practice. The program contained of daily water exercises, exercises for flexibility, muscle strength, and cardio-respiratory fitness.
Results
A total of 87 ax-SpA patients (60 men, 27 women), aged ≥ 18 years were identified to have participated in the 2-weeks in-patient rehabilitation program. Mean age was 49 years and disease duration was 14 years. 92.5% were HLA-B27 positive, 62% were current users of non-steroidal anti-inflammatory drugs, and 17% were current users of tumour necrosis factor inhibitors. After 2-weeks, a statistical significant improvement (p < 0.001) was observed for patient-reported outcomes (Bath Ankylosing Spondylitis (BAS) Disease Activity Index 4.3 vs. 3.1, BAS Functional Index 3.1 vs. 2.4) and physical measured outcomes (BAS Metrology Index 3.23 vs. 2.29, Gait Velocity 2.2 vs. 2.6 m/s, timed-stands test 22.5 vs. 16.3 s, finger-floor distance 17.9 vs. 8.9 cm, chest expansion 3.9 vs. 4.6 cm).
Conclusion
Data, from our retrospective case series report, support that patient with ax-SpA benefit from short-term rehabilitation when it is carried out in ordinary clinical care. Data from ordinary clinical care may be important when discussing the effectiveness of a treatment and allocating resources in the health care system.
Different cryotherapy modalities have distinct effects on sensory and motor nerve conduction parameters. However, it is unclear how these parameters change during the post-cooling period and how the exercise carried out in this period would influence the recovery of nerve conduction velocity (NCV).
To compare the effects of three cryotherapy modalities on post-cooling NCV and to analyze the effect of walking on the recovery of sensory and motor NCV.
Thirty six healthy young subjects were randomly allocated into three groups: ice massage (n=12), ice pack (n=12) and cold water immersion (n=12). The modalities were applied to the right leg. The subjects of each modality group were again randomized to perform a post-cooling activity: a) 30 min rest, b) walking 15 min followed by 15 min rest. The NCV of sural (sensory) and posterior tibial (motor) nerves was evaluated. Initial (pre-cooling) and final (30 min post-cooling) NCV were compared using a paired t-test. The effects of the modalities and the post-cooling activities on NCV were evaluated by an analysis of covariance. The significance level was α=0.05.
There was a significant difference between immersion and ice massage on final sensory NCV (p=0.009). Ice pack and ice massage showed similar effects (p>0.05). Walking accelerated the recovery of sensory and motor NCV, regardless of the modality previously applied (p<0.0001).
Cold water immersion was the most effective modality for maintaining reduced sensory nerve conduction after cooling. Walking after cooling, with any of the three modalities, enhances the recovery of sensory and motor NCV.
This first update of the ASAS/EULAR recommendations on the management of ankylosing spondylitis (AS) is based on the original paper, a systematic review of existing recommendations and the literature since 2005 and the discussion and agreement among 21 international experts, 2 patients and 2 physiotherapists in a meeting in February 2010. Each original bullet point was discussed in detail and reworded if necessary. Decisions on new recommendations were made - if necessary after voting. The strength of the recommendations (SOR) was scored on an 11-point numerical rating scale after the meeting by email. These recommendations apply to patients of all ages that fulfill the modified NY criteria for AS, independent of extra-articular manifestations, and they take into account all drug and non-drug interventions related to AS. Four overarching principles were introduced, implying that one bullet has been moved to this section. There are now 11 bullet points including 2 new ones, one related to extra-articular manifestations and one to changes in the disease course. With a mean score of 9.1 (range 8-10) the SOR was generally very good.
This study aims to evaluate the frequency of fatigue in Moroccan patients with ankylosing spondylitis (AS), and its relationships with disease-specific variables, psychological status, and sleep disturbance. A cross-sectional study included patients fulfilled the modified New York classification criteria for ankylosing spondylitis. To assess fatigue, the first item of Bath ankylosing spondylitis disease activity index (BASDAI) and the multidimensional assessment of fatigue (MAF) was used. The evaluation included the activity of the disease (BASDAI), global well-being (Bath ankylosing spondylitis global index), functional status (Bath ankylosing spondylitis functional index), metrologic measurements (Bath ankylosing spondylitis metrological index), and visual analog scale of axial or joint pain. The erythrocyte sedimentation rate and C-reactive protein were measured. To assess psychological status, the hospital anxiety and depression scale (HADS) was used. Sleep disturbance was assessed by the fourth item of Hamilton anxiety scale. One hundred and ten patients were included, of average age 38.0 years ± 12.6. In our data, 66.4% experienced severe fatigue (BASDAI fatigue ≥ 5). The mean total score of MAF was 26 ± 12.77. The disease-specific variables contributed significantly with both BASDAI fatigue and MAF as dependent variables, accounting for 71.3 and 65.6% of the variance, respectively. The contribution of the depression, anxiety, and sleep disturbance were 24.9, 18.4 and 15.4%, respectively. This study state the importance of fatigue in AS patients. Even though disease activity was the most powerful predictor of fatigue, the effects of psychogenic factors and sleep disturbance, should be taken into consideration in the management of AS.
