ArticleLiterature Review

The Cochrane review of physiotherapy interventions for ankylosing spondylitis

November 2005
The Journal of Rheumatology 32(10):1899-906

Source
PubMed

Authors:

Diakonhjemmet Hospital (Norway)

To update the Cochrane review on the effectiveness of physiotherapy interventions in the management of ankylosing spondylitis (AS). All randomized studies available in systematic searches (electronic databases, contact with authors, reference lists) up to February 2004 were included. Two reviewers independently selected trials for inclusion, assessed the validity of included trials, and extracted data. Investigators were contacted to obtain missing information. Six trials with a total of 561 participants were included. Two trials compared individualized home exercise programs with no intervention. Low quality evidence for effects in favor of the home exercise program was found in physical function and spinal mobility [absolute benefit 10.3 cm on fingertip to floor distance; relative percentage difference (RPD) 37%)]. Further, the trials showed low quality evidence for no group differences in pain. Three trials compared supervised group physiotherapy with an individualized home exercise program. Moderate quality evidence for effectiveness was found in patient global assessment and spinal mobility in favor of the supervised group. The trials showed moderate quality evidence for no differences in pain intensity between the groups. One trial compared a 3-week inpatient spa-exercise therapy followed by weekly outpatient group physiotherapy with weekly outpatient group physiotherapy alone. Moderate quality evidence was found for effects in pain (absolute benefit 0.9 cm on visual analog scale; RPD 19%), physical function (absolute benefit 1 cm; RPD 24%), and patient global assessment (absolute benefit 1.3 cm; RPD 27%), in favor of the combined spa-exercise therapy. The current best available evidence suggests that physiotherapy is beneficial for people with AS. However, it is still not clear which treatment protocol should be recommended in the management of AS.

Occupational therapy assessments and interventions for patients with ankylosing spondylitis: a scoping review protocol

Article

May 2024

Objective The proposed scoping review aims to explore the literature on the occupational therapy (OT) scope of practice for patients with ankylosing spondylitis (AS), including assessment methods and intervention approaches used by OT practitioners, areas of impairment addressed, and practice settings where OT practitioners provide services. Introduction AS is a type of spondyloarthritis primarily involving inflammation of the spine. Studies have begun to examine the role of OT in addressing pain, function, and disability among AS patients. Given the increased recognition of OT services for this population, a comprehensive understanding of the assessment methods and intervention approaches used by OT practitioners when working with AS would benefit clinicians, providers, and patients and support future research efforts. Inclusion criteria The review will consider studies that include participants of any age diagnosed with AS and any form of OT assessment and intervention. All relevant published and unpublished studies will be considered, without date or language limitations, including all primary studies, gray literature, text and opinion papers, and clinical guidelines. Methods The review will follow the JBI methodology for scoping reviews. Searches will be conducted in MEDLINE (PubMed), Embase, CINAHL (EBSCOhost), Scopus (EBSCOhost), PsycINFO, ProQuest Dissertations and Theses Global, SportDiscus (EBSCOhost), OTDBase, OTSeeker, and Google Scholar. Two independent reviewers will extract data from selected papers using a standardized tool modified for the review. The results will be presented using frequency tables and will be accompanied by a narrative summary. Details of the review protocol can be found in Open Science Framework https://doi.org/10.17605/OSF.IO/VPY56

Efficacy of myofascial induction compared with its simulation on joint amplitude in people with axial spondylarthritis: Protocol of a randomized controlled clinical trial

Article

Full-text available

Oct 2023
PLOS ONE

Background Axial spondyloarthritis (AxSpA) produces structural changes that cause alterations in body functions. One tissue that seems to have a predictive role in the etiology and progression of the disease is the soft tissue, particularly the fascia. However, little is known about the use of myofascial induction in people with AxSpA, and clinical evidence from physiotherapy regarding potential strategies is limited. Objective To evaluate the efficacy of myofascial induction compared with its simulation on joint amplitude in people with AxSpA. Methods In this randomized controlled parallel superiority clinical trial, 84 people with an AxSpA diagnosis confirmed by a rheumatologist will be randomly assigned to groups: the experimental group or the control group. The experimental group will receive myofascial induction, and the control group will undergo a simulation of the technique. Both groups will receive an examination session and six intervention sessions twice per week for three weeks. A baseline follow-up will be performed immediately after the intervention and four weeks after treatment. Conclusion The results of this study may contribute to a better understanding of the efficacy of myofascial induction for joint mobility in people with AxSpA. The implications of these results have a potential transformative effect on the understanding, analysis, evaluation, and physiotherapeutic treatment of this health condition. Trial registration ClinicalTrials.gov NCT04424589. Registered 11 June 2020.

Physiotherapy for Ankylosing Spondylitis: Systematic Review and a Proposed Rehabilitation Protocol

Article

Oct 2016
Curr Rheumatol Rev

Ankylosing Spondylitis (AS) is a chronic inflammatory disease of insidious onset, mostly affecting the axial skeleton. It leads to varying degrees of restricted spinal mobility, pain and loss of functional capacity. Rehabilitation, especially Physiotherapy and exercises, are considered integral components of its management. Various rehabilitation modalities are available for the benefit of individuals with AS, but a sequenced protocol has not been reported. A scientific review was performed using the following search engines: MEDLINE (Pubmed), COCHRANE Library and Physiotherapy Evidence Database (PEDro). Studies which had at least one of the group receiving rehabilitation and the major outcomes studied were pain, stiffness, mobility (spine and chest wall) and physical function (disease activity, ADL, QOL and global function) were selected. A total of 19 studies were shortlisted for the review which included a total of 1142 subjects with AS. The review of literature showed that individuals with AS had beneficial effects from exercise programmes compared to no exercise. Patient education, active involvement and motivation of individuals with AS played an important role in the overall treatment outcomes. Based on the review, a four phase sequenced rehabilitation protocol has been laid down for the benefit of individuals with AS.