It is well known that reducing tissue temperature changes sensory and motor nerve conduction. However, few studies have compared the effect of different cold modalities on nerve conduction parameters.
The purpose of this study was to compare the effects of ice pack, ice massage, and cold water immersion on the conduction parameters of the sural (sensorial) and tibial motor nerves.
An experimental study was conducted in which the participants were randomly assigned to 1 of 3 intervention groups (n=12 per group). Independent variables were cold modality and pre- and post-cooling measurement time. Dependent variables were skin temperature and nerve conduction parameters.
Thirty-six people who were healthy, with a mean (SD) age of 20.5 (1.9) years, participated in the study. Each group received 1 of the 3 cold modalities, applied to the right calf region for 15 minutes. Skin temperature and nerve conduction parameters were measured before and immediately after cooling.
All 3 modalities reduced skin temperature (mean=18.2 degrees C). There also was a reduction in amplitude and an increase in latency and duration of the compound action potential. Ice massage, ice pack, and cold water immersion reduced sensory nerve conduction velocity (NCV) by 20.4, 16.7, and 22.6 m/s and motor NCV by 2.5, 2.1, and 8.3 m/s, respectively. Cold water immersion was the most effective modality in changing nerve conduction parameters.
The cooling area of the ice massage and ice pack was smaller than that of the cold water immersion. The examiner was not blinded to the treatment group. The population included only participants who were healthy and young.
All 3 modalities were effective in reducing skin temperature and changing sensory conduction at a physiological level that is sufficient to induce a hypoalgesic effect. The results suggest that cold water immersion, as applied in this study, is the most indicated modality for inducing therapeutic effects associated with the reduction of motor nerve conduction.
The field of spondyloarthritis (SpA) has experienced major progress in the last decade, especially with regard to new treatments, earlier diagnosis, imaging technology and a better definition of outcome parameters for clinical trials. In the present work, the Assessment in SpondyloArthritis international Society (ASAS) provides a comprehensive handbook on the most relevant aspects for the assessments of spondyloarthritis, covering classification criteria, MRI and x rays for sacroiliac joints and the spine, a complete set of all measurements relevant for clinical trials and international recommendations for the management of SpA. The handbook focuses at this time on axial SpA, with ankylosing spondylitis (AS) being the prototype disease, for which recent progress has been faster than in peripheral SpA. The target audience includes rheumatologists, trial methodologists and any doctor and/or medical student interested in SpA. The focus of this handbook is on practicality, with many examples of MRI and x ray images, which will help to standardise not only patient care but also the design of clinical studies.
To compare, in patients with ankylosing spondylitis (AS), the effectiveness on pain, functional and psychological status of an intensive group exercise programme under the supervision of a physiotherapist and a home physiotherapy programme.
Fifty-one patients with AS were randomly allocated into study and control groups. The study was designed as a prospective, double-blind study.
Outpatient department, Istanbul Medical Faculty.
Patients who consulted with complaints of pain, morning stiffness and restricted range of movement with a confirmed diagnosis of ankylosing spondylitis.
Before exercise, both groups were given an education programme about AS. For group I patients an intensive exercise programme was organized under the supervision of a physiotherapist for six weeks. Group II patients had to practise exercises individually at home.
Both groups were evaluated and compared for pain, functional and psychological status before treatment, at the end of treatment and three months after treatment using a visual analogue scale (VAS) for pain, Beck Depression Scale and Bath Ankylosing Spondylitis Functional Index (BASFI).
Six patients withdrew, four from group I. Results from the remaining 45 showed more positive changes in the patients undertaking group exercise at six weeks and three months after treatment. Values showed a statistical significant difference in favour of group I.
Group exercise in hospital may be more effective than home-based exercises at reducing impairment associated with ankylosing spondylitis.
To determine the impact of the application of cryotherapy on nerve conduction velocity (NCV), pain threshold (PTH) and pain tolerance (PTO).
A within-subject experimental design; treatment ankle (cryotherapy) and control ankle (no cryotherapy).
Hospital-based physiotherapy laboratory.
A convenience sample of adult male sports players (n = 23).
NCV of the tibial nerve via electromyogram as well as PTH and PTO via pressure algometer. All outcome measures were assessed at two sites served by the tibial nerve: one receiving cryotherapy and one not receiving cryotherapy.
In the control ankle, NCV, PTH and PTO did not alter when reassessed. In the ankle receiving cryotherapy, NCV was significantly and progressively reduced as ankle skin temperature was reduced to 10 degrees C by a cumulative total of 32.8% (p<0.05). Cryotherapy led to an increased PTH and PTO at both assessment sites (p<0.05). The changes in PTH (89% and 71%) and PTO (76% and 56%) were not different between the iced and non-iced sites.
The data suggest that cryotherapy can increase PTH and PTO at the ankle and this was associated with a significant decrease in NCV. Reduced NCV at the ankle may be a mechanism by which cryotherapy achieves its clinical goals.
To assess the effectiveness of rehabilitation in a group of patients with active ankylosing spondylitis (AS) by the Assessment in Ankylosing Spondylitis (ASAS) Working Group response criteria.
Fifty-two active AS patients consecutively admitted to a rehabilitation inpatient clinic were enrolled. Patients underwent a 3-week intensive rehabilitation programme and were then discharged with home exercises. The primary outcome measure was the proportion of patients achieving a response based on ASAS 20 at discharge, and at 6 and 12 weeks after. Secondary outcome measures included an improvement in the Revised Leeds Disability Questionnaire (RLDQ) and function expressed as anthropometric measures.
The ASAS 20 was achieved in 46 patients (88.5%) at the end of the rehabilitation, in 31 (59.6%) and in 17 (32.7%) patients at 6 and 12 weeks follow-up, respectively. The percentage of ASAS 20 responders statistically declined over time measured from the end of rehabilitation compared with 6 (P < 0.001) and 12 weeks follow-up (P < 0.001). Conclusion: The present study shows the effectiveness of rehabilitation as assessed by the ASAS 20, a validated instrument for treatment response, suggesting its usage in rehabilitation settings. Moreover, the results obtained show that the effectiveness of the intensive inpatient rehabilitation declined over time.
The objective of this non-randomised controlled trial was to evaluate the impact of group-based exercise programme and a home-based exercise programme on Bath Ankylosing Spondylitis Indices, depression and quality of life in patients with ankylosing spondylitis (AS). Approximately 41 patients in a rehabilitation unit were divided into two groups, either group- or home-based exercise programme. Exercise sessions were performed three times a week for a period of 6 weeks. The patients were compared before and after the rehabilitation programme, with respect to Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Disease Assessment Index (BASDAI), Bath Ankylosing Spondylitis Metrology Index (BASMI), Beck Depression Inventory (BDI) and The Nottingham Health Profile (NHP). A statistically significant improvement was observed on BASDAI, BASMI and energy, pain, reaction of emotional and sleep subscores of NHP in both exercise groups after the exercise programme (p < 0.05). No statistically significant changes were detected in BASFI, BDI and social and mobility subscores of NHP in both exercise groups (p > 0.05). No statistically significant differences were found between the two exercise programmes (p > 0.05). Group and home-based exercise programmes are efficient in improving symptoms and mobility and had an important effect on quality of life in patients with AS. Home-based exercise programme, as it is cheaper, more easily performed and efficient, may be preferable for the management programme in AS.
Objective: To compare group exercise program performed at hospital with home exercise pogram in patients with ankylosing spondylitis and to observe the efficacy of type of exercises. Patients and method: Forty-six patients with ankylosing spondylitis were enrolled into this prospective, randomized, comparative, open clinical trial. The first group performed instructed exercises at home for 6 months whereas the second group did the same exercises at the hospital for 2 hours weekly under the observation of a physiotherapist for 3 months. Three and 6 months after; pain at rest (VAS) and during activity, spinal mobility, functional capacity were evaluated. Results: In group 1 significant improvement was observed at rest and during activity pain (p < 0.005). Functinal improvement was better in the second group within 3 months. Since group 1 had a good range of cervical rotation, group 2 improved better (p < 0.01). Conclusion: Spinal ranges of motion, functional status, depression and quality of life improved in group 2 patients remarkably. Group exercise had a decreasing effect on pain, activity of disease and fatigue. While home exercises improved spinal activity, it had no effect on functional status, disease activity, depression and fatigue.
Objective:
To investigate which of the 2 ankylosing spondylitis (AS) disease activity instruments identifies better those patients with characteristics that have been associated with positive response to anti-TNF therapy.