Citation: SAS Journal of Medicine Abbreviated Key Title: SAS J Med A Comparative Study between NSAID with McKenzie Exercise versus NSAID Treatment in Ankylosing Spondylitis

Article

Full-text available

Feb 2025

Original Research Article Background: McKenzie method of mechanical diagnosis and therapy (MDT)) is a technique primarily used in physical therapy. It was developed in the late 1950s by New Zealand physiotherapist Robin McKenzie. In 1981 he launched the concept which he called Mechanical Diagnosis and Therapy (MDT) a system encompassing assessment, diagnosis and treatment for the spine and extremities. On the other hand, Ankylosing spondylitis (AS) is a type of arthritis that causes lower back pain, hip pain and a stiff back which causes due to overtime work, vertebrae in the spinal column. In relieving pain and inflammation in AS patients, non-steroidal anti-inflammatory drugs (NSAIDs) are among the most commonly prescribed drugs in the world. Aim of the Study: The aim of this study was to compare between NSAID with McKenzie exercise versus NSAID treatment in Ankylosing spondylitis. Methods: This was a comparative experimental study which was conducted in the department of Physical Medicine and Rehabilitation, BSMMU, Dhaka, Bangladesh from October 2019 to September 2020. The study was approved by Institutional Review Board (IRB) of BSMMU. A total of 112 patients with ankylosing spondylitis were selected who were divided into two groups. 56 patients were allotted in group A (NSAID group) and another 56 were allotted in group B (NSAID with McKenzie exercise). All comparative data were analyzed and disseminated by using MS Excel and SPSS version 23.0. Results: The mean age was 28.02±5.86 years in group A whereas 28.8±5.94 years in group B and the difference was statistically not significant (p>0.05). The mean VAS score at baseline was 34.44±2.78 in group A and 34.03±2.23 in group B, at 4 weeks 28.89±3.67 in group A and 21.23±3.57 in group B, at 8 weeks 30.59±3.69 in group A and 16.95±3.62 in group B and at 12 weeks 28.08±3.34 in group A and 15.04±3.77 in group B. The mean BASFI at baseline was 3.19±0.15 in group A and 3.51±0.18 in group B, at 4 weeks 2.99±0.15 in group A and 2.15±0.05 in group B, at 8 weeks 1.99±0.09 in group A and 1.26±0.22 in group B and at 12 weeks 2.01±0.09 in group A and 1.25±0.2 in group B. The mean BASDAI at baseline was 5.01±0.39 in group A and 4.95±0.4 in group B, at 4 weeks 3.99±0.07 in group A and 3.43±0.09 in group B, at 8 weeks 3.97±0.09 in group A and 3.02±0.07 in group B and at 12 weeks 3.49±0.06 in group A and 1.98±0.09 in group B. The differences of VAS score, BASFI and BASDAI at 4, 8 and 12 weeks were statistically significant (p<0.05) between two groups. The mean BASDAI at baseline was 5.01±0.39 in group A and 4.95±0.4 in group B. At 4 weeks was 3.99±0.07 in group A and 3.43±0.09 in group B, at 8 weeks was 3.97±0.09 in group A and 3.02±0.07 in group B, at 12 weeks was 3.49±0.06 in group A and 1.98±0.09 in group B. The difference of BASDAI at 4, 8 and 12 weeks were statistically significant (p<0.05) between two groups. Conclusion: This study demonstrated the functional improvement of patients with AS in terms of pain, functional improvement and disease activity. However, as this study was done with a small sample size samples in a single center, we will recommend similar further studies in multiple centers with larger sample size. Ankylosing spondylitis (AS) causes pain and stiffness to affected joints as well as the spine and if the disease progresses, it can cause fusion of the joints, which can limit a person's mobility and flexibility.

Functional Outcome of McKenzie Exercise in Patients with Ankylosing Spondylitis-A Single Center Study in Bangladesh

Article

Full-text available

Jan 2023

Background: Ankylosing spondylitis (AS) is a common inflammatory rheumatic disease that affects the axial skeleton, causing inflammatory back pain and can lead to structural and functional impairments. On average, ankylosing spondylitis (AS) incidence rates range from 0.2% to 1% of the adult population. McKenzie exercise seems to be beneficial for those affected by AS, in particular when it is planned according to the needs of the individual aiming to maintain or improve the level of physical fitness. The prevalence of AS is generally believed to be between 0.1% and 1.4% globally. Aim of the study: The aim of this study was to evaluate the functional outcome of McKenzie exercise in patients with ankylosing spondylitis. Methods: This was a comparative experimental study which was conducted in the Department of Physical Medicine and Rehabilitation, BSMMU, Dhaka, Bangladesh from October 2019 September 2020. The study was approved by Institutional Review Board (IRB) of BSMMU on. A total of 112 patients with ankylosing spondylitis were selected who were divided into two groups. 56 patients were allotted in group A (NSAID group) and another 56 patients were allotted in group B (NSAID with McKenzie exercise). Collected data were processed, analyzed and disseminated by using MS Excel and SPSS version 23.0 program as per necessity. Results: The mean VAS score at baseline was 34.44 ±2.78 in group A and 34.03±2.23 in group B, at 4 weeks 28.89±3.67 in group A and 21.23 ±3.57 in group B, at 8 weeks 30.59 ±3.69 in group A and 16.95±3.62 in group B and at 12 weeks 28.08±3.34 in group A and 15.04 ±3.77 in group B. The mean BASFI at baseline was 3.19±0.15 in group A and 3.51±0.18 in group B, at 4 weeks 2.99±0.15 in group A and 2.15±0.05 in group B, at 8 weeks 1.99±0.09 in group A and 1.26±0.22 in group B and at 12 weeks 2.01±0.09 in group A and 1.25±0.2 in group B. The mean BASDAI at baseline was 5.01±0.39 in group A and 4.95±0.4 in group B, at 4 weeks 3.99±0.07 in group A and 3.43±0.09 in group B, at 8 weeks 3.97±0.09 in group A and 3.02±0.07 in group B and at 12 weeks 3.49±0.06 in group A and 1.98±0.09 in group B. The differences of VAS score, BASFI and BASDAI at 4, 8 and 12 weeks were statistically significant (p<0.05) between two groups. Conclusion: Ankylosing spondylitis (AS) causes pain and stiffness to affected joints and the spine and if the disease progresses, it can cause fusion of the joints, which can limit a person's mobility and flexibility. In analyzing the outcomes of McKenzie exercise in patients with ankylosing spondylitis the differences of VAS score, BASFI and BASDAI at 4, 8 and 12 weeks were found as statistically significant (p<0.05) between NSAID group and NSAID with McKenzie exercise patient groups.

The relationship between myotonometry parameters and spinal mobility in ankylosing spondylitis patients included in a physical exercise program

Article

Full-text available

Sep 2024

Studies showed that the mechanical properties of spinal muscles in patients with ankylosing spondylitis (AS) differ from healthy controls; the continued disease duration alters elasticity and stiffness. Our research focused on analyzing the myotonometry parameters of the longissimus capitis and lumbar erector spinae muscles and spinal mobility in AS patients who followed an 8-week physical exercise program. 34 AS patients were evaluatedevaluated at the beginning of the physical exercise program and after 8 weeks by MyotonPRO (the device measures frequency, stiffness, decrement, relaxation time, and creep) and cervical and lumbar spine assessments. Significantly higher frequency was noted for right and left longissimus capitis muscle after rehabilitation. We recorded statistically significant decreasedstiffness and higher decrement for the right lumbar erector spinae muscle at the second assessment. After the physical exercise program, the cervical spine range of motionmotion improved significantly for all the tested movements. The Schober test had significantly increased values, while the finger-to-floor test decreased significantly. Significant correlations were noted between stiffness and right lumbar rotation and right lumbar lateral flexion at both baseline and 8-week assessments. Improvements in cervical and lumbar spinal motions can be analyzed in relation to mechanical muscles properties in AS pa-tients who have followed a physical exercise program.

Physical Therapy Approaches in Ankylosing Spondylitis: A Systematic Review

Article

Full-text available

Feb 2023

Background: Ankylosing spondylitis (AS) is a chronic, progressive, inflammatory disorder that mainly affects the axial skeleton with aseptic inflammation of synovial tissue, spinal ligaments, intervertebral discs and facet joints. The purpose of this review is to describe the effectiveness of different physical therapy approaches in patients with AS. Method: This review followed PRISMA guidelines. A search was conducted in electronic databases Google Scholar, PubMed, and Cochrane. Publications were included if the study group included patients with a diagnosis of AS according to the classification system described in the New York criteria. Results: A total of 6 clinical trials and 4 reviews were included in this review. One trial (n=1) had no intervention, most studies (n=4) and all the reviews (n=4) compared a variation in type of exercises, such as aerobic exercise, Pilates, swimming, one trial (n=1) was a follow-up evaluation. Conclusions: The results of this review show that different types of treatment programs improve areas related to the physical health of patients with AS such as pain intensity, mobility, functionality, muscle strength, balance, fatigue, anxiety, depression. The most significant improvement in pain across all research data is noted after aquatic therapy. Supervised physiotherapy is more effective than usual care in improving disease activity, functional capacity and pain in patients with AS.

ASAS-EULAR recommendations for the management of axial spondyloarthritis: 2022 update

Article

Full-text available

Oct 2022

Objectives To update the Assessment of SpondyloArthritis international Society (ASAS)-EULAR recommendations for the management of axial spondyloarthritis (axSpA). Methods Following the EULAR Standardised Operating Procedures, two systematic literature reviews were conducted on non-pharmacological and pharmacological treatment of axSpA. In a task force meeting, the evidence was presented, discussed, and overarching principles and recommendations were updated, followed by voting. Results Five overarching principles and 15 recommendations with a focus on personalised medicine were agreed: eight remained unchanged from the previous recommendations; three with minor edits on nomenclature; two with relevant updates (#9, 12); two newly formulated (#10, 11). The first five recommendations focus on treatment target and monitoring, non-pharmacological management and non-steroidal anti-inflammatory drugs (NSAIDs) as first-choice pharmacological treatment. Recommendations 6–8 deal with analgesics and discourage long-term glucocorticoids and conventional synthetic disease-modifying antirheumatic drugs (DMARDs) for pure axial involvement. Recommendation 9 describes the indication of biological DMARDs (bDMARDs, that is, tumour necrosis factor inhibitors (TNFi), interleukin-17 inhibitors (IL-17i)) and targeted synthetic DMARDs (tsDMARDs, ie, Janus kinase inhibitors) for patients who have Ankylosing Spondylitis Disease Activity Score ≥2.1 and failed ≥2 NSAIDs and also have either elevated C reactive protein, MRI inflammation of sacroiliac joints or radiographic sacroiliitis. Current practice is to start a TNFi or IL-17i. Recommendation 10 addresses extramusculoskeletal manifestations with TNF monoclonal antibodies preferred for recurrent uveitis or inflammatory bowel disease, and IL-17i for significant psoriasis. Treatment failure should prompt re-evaluation of the diagnosis and consideration of the presence of comorbidities (#11). If active axSpA is confirmed, switching to another b/tsDMARD is recommended (#12). Tapering, rather than immediate discontinuation of a bDMARD, can be considered in patients in sustained remission (#13). The last recommendations (#14, 15) deal with surgery and spinal fractures. Conclusions The 2022 ASAS-EULAR recommendations provide up-to-date guidance on the management of patients with axSpA.