Methods:
Data from patients with AS in the REGISPONSER registry were analyzed. Patients were categorized by disease activity using 3 different selection criteria: elevated Bath Ankylosing Spondylitis Disease Activity Index criteria (BASDAI≥4), high Ankylosing Spondylitis Disease Activity Score (ASDAS≥2.1), or very high ASDAS (ASDAS≥3.5). To determine which criterion selects for patients most likely to respond to anti-TNF therapy, the groups of patients selected with each criterion were compared on five disease characteristics that are associated with good response to anti-TNF therapy: lower age, lower function score, less enthesitis, higher C-reactive protein (CRP), and HLA-B27-positive status.
Results:
50.9%, 66.3%, and 24.9% of 1156 patients had elevated BASDAI, high ASDAS, or very high ASDAS, respectively. Compared to patients selected with elevated BASDAI, more patients selected with high ASDAS had characteristics associated with good response to anti-TNF therapy. Patients with very high ASDAS had higher CRP and were younger, but more frequently had enthesitis and had higher function scores when compared to those with elevated BASDAI.
Conclusions:
Selection of AS patients with the ASDAS instrument results in patient sub-populations with different characteristics than those selected with the BASDAI instrument. Since some of these characteristics have been associated with response to anti-TNF therapy, further study should establish if the choice of selection instrument improves the outcome of therapy in the selected populations.
In der Literatur liegen einzelne Berichte über analgetische Wirkungen von Kältekammerexpositionen bei Fibromyalgesiesyndrom vor. Neben der Schmerzsymptomatik leiden Patienten mit diesem Krankheitsbild aber häufig unter einer verstärkten Kälteempfindlichkeit. So wurde die Wirkung von Kältekammerexpositionen (- 67°C, 1-3 min) auf Schmerzempfindlichkeit, thermisches Komfortempfinden und aktuelle Schmerzintensität bei 17 Patientinnen mit Fibromyalgesiesyndrom (ACR-Kriterien) vergleichend zu einem Leerversuch ohne Anwendung geprüft. Messparameter waren Druck-, Hitze- und Kälteschmerzschwellen (Pressure-Algometrie, Peltier-Thermode), thermisches Komfortempfinden (mittels Peltier-Thermode applizierte lokale thermische Hautreize; 17,5- 40°C; 2,5 °C-Schritte; systematisch variierte Reizfolge) sowie aktuelle Schmerzintensität und allgemeines Wohlbefinden (VAS). Die thermischen Schmerzwellen wurden jeweils an der Unterarminnenfläche, die Druckschmerzempfindlichkeit am Styloideus radii bestimmt; die thermischen Komfortmessungen wurden an der Stirn durchgeführt. Nach den Kältekammerexpositionen waren die Kälte- und Druckschmerzschwellen signifikant bzw. hochsignifikant angehoben, während bei den Hitzeschmerzen keine Schwellenverschiebungen nachweisbar waren. Im Bereich applizierter Thermodentemperaturen von 17,5-27,5 °C war die subjektive Temperaturempfindungskurve nach der Kältekammerexposition gegenüber Ausgangswerten und Kontrollperiode signifikant angehoben. Der aus den Schnittpunkten der Komfortwert- Kurve mit den applizierten Temperaturen ermittelte mittlere thermische Toleranzbereich zeigte eine statistisch signifikante Zunahme. Eine solche Verbesserung der thermischen Toleranz war bei den Kontrollen nicht nachweisbar. Auch die aktuellen Schmerzangaben waren nach der Kältekammerexposition im Mittel signifikant erniedrigt und das allgemeine Wohlbefinden gesteigert. Es wird gefolgert, daß Kältekammerexpositionen bei Fibromyalgiesyndrom analgetisch wirken und darüber hinaus die thermische Toleranz erhöhen. In weiteren Studien muß nunmehr geklärt werden, ob bei wiederholter Applikation stabile adaptive Besserungen thermischer Mißempfindungen erzielt werden können.