Social Support

Chapter

Full-text available

Aug 2022

The key symptoms of axSpA such as pain, fatigue, and stiffness can combine to have a profound impact on a patient’s ability to maintain a healthy social life.

Diagnosis

Chapter

Full-text available

Aug 2022

The diagnosis of axSpA is challenging and is usually based on a combination of clinical symptoms (e.g. unexplained inflammatory back pain), patient characteristics (e.g. age <45 years, family history of axSpA, presence of genetic risk factors [human leukocyte antigen allele B27 (HLA-B27) positivity]), and the presence of inflammation on imaging (e.g. sacroiliitis on magnetic resonance imaging [MRI] or X-ray).

Axial Spondyloarthritis: Patient-Reported Impact in Europe

Book

Full-text available

Jan 2022

Objectives

Chapter

Full-text available

Aug 2022

The overarching aim of the IMAS European project was to expand the knowledge of axSpA in Europe by gathering the perspectives of patients diagnosed with the disease.

Healthcare

Chapter

Full-text available

Aug 2022

axSpA has a considerable impact on healthcare systems, both in terms of absolute monetary costs and healthcare resource utilization (Heijde et al. Ann Rheum Dis 76:978–991, 2017; Harvard S, Guh D, Bansback N, et al. Costs of early spondyloarthritis: estimates from the first 3 years of the DESIR cohort. RMD Open. 2016;2:e000230.).

Employment Status and Productivity

Chapter

Full-text available

Aug 2022

Due to the pain, fatigue, and loss of mobility associated with their disease, patients with axSpA often struggle to meet the demands of employment, which can lead to higher rates of unemployment, sick leave (absenteeism), and impairment while at work (presenteeism) compared with the general population (Boonen et al. Ann Rheum Dis 69:1123–1128, 2010;Boonen et al. Ann Rheum Dis 60:1033–1039, 2001;; Mau et al. J Rheumatol 32:721–728, 2005; Healey et al. Scand J Rheum 40:34–40, 2011).

Fears and Hopes

Chapter

Full-text available

Aug 2022

Patients with axSpA are likely to live with a range of hopes, such as retaining a good quality of life and normal social and physical functioning, and fears, including a fear of suffering, losing autonomy, and being a burden on relatives, relating to their disease (Garrido-Cumbrera et al. Rheumatol Ther. 2017:219–231, 2017; Gossec et al. Value Health. 18:A715, 2015).

Physical Health

Chapter

Full-text available

Aug 2022

In this chapter, the physical health of European IMAS participants is examined, including disease activity, spinal stiffness, inflammation, and comorbidities.

Habits and Lifestyle

Chapter

Full-text available

Aug 2022

Various aspects of the habits and lifestyle of patients with axSpA can affect their physical health, mental health, and indeed response to therapy.

Methodology

Chapter

Full-text available

Aug 2022

This cross-sectional market research survey was adapted from the Spanish Atlas of Axial Spondyloarthritis 2017, a pilot survey conducted from January to March 2016 (Garrido-Cumbrera et al. Reumatol Clin. 15:127–132, 2019a).

Demographic Profile of Survey Respondents

Chapter

Full-text available

Aug 2022

The IMAS European survey was conducted across 13 European countries and included a wide range of patients with axSpA from varying sociodemographic backgrounds.

Psychological Health

Chapter

Full-text available

Aug 2022

Psychological distress is frequently experienced by patients with axSpA, with some studies reporting that more than 50% of patients have concomitant depression or anxiety (Zou et al. Med Sci Monit 22:3202–3208, 2016; Kilic G, Kilic E, Ozgocmen S. Relationship between psychiatric status, self-reported outcome measures, and clinical parameters in axial spondyloarthritis. Medicine. 2014;93:e337.; Shen et al. J Rheumatol 43:625–631, 2016; Hakkou et al. Rheumatol Int 33:285–290, 2013; Meesters et al. Arthritis Res Ther 16:418, 2014a). The exact mechanisms that lead to poor psychological status are not completely understood.

Recomposer ses spatialités à l’aune de sa corporéité endolorie

Thesis

Full-text available

Aug 2021

Andréa Dalila Paulus

La présente recherche visera à comprendre au moyen d’une approche féministe matérialiste, les répercussions de la douleur et de la fatigue chronique, provoquées par la spondylarthrite ankylosante et la fibromyalgie sur la spatialité des femmes vivant avec ces pathologies. Pour ce faire, elle montrera que la maladie est un processus d’adaptation interrelationnel, se traduisant spatialement par la recomposition des géographies quotidiennes. Elle cherchera ainsi à mettre en évidence la nouvelle normalité sociospatiale qui s’institue en réaction à une corporéité endolorie. Cette recherche postule, par conséquent, que la restructuration des spatialités quotidiennes s’articule autour d’une fréquentation de nouveaux espaces, d’une resignification de la symbolique attribuée à certains lieux et d’une diminution de certains déplacements et de certaines activités. L’hypothèse soutenue sera évaluée sous l’angle de la production discursive récoltée durant une étude de terrain exploratoire. Celle-ci a été menée au sein de communautés virtuelles dédiées à ces affections et réalisée à l’aide d’outils de méthodologie qualitative tels que l’ethnographie en ligne et l’entretien biographique

Efektywność masażu klasycznego u chorych z zesztywniającym zapaleniem stawów kręgosłupa

Article

Jul 2021

Association of methylation level and transcript level in TRAF5 gene with ankylosing spondylitis: a case-control study

Article

Full-text available

Jun 2021

To explore the association between methylation level and transcript level of TNF receptor-associated factor 5 (TRAF5) gene with ankylosing spondylitis (AS) in Chinese Han population. Methylation and mRNA expression level of the TRAF5 gene were tested in 98 patients and 98 healthy controls. Among the 21 CpG sites, methylation levels at eight sites were significantly different between AS patients and healthy controls. However, only three sites remained significantly different after the correction by the Benjamini–Hochberg method. Compared with controls, the CpG island of TRAF5 gene promoter was highly methylated in AS patients, and the relative mRNA expression level of TRAF5 was significantly reduced in AS patients. And the mRNA level was negatively correlated with the methylation level of TRAF5 gene in AS patients (rs = −0.453, P < 0.001). Subgroup analyses indicated that there was no significant difference in the level of methylation between groups of different status of HLA-B27 and medications in AS patients. Multiple linear regression showed that disease-modifying antirheumatic drugs could reduce methylation levels of AS patients after adjusting for the effects of other drugs. In conclusion, the hypermethylation of the TRAF5 might contribute to the pathogenesis of AS, but many open questions remain.

Non-Steroidal Anti-Inflammatory Drug Etoricoxib Facilitates the Application of Individualized Exercise Programs in Patients with Ankylosing Spondylitis

Article

Full-text available

May 2020
MED LITH

Background and objectives: The main objective of this study is to highlight the efficiency of different therapeutic means in patients with ankylosing spondylitis, resulting in the improvement of their quality of life. Materials and Methods: We conducted a randomized, longitudinal, controlled trial on 92 patients with ankylosing spondylitis over a period of 6 years. Disease activity was assessed using the BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) score. The assessment of functional disabilities was performed using BASFI (Bath Ankylosing Spondylitis Functional Index). We assessed the quality of life using the HAQ questionnaire (Health Assessment Questionnaire). Based on the HAQ, we calculated the minimum number of patients to be treated for 52 weeks to prevent a decrease in the quality of life for at least one of them (the number needed to treat (NNT)). Results: For the combination therapy group, the result we obtained was 2, lower than the other therapies compared (the medication group and the group with physical exercise). We point out a correlation between the improvement of the functional status (BASFI) and the increase of the quality of life (HAQ), estimated as moderately high (0.8). The superiority of the effects of the combined treatment, in which we combined a nonsteroidal anti-inflammatory drug (etoricoxib) to the exercise program, is reflected by the model of the significant improvements (p < 0.05) obtained for the functional status and quality of life scores (BASFI and HAQ). Conclusions: The nonsteroidal anti-inflammatory drugs, in our case, etoricoxib, facilitate the application of individualized exercise programs in patients with ankylosing spondylitis.

TNFAIP3 genetic polymorphisms reduce ankylosing spondylitis risk in Eastern Chinese Han population

Article

Full-text available

Jul 2019

Abstract This study was conducted to clarify the associations of tumor necrosis factor-α induced protein 3 (TNFAIP3) and TNFAIP3-interacting protein 1 (TNIP1) genetic polymorphisms with ankylosing spondylitis (AS) susceptibility. Five single nucleotide polymorphisms (SNPs) in TNFAIP3 gene and four in TNIP1 gene were genotyped in 667 AS patients and 667 matched healthy controls. Genotypes and haplotype analysis were conducted by using SPSS 23.0 and Haploview 4.2 software. The T allele and CT genotype in TNFAIP3 rs10499194 were significantly associated with a reduced AS risk (T allele vs. C allele, OR = 0.619, 95% CI = 0.430–0.889, P = 0.009; CT vs. CC, OR = 0.603, 95% CI = 0.416–0.875, P = 0.007). However, no association remained significant after Bonferroni correction. The rs13207033A- rs10499194T haplotype of TNFAIP3 conferred a protective effect on AS susceptibility. Stratification analyses suggested that rs10499194 polymorphism decreased the risk of AS in the male subgroup, subgroup aged ≥ 29, HLA-B27 positive subgroup as well as the subgroups of BASFI

Effect of Clinical Pilates training on the fear of movement in patients with ankylosing spondylitis

Article

Full-text available

Nov 2018

Background/Aims Exercise training has been shown to be beneficial in reducing symptoms in patients with ankylosing spondilitis. However, exercise effect on fear and avoidance of movement has not been assessed. The aim of this study was to evaluate the effect of Pilates training on kinesiophobia, disease activity, functional status and quality of life in patients with ankylosing spondilitis. Methods A total of 21 patients with ankylosing spondilitis with stable medication participated in the study. Tampa Scale for Kinesiophobia, Bath Ankylosing Spondilitis Disease Activity Index, Bath Ankylosing Spondilitis Functional Index, ankylosing spondilitis Quality of Life Questionnaire and Beck Depression Inventory were completed by patients before and after a 6-week modified Pilates training programme. Findings The patients were 41.6 ± 11.8 years old and the mean disease duration was 68 ± 87months. Mobility, disease acitivity and functional scores improved with exercise training (P<0.05). Moreover, quality of life, depression and kinesiophobia levels also showed significant improvement (P<0.05). Conclusions The results of this study showed that 6-week supervised modified Pilates training programme improved clinical symptoms in patients with Aankylosing spondilitis. Moreover, patients benefited from this exercise method regarding quality of life, depression and fear of movement (kinesiophobia) considerably.

Pulmonary Impairment Does Not Limit Exercise Capacity in Patients with Ankylosing Spondylitis with Low Disease Activity

Article

Full-text available

Jan 2018

Which Factors Affect the Functional Situation and Quality of Life in Patients with Ankylosing Spondylitis?