Cryotherapies are frequently used to supplement the rehabilitation of patients with rheumatoid arthritis (RA) owing to their analgesic and anti-inflammatory effects. Forty patients with active RA were recruited and received 10 days of comprehensive therapy with different local cryotherapies. None of the respondents were subjected to biological treatment. They were divided into two groups according to the therapy received: nitrogen vapour at -160 °C (group I) or cold airflow at -30 °C (group II). Levels of tumour necrosis factor α (TNF-α), interleukin 6 (IL-6), disease activity score (DAS28), and functional variables were used to assess the outcomes. After the therapy, both groups exhibited similar improvements. Significant reduction in TNF-α level (nitrogen: p < 0.01; cold air: p < 0.05) and no change in IL-6 were observed. DAS28, the clinical severity of pain, duration of morning stiffness, degree of self-reported fatigue, and health assessment questionnaire (HAQ) scores improved significantly. In addition, the active range of knee extension, time, and the number of steps in the 50-m walk test also clearly got better in both groups. The 10-day comprehensive therapies including different local cryotherapies for the patients with RA cause significant decrease in TNF-α systemic levels, meaningly improve DAS28, HAQ scores, and some functional parameters, but do not change IL-6 levels. However, there were no differences in the effectiveness of either cryotherapy.
Background: The basic premise of cryotherapy is to cool injured tissue; however, there is much confusion around how much cooling is adequate, and how this can be achieved clinically. Objectives: Our objective was to review recent literature to determine the rate and magnitude of tissue temperature reduction with cryotherapy. Values were compared with current recommended threshold temperatures deemed necessary for optimal cold induced analgesia (skin temperature
To perform a systematic literature review as a basis for the update of the Assessment in SpondyloArthritis International Society and European League Against Reumatism (ASAS/EULAR) recommendations for the management of AS with non-pharmacological interventions and non-biologic drugs.
The search was performed in PubMed, EMBASE, PEDro and Cochrane between 1 January 2005 and 1 December 2009, and in abstracts of EULAR and ACR meetings (2007-09). Effect sizes for outcomes on pain, disease activity, spinal mobility and physical function and level of evidence were presented.
Of 2383 papers, 35 with complete data were included. Physical therapy exercises in various modalities have positive effects on BASFI, BASDAI, pain and mobility function. Various NSAIDs including coxibs improve BASDAI, disease activity and BASFI. No effect of SSZ and MTX on any variable was found. Surgical interventions of the spine and the hip can give excellent results by restoring function.
This concise summary of current evidence for non-pharmacological interventions and non-biologic drugs formed the basis for the update of the ASAS/EULAR recommendations for the management of AS.
Ankylosing spondylitis (AS) is a disease that tends to affect younger individuals, many of whom are in the prime of their lives; therefore, incorporating the most up-to-date evidence into physiotherapy practice is critical. The purpose of this review is to update the most recent evidence related to physiotherapy intervention for AS and highlight the application of the findings to current physiotherapy research and clinical practice.
The results of this review add to the evidence supporting physiotherapy as an intervention for AS. The emphasis continues to be on exercise as the most studied physiotherapy modality, with very few studies examining other physiotherapy modalities. Results of the studies reviewed support the use of exercise, spa therapy, manual therapy and electrotherapeutic modalities. In addition, the results of this review help to understand who might benefit from certain interventions, as well as barriers to management.
A review of recently published articles has resulted in a number of studies that support the body of literature describing physiotherapy as an effective form of intervention for AS. In order to continue to build on the existing research, further examination into physiotherapy modalities, beyond exercise-based intervention, needs to be explored.
Exercise therapy is an important component of current standard therapy for patients with ankylosing spondylitis. The purpose of this review is to provide important guidelines when prescribing exercises by reviewing articles evaluating the effectives and usefulness of exercise therapy in patients with ankylosing spondylosis.
As yet, whole-body cryotherapy is especially used for the therapy of chronic inflammatory arthritis. An analgetic effect has been described in several studies. However, only few data exist concerning the long-term effects of this therapy.
A total of 60 patients with rheumatoid arthritis (n = 48), and ankylosing spondylitis (n = 12) was analyzed. Patients underwent treatment with whole-body cryotherapy twice a day. The average age was 55.7 +/- 10.33. The study group consisted of 48 female and twelve male patients. The average number of therapeutic treatments with cryotherapy was 15.8 +/- 8.37, the average follow-up 63.4 +/- 63.48 days.
13 patients (21.7%) discontinued treatment because of adverse effects. For patients with rheumatoid arthritis, DAS28 (Disease Activity Score) and VAS (visual analog scale) were determined. A significant reduction of both parameters was found (DAS 3.9 +/- 1.22 vs. 3.4 +/- 1.08; p < 0.01; VAS 51.4 +/- 16.62 vs. 37.9 +/- 19.13; p < 0.01). BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) was analyzed for patients with ankylosing spondylitis, and also showed a significant reduction (4.4 +/- 1.91 vs. 3.1 +/- 1.34; p = 0.01).
Thus, whole-body cryotherapy is an effective option in the concept of treatment of inflammatory rheumatic diseases. The relief of pain allows an intensification of physiotherapy. A significant reduction of pain over a period of 2 months could be shown.
The effects of 30 min cycle ergometry at ∼ 100 W (mean 98.9 W; range 34–151 W) in 11 male patients who had no hip involvement
were studied. In most patients, exercise produced immediate increases in spinal flexibility and bilateral cervical tilt, and
a reduction in pain. However, these improvements steadily waned and all had disappeared by 3–5 h. Exercise induced marked
changes in the numbers of circulating leucocytes and platelets, and in the distribution of lymphocyte subsets, similar to
those previously reported to occur in individuals without the disease. In a majority of patients, there were positive associations
(Kendall's τ test) between Schober's index and the platelet count, and negative associations between Schober's index and the
percentage of CD4-positive cells over a 5 h period on the exercise day, whereas there were negative associations between the
pain score and the leucocyte and neutrophil counts over a comparable period on a control day without exercise. We conclude
that exercising those regions of the body unaffected by disease can elicit short-term beneficial effects by a systemically
mediated mechanism(s).
Although exercise is a commonly recommended treatment for ankylosing spondylitis (AS), little is known about the effectiveness of unsupervised recreational and back exercises. We examined the effects of recreational exercise and back exercises on patient-reported pain severity, stiffness severity, and functional disability in a prospective longitudinal study of 220 patients with AS.
Participants provided information on exercise habits and health status every 6 months using mailed questionnaires (median follow-up, 4.5 years). Pain severity and stiffness severity were measured using visual analog scales, and functional disability was measured using the Health Assessment Questionnaire (HAQ) Disability Index.
Among all patients, there were no associations between either the number of exercise minutes per week or the number of days of back exercise per week and short-term (6-month) changes in pain, stiffness, or HAQ Disability Index. However, among those who had AS for 15 years or less, pain scores were 0.18 points lower (on a scale of 0-3; P =.04), and stiffness scores were 6.4 points lower (on a scale of 0-100; P =.005) during periods with more than 200 minutes per week of exercise compared with periods with 0 to 30 minutes of exercise per week. Among those who had AS for more than 15 years, pain scores were 0.11 points lower (on a scale of 0-3; P =. 03), and HAQ Disability Indexes were 0.08 points lower (on a scale of 0-3; P<.001) during periods with 5 to 7 days per week of back exercise compared with periods when back exercises were not performed. Less intense levels of exercise were not associated with improvements in health status.
Unsupervised recreational exercise improves pain and stiffness, and back exercise improves pain and function in patients with AS, but these effects differ with the duration of AS. Health status is improved when patients perform recreational exercise at least 30 minutes per day and back exercises at least 5 days per week. Arch Intern Med. 2000;160:2969-2975
Ankylosing spondylitis (AS) is a chronic rheumatic disease. Due to the consequences of the disease, physiotherapy is regarded to be an important part of the treatment.
The objective is to summarise the available scientific evidence on the effectiveness of physiotherapy interventions in the management of AS.
We searched the Cochrane Musculoskeletal Group Trial register, Cochrane Controlled Trials Register, MEDLINE, EMBASE, CINAHL and Pedro up to February 2000 for all relevant publications, limited to English and Scandinavian languages. The reference lists of relevant articles were checked and the authors of included articles were contacted.
We included randomised and quasi randomised studies where the participants were patients with AS, classified by the New York criteria, and where at least one of the comparison groups received some kind of physiotherapy. The main outcomes of interest were spinal mobility, pain, stiffness, physical function and global assessment of change.
Both reviewers independently selected trials for inclusion, extracted data and assessed trial quality. Investigators were contacted to obtain missing information.
Three trials were included with 241 participants, and all were assessed to have moderate to high risk of bias. Two trials compared the effect of supervised group physical therapy with an individualised home exercise program, and reported differences in favour of the supervised group. For pain and stiffness, the relative difference in change from baseline for the supervised group compared to the home exercise group was 50% after treatment. One trial compared an individual program of exercises and disease education with no intervention, and found differences in favour of the exercise group.
The tendency toward positive effects of physiotherapy, in the management of AS, call for further research in this field in order to reach sufficient evidence on which physiotherapy modalities and applications are to be recommended. New trials should address other physiotherapy interventions commonly used in practice. There is not sufficient evidence yet available to base recommendations for or against the use of physiotherapy interventions for ankylosing spondylitis.
Local cryotherapy is used to relieve pain and inflammation in injuries and inflammatory conditions. Whole-body cryotherapy is an extreme method administered at -110 degrees C for 2 to 3 minutes. The aim of the study was to compare the effect of cryotherapies on pain and inflammation in patients with rheumatoid arthritis (RA).