Article

Full-text available

Dec 2017

Giriş: Bu çalışma, Ankilozan spondilit (AS) hastalarında fonksiyonel durumu ve yaşam kalitesini etkileyen olası faktörleri belirlemek amacıyla yapıldı.Materyal ve Metot: Çalışmaya AS'li toplam 88 adet gönüllü Türk hasta dahil edildi. Hastalarda Bath AS Fonksiyonel İndeks (BASFI), Bath AS Hastalık Aktivite İndeksi (BASDAI), Bath AS Metrology İndeksi (BASMI) ve AS Yaşam Kalitesi Anketi (ASQoL) değerlendirildi. Yaş, cinsiyet, eğitim düzeyi, sabah tutukluğu süresi, sigara içme durumu, evde egzersiz yapma durumları sorgulandı ve mobilite ölçümleri yapıldı ve bunlar kaydedildi. Bulgular: BASFI skoru sigara içme (p=0,019), egzersiz (p=0,002), sabah tutukluğu (p=0,001), vücud kütle indeksi (p=0,020), BASMI (p0,001) ve BASDAI (p0,001) ile korele bulundu. Kategorik regresyon analizine göre ise BASDAI BASFI skoru ile ilişkili bulundu (:0.574, p0,001). ASQoL ise sabah tutukluğu (p=0,004), eğitim durumu (p=0,030), sigara içme (p=0,049), egzersiz (p=0,007), BASDAI (p0,001) ve BASFI (p0,001) korele bulundu. ASQoL üzerinde BASFI’nin belirgin etkisi olduğu saptandı (p=0,007).Sonuç: Hastalık süresi değiştirilemediği halde, sigara içme, sabah tutukluğunun süresi, evde egzersiz programına uyum ve hareketlilik ölçümleri nispeten değiştirilebilir faktörler gibi gözükmektedir. Bu nedenle, AS'li hastaları takip eden hekimlerin her ziyarette, bu konularda eğitim vererek ve bunu vurgulayarak hastaların yaşam kalitelerini ve fonksiyonlarını etkileyebileceklerine inanıyoruz.

Diagnosis and Treatment of Inflammatory Joint Disease

Article

Full-text available

Dec 2017

Arthritis damages the cartilage within joints, resulting in degenerative changes, including loss of function and joint instability. Ankylosing spondylitis (AS) is a chronic inflammatory condition affecting the spine and bone-to-tendon attachment area within the sacroiliac joint leading to back pain and progressive spinal stiffness. In the final stages, AS causes hyperkyphosis-a condition closely tied to the human leukocyte antigen-B27 gene. Rheumatoid arthritis is a chronic, systemic autoimmune disease characterized by the simultaneous inflammation of the synovium of multiple joints, leading to joint damage (e.g., destruction, deformation and disability). In the past, nonsteroidal anti-inflammatory drugs or conventional disease-modifying antirheumatic drug (DMARDs) have been used for the treatment of these autoimmune diseases, but biologic DMARDs have recently been introduced with excellent results. Gout is a chronic inflammatory disease that causes an alteration of joints resulting in severe pain. Specifically, gout is associated with an accumulation of uric acid within the body resulting from dysregulated purine metabolism, causing recurrent paroxysmal inflammation in the joints. Allopurinol and febuxostat are the primary treatment options for individuals with gout. It is necessary to have an accurate understanding of the pathogenesis, pathological ecology and treatment of AS, rheumatoid arthritis, and gouty arthritis, which are the representative diseases that may cause inflammatory arthritis.

Pilates en pacientes con espondilitis anquilosante: repercusión en la función pulmonar

Article

Full-text available

Aug 2017
Fisioterapia

Aim: To evaluate the impact of physiotherapy, based on the Pilates Method, on the lung function of patients with Ankylosing Spondylitis (AS). Material and methods: A randomised clinical trial (RCT) was performed with 49 patients diagnosed with AS according to the modified New York criteria. Two groups were randomly established. Therapeutic Pilates-based exercise was performed by 26 patients for 17 weeks, in 90. minute sessions on alternative days, supervised by a physiotherapist. The control group (23 patients) used a conventional exercise program at home. The variables analysed were: rib cage expansion, forced vital capacity (FVC), forced expiratory volume (FEV1), and the FEV1/FVC ratio. Results: No significant differences were found in the values of rib cage expansion between control and experimental groups (P=.686), while there were differences before and after intervention in the experimental group (P=.780). The values of spirometry were similar in both control and experimental groups. No-significant increase in FVC was observed in the experimental group (P=.122). Conclusions: The impact of Pilates-based exercises on spirometry values and rib cage expansion is limited, although there was a tendency to improve FVC after Pilates exercises. These types of exercise protocols should be considered, for their clinical application, in specific respiratory physiotherapy.

Comparison of Deep Tissue Massage and Therapeutic Massage for Lower Back Pain, Disease Activity, and Functional Capacity of Ankylosing Spondylitis Patients: A Randomized Clinical Pilot Study

Article

Full-text available

Aug 2017
EVID-BASED COMPL ALT

Objectives. This study aims to compare the effectiveness of deep tissue massage (DTM) and therapeutic massage (TM) in the management of ankylosing spondylitis (AS) patients. Materials and Methods. This was a small, randomized clinical pilot study. Subjects were 27 men with diagnosed AS, randomly assigned to DTM group or TM group. Subjects in each group had 10 sessions of massage. Outcomes included the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Functional Index (BASFI), Modified Schober Test, Finger to Floor Test, chest expansion, and pain intensity of lower back. Results. There are no statistical significant differences between groups, except for BASDAI and pain intensity of lower back. Conclusions. This study suggests that massage may have clinical benefits for treating ankylosing spondylitis patients. Additional scientific research in this area is warranted.