Sixty patients with active seropositive RA were recruited in a randomised controlled single-blinded study to receive whole-body cryotherapy at -110 degrees C, whole-body cryotherapy at -60 degrees C, application of local cold air at -30 degrees C and the use of cold packs locally. In the final analysis, the last 2 groups were pooled. The patients had 2-3 cryotherapy sessions daily for one week plus conventional physiotherapy. Clinical and laboratory variables and patient's and physician's global assessments were used to assess the outcome. Disease activity was calculated by DAS.
Pain decreased in all treatment groups, most markedly in the whole-body cryotherapy (-110 degrees C) group. DAS decreased slightly with no statistically significant differences between the groups. No serious or permanent adverse effects were detected. Six of 40 patients (15%) discontinued the whole-body cryotherapy.
Pain seemed to decrease more in patients in the whole-body cryotherapy at -110 degrees C than during other cryotherapies, but there were no significant differences in the disease activity between the groups. However, cryotherapy at -110 degrees C is expensive and available only in special centres and may have minor adverse effects. Based on our results, whole-body cryotherapy at -110 degrees C is not superior to local cryotherapy commonly used in RA patients for pain relief and as an adjunct to physiotherapy.
Ankylosing spondylitis 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. New imaging techniques and therapies have substantially changed the management of this disease in the past decade. Whether inhibition of radiographic progression and structural damage can be reached with available drugs is as yet unclear. Furthermore, treatment with non-steroidal anti-inflammatory agents and physiotherapy remains an important approach to long-term management of patients with ankylosing spondylitis. The new treatment options with tumour necrosis factor blockers seems a breakthrough for patients refractory to conventional treatment.
Ankylosing spondylitis (AS) is a chronic, inflammatory rheumatic disease. Physiotherapy is considered an important part of the overall management of AS.
To summarise the available scientific evidence on the effectiveness of physiotherapy interventions in the management of AS.
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, AMED, CINAHL and PEDro up to January 2007 for all relevant publications, without any language restrictions. We checked the reference lists of relevant articles and contacted the authors of included articles.
We included randomised and quasi-randomised studies with AS patients and where at least one of the comparison groups received physiotherapy. The main outcomes of interest were pain, stiffness, spinal mobility, physical function and patient global assessment.
Two reviewers independently selected trials for inclusion, extracted data and assessed trial quality. Investigators were contacted to obtain missing information.
Eleven trials with a total of 763 participants were included in this updated review. Four trials compared individualised home exercise programs or a supervised exercise program with no intervention and reported low quality evidence for effects in spinal mobility (Relative percentage differences (RPDs) from 5-50%) and physical function (four points on a 33-point scale). Three trials compared supervised group physiotherapy with an individualised home-exercise program and reported moderate quality evidence for small differences in spinal mobility (RPDs 7.5-18%) and patient global assessment (1.46 cm) in favour of supervised group exercises. In one study, a three-week inpatient spa-exercise therapy followed by 37 weeks of weekly outpatient group physiotherapy (without spa) was compared with weekly outpatient group physiotherapy alone; there was moderate quality evidence for effects in pain (18%), physical function (24%) and patient global assessment (27%) in favour of the combined spa-exercise therapy. One study compared daily outpatient balneotherapy and an exercise program with only exercise program, and another study compared balneotherapy with fresh water therapy. None of these studies showed significant between-group differences. One study compared an experimental exercise program with a conventional program; statistically significant change scores were reported on nearly all spinal mobility measures and physical function in favour of the experimental program.
The results of this review suggest that an individual home-based or supervised exercise program is better than no intervention; that supervised group physiotherapy is better than home exercises; and that combined inpatient spa-exercise therapy followed by group physiotherapy is better than group physiotherapy alone.
Local as well as whole-body cryotherapy is used to relieve pain and inflammation in rheumatic diseases. In comparison with a chamber-based whole-body cryotherapy, the novel criostream whole-body therapy (single-person cabin with cold air cooled by liquid nitrogen) as an innovative technique offers not only a rapid therapeutic effect but also a considerable reduction in costs. The aim of this study was to compare the effect of whole-body cryotherapy in the criostream on pain reduction, disease activity and pro-inflammatory cytokines (tumor necrosis factor-[TNF-]alpha and interleukin-[IL-]1), and improvement in functional scores.
Ten patients with different active inflammatory rheumatic diseases (four patients with rheumatoid arthritis, three patients with ankylosing spondylitis, and three patients with psoriatic arthritis/spondylitis) underwent nine sessions of whole-body cryotherapy in 5 days for a short time period (at first 90 s, with step-up in each application to 2.5 min total time).