Deep tissue massage and its impact on disease acticity and functional performance in patient with ankylosing spondylitis - case report

Article

Full-text available

Oct 2013

Introdaction AS is a chronic inflamatory disease that affects the axial skeleton. It is characterised by inflammatory back pain, bony fusion of the spine, decreased mobility, functional impairment and decreased quality of life. Techniques of DTM lead to relaxation of muscles and tissues and could be use in therapy AS patents. Objective The goal of the present study was to estimate an influence of DTM on pain and function patient with AS. Patient and Methods The patient, a 42-year-old man with AS. The diagnosis was made 7 years ago. The clinical outcome was evaluated by BASDAI and BASFI index and functional tests: Schober, Otta, chest expansion, fingers to floor distance and wall-occiput test. DTM was made 20 sessions in two stages: 1. DTM on superficial back line – 10 sessions after 30 days break 2. DTM from sacrum to occipital ridge – 10 sessions. All functional tests and indexes were estimated six times before therapy, after 5 and 10 day of DTM in both treatments. Results BASDAI, BASFI and the results of functional tests improved in both cases of therapy. It should be noted that treatment number 2 resulted in better mobility of the spine. These data are encouraging and positive, representing optimism and a hopeful outlook for future research in this area.

Combination Treatment with Etanercept and an Intensive SPA Rehabilitation Program in Active Ankylosing Spondylitis

Article

Full-text available

Oct 2009
INT J IMMUNOPATH PH

The aim of this study is to determine the effects of a combination treatment with etanercept and spa rehabilitation versus etanercept alone on function, disability and quality of life in a group of patients with active ankylosing spondylitis (AS). Sixty patients with AS underwent etanercept as suggested by ASAS/EULAR recommendations. As the clinical and laboratory conditions improved, 30 patients accepted the proposal of coupling the medical therapy with a 7-day rehabilitation program in a thermal baths centre; the remaining 30 subjects continued to take the biologic agent alone. The comparisons between the 2 groups were made after 3 and 6 months. The primary outcome was an improvement in BASFI. The secondary outcome was an improvement in the visual analogic scale of EuroQol (EQ-5Dvas). After 6 months a statistically significant improvement in BASFI (p < 0.05) and EQ-5DVAS (p < 0.05) scores was observed in both groups. The mean change in EQ-5DVAS value showed a statistically significant difference in favour of the combination therapy group versus the monotherapy group (22 vs 32, p < 0.05). A therapeutic regimen combining etanercept with an intensive rehabilitation program contributes to disability reduction and ameliorates quality of life for AS patients.

Spinal fractures related to ankylosing spondylitis – Epidemiology, clinical outcome and biomechanics.

Thesis

Full-text available

Jan 2017

Yohan Robinson

Background: Spinal fractures related to ankylosing spondylitis (AS) are often associated with serious complications. Therefore, knowledge of the incidence, best treatment, outcome, and prevention would assist in improving current guidelines. Objectives: This thesis aims at (1) analysing the complications and mortality of surgical treatment, (2) mapping the incidence and treatment modalities for these patients in Sweden, as well as (3) investigating the putative preventive effect of biological disease modifying antirheumatic drug (bDMARD) therapy on spinal fractures related to AS. Methods: Merged multiple national registries were used to identify predictors of mortality and spinal fractures in patients with AS. Beyond that a finite element model (FEM) was designed to simulating a cervicothoracic fracture related to AS. Results and Conclusions: During the last two decades an increase of the incidence of vertebral fractures in patients with AS was observed. With the introduction of bDMARD treatment of AS was revolutionised and quality of life and function improved. It seems that the improved quality of life and function in these patients does not correlate with a reduced fracture risk. Still, for the first time a beneficial effect of bDMARD with regard to spinal fracture occurrence was provided. The risk of spinal fractures was not reduced, but the debut of a spinal fracture was delayed with bDMARD. Since for this study the observation interval was only a decade, a future follow-up should revisit the effect of bDMARD on spinal fractures related to AS. Furthermore, it was shown that posterior stabilisation is an effective method for restoring stability without the necessity of additional external fixation. Most likely the early rehabilitation reduced pulmonary complications, which in turn reduced early mortality of these fractures. The FEM could be used to identify the most appropriate implant configuration, since no wellestablished cadaver models exist. Clinical Trial Registration: ClinicalTrials.gov, Identifier NCT02840695.

Psychological Co-Morbidities and Physical Therapy in Patients with Ankylosing Spondylitis

Article

Sep 2016

strong>Background: Ankylosing Spondulitis is a chronic inflammatory disease of the axial skeleton with variable involvements of the peripheral joints. Symptoms appear gradually with pain and stiffness especially in the morning. As the disease progresses, loss of spinal mobility and chest expansion with limitation of anterior flexion, lateral flexion, and extension of the lumbar spine, are seen. Pain is often severe at rest, but improves with physical activity. Though physical therapy remedies have been scarcely documented, therapeutic exercises are used to help manage pain and improve functions. Methodology: 10 patients (8 males) diagnosed with ankylosing spondylitis with HLA-B27 antigen positive participated in the study. After basic evaluation, the patients were asked to fill the quality of life questionnaire and hospital anxiety depression scale. Physical therapy exercises were introduced for a period of 4 weeks. The outcome measures were reassessed after this. The data thus obtained, was then statistically analyzed. Results: The mean age of patients was 26 years with the mean duration of the disease about 1 year and 2 months. Both the scales showed decreased scores post physiotherapy. Conclusion: Physical therapy improved the quality of life in patients with Ankylosing Spondylitis. Patients were seen to be depressed and anxious due to the disease process. Also, financial status gets affected due to expenditure on medicines and surgical interventions further affecting the psychological status.