Pain and disease activity scores decreased significantly, and, subsequently, also the functional scores showed a significant amelioration. Furthermore, there was a significant reduction in TNF-alpha (p < 0.01) and IL-1 (p < 0.05). Side effects were reported only after the first application in two cases (headache and sensation of cold).
The criostream offers an elegant and, from the patient's point of view, attractive therapeutic agent in the multimodal treatment concept for inflammatory rheumatic diseases.
Whole-body cryotherapy in rehabilitation of patients with rheumatoid diseases-pilot study
- Metzger
Cytokine re-455 duction and immunomodulation without stress provoking by 456 whole body cryotherapy at −110•C in rheumatoid arthritis 457 and ankylosing spondylitis
- R Fricke
- C Richter
- B Fricke
- K Frye
- A Moheb
Fricke R, Richter C, Fricke B, Frye K, Moheb A. Cytokine re-455
duction and immunomodulation without stress provoking by 456
whole body cryotherapy at −110•C in rheumatoid arthritis 457
and ankylosing spondylitis. Reumatologia. 1998; 38: 191.
458
The effect of cryotherapy on nerve conduction velocity, pain threshold and pain tolerance
- Algafly
Algafly AA, George KP. The effect of cryotherapy on nerve
526
conduction velocity, pain threshold and pain tolerance. Br J
527
Sports Med. 2007; 41(6): 365-9.
- Rheumatoid Arthritis
Rheumatoid Arthritis. Biomed Res Int. 2015. doi: 10.1155/
439
Wholebody cryotherapy in rehabilitation of patients with rheumatoid diseases-pilot study
- D Metzger
- C Zwingmann
- W Protz
- W H Jäckel
Metzger D, Zwingmann C, Protz W, Jäckel WH. Wholebody cryotherapy in rehabilitation of patients with rheumatoid diseases-pilot study. Rehabilitation (Stuttg). 2000; 39(2):
93-100.
ASAS/EULAR management recommendations in ankylosing 554 spondylitis
ASAS/EULAR management recommendations in ankylosing 554
spondylitis. Rheumatology (Oxford). 2012; 51(8): 1388-96.
555
The 460 effect of whole-body cryotherapy at different temperatures on 461 proinflammatory cytokines, oxidative stress parameters, and 462 disease activity in patients with ankylosing spondylitis. Oxid 463 Med and Cell Longev
- A Kwaśniewska
- W Romanowski
- M Iskra
- R Rutkowski
Kwaśniewska A, Romanowski W, Iskra M, Rutkowski R. The 460
effect of whole-body cryotherapy at different temperatures on 461
proinflammatory cytokines, oxidative stress parameters, and 462
disease activity in patients with ankylosing spondylitis. Oxid 463
Med and Cell Longev. 2018. doi: 10.1155/2018/2157496.
464
Sieron-Stoltny K. Can whole-body cryotherapy with subsequent kinesiotherapy procedures in closed type cryogenic chamber improve BASDAI, BASFI, and some spine mobility parameters and decrease pain intensity in patients with ankylosing spondylitis?
- A Stanek
- A Cholewka
- J Gadula
- Z Drzazga
- A Sieron
Stanek A, Cholewka A, Gadula J, Drzazga Z, Sieron A,
Sieron-Stoltny K. Can whole-body cryotherapy with subsequent kinesiotherapy procedures in closed type cryogenic
chamber improve BASDAI, BASFI, and some spine mobility
parameters and decrease pain intensity in patients with ankylosing spondylitis? Biomed Res Int. 2015; 2015: 404259.
Dougados Functional Index (DFI), and Health Assessment Questionnaire for the Spondylarthropathies (HAQ-S)
- J Zochling
Zochling J. Measures of symptoms and disease status in ankylosing spondylitis: Ankylosing Spondylitis Disease Activity Score (ASDAS), Ankylosing Spondylitis Quality of Life
Scale (ASQoL), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional
Index (BASFI), Bath Ankylosing Spondylitis Global Score
(BAS-G), Bath Ankylosing Spondylitis Metrology Index
(BASMI), Dougados Functional Index (DFI), and Health Assessment Questionnaire for the Spondylarthropathies (HAQ-S). Arthritis Care Res (Hoboken). 2011; 63(Suppl 11): S47-58.
Cytokine reduction and immunomodulation without stress provoking by whole body cryotherapy at -110∘C in rheumatoid arthritis and ankylosing spondylitis
- Fricke