Efficiency of training programs aimed at ankylosing spondylitis early detection for primary care doctors in Kazan

Article

Full-text available

Jun 2016

In practice, the average time difference between a diacrisis of ankylosing spondylitis and the onset of the disease is 7- 8 years. Training programs for primary care doctors can accelerate the diagnosis of the disease. The work on the compilation of training programs and the evaluation of their efficiency was carried out in 3 (three) stages: 1) assessment of the level of knowledge and problems regarding ankylosing spondylitis diagnostics and treatment among general practice doctors and neurologists; 2) development of training programs, suitable for use in actual clinical practice; 3) analysis of the programs’ implementation efficiency in accordance with the Kazan Rheumatology Center work statements in 2009-2011.The knowledge of 130 doctors (rheumatologists, neurologists and primary care doctors) regarding the criteria of differential diagnostics, back pain and inflammatory back pain was tested. Rheumatologists were tested separately, in order to determine the validity of questions. Basic findings: After the conduction of training, the number of ankylosing spondylitis carriers at the Kazan State Rheumatology Center increased almost twofold, from 378 in 2009 to 683 in 2011, while the diagnosis duration reduced from 8.4 years to 3.5 years in the same period. Training programs for primary care doctors and neurologists of Kazan are of great importance, since facilitate the early detection of AS, timely therapy initiation, quality of life improvement, and can subsequently lead to a reduction of the number of disabled people in this patient group. © 2016, International Journal of Pharmacy and Technology. All rights reserved.

Experience with conservative rehabilitation in patients with juvenile chronic arthritis

Article

Full-text available

Jan 2016

Objective: to estimate a need for conservative rehabilitation treatment in patients with juvenile chronic arthritis (JCA).Material and methods. Data on the principles and procedures of rehabilitation treatment were analyzed in patients with JCA on the basis of 25- year experience. The need for these packages of measures in 1999, 2008, and 2014 was compared. Standard procedures for joints at different sites were described. According to the degree of joint functions, there were rehabilitation treatment packages: corrective, mobilization, and general health-improving.Results and discussion. All patients with juvenile arthritis need rehabilitation (physical, psychological, and social). Comparison of the total number of patients who had received rehabilitation treatment in 1999, 2008, and 2014 showed a small trend towards its reduction. This is due to the smaller number of patients with dysfunctions and to the larger number of those without movement disorders who had received adequate treatment in early periods of the disease. The high percentage of patients having limited joint functions needs a mobilization package. Analysis of the data available in the literature and the authors' experience may lead to the conclusion that all patients with JCA need exercise therapy. The latter is a major procedure for physical rehabilitation and should be included in the standards for adjuvant treatment during basic medical therapy. Emphasis is laid on the importance of the early initiation of treatment to prevent incapacitating deformity at early stages of the disease.

Deformity Surgery for Ankylosing Spondylitis

Chapter

Jan 2022

Research Status of Diagnosis and Treatment of Ankylosing Spondylitis

Article

Jan 2024

雪云

The Effects of Pilates Exercise Training Combined with Walking on Cardiorespiratory Fitness, Functional Capacity, and Disease Activity in Patients with Non-Radiologically Confirmed Axial Spondylitis

Article

Full-text available

Oct 2023

The objective of the study was to examine the effects of Pilates exercise training combined with walking on cardiorespiratory fitness, functional capacity, and disease activity in patients with non-radiologically confirmed axial spondylitis (nr-axSpA). Thirty patients with nr-axSpA (seven women (90%), with a mean age of 46.07 ± 10.48 years old and C-reactive protein (CRP) 2.26 ± 2.14 mg/L) were randomly divided into two groups: A (n1 = 15 patients) and B (n2 = 15 patients). Group A followed a 6-month home-based Pilates exercise training program, while Group B remained untrained until the end of the study. A cardiopulmonary exercise test (CPET), timed up and go test (TUG), five times sit-to-stand test (5×STS), sit-and-reach test (SR), back scratch test for the right (BSR) and the left arm (BSL), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and Ankylosing Spondylitis Disease Activity Score (ASDAS) were applied to all patients, both at the beginning and at the end of the study. After 6 months, Group A showed higher values in exercise time by 37.41% (p = 0.001), higher peak oxygen uptake (VO2peak) by 25.41% (p = 0.01), a higher ratio between oxygen uptake and maximum heart rate (VO2/HRmax) by 14.83% (p = 0.04), and higher SR by 18.70% (p = 0.007), while lower values were observed in TUG by 24.32% (p = 0.001), 5×STS by 12.13% (p = 0.001), BASDAI score by 20.00% (p = 0.04) and ASDAS score by 23.41% (p = 0.03), compared to Group B. Furthermore, linear regression analysis showed a positive correlation in Group A between BASDAI and 5×STS (r = 0.584, p = 0.02), BASDAI and TUG (r = 0.538, p = 0.03), and ASDAS and 5×STS (r = 0.538, p = 0.03), while a negative correlation was found between BASDAI and VO2peak (r = −0.782, p < 0.001), ASDAS and SR (r = −0.548, p = 0.03), and ASDAS and VO2peak (r = −0.659, p = 0.008). To sum up, cardiorespiratory fitness, functional capacity, and disease activity improved after a long-term Pilates exercise training program in patients with nr-axSpA.

Ankylosing Spondylitis

Chapter

Jan 2010

Matthew P. Bunyard

Kinesiotherapy in patients with ankylosing spondylitis

Article

Apr 2020

Ankylosing spondylitis is a chronic inflammatory disease from the group of spondylarthritis, characterized by damage to the predominantly axial skeleton, gradual formation of functional disorders of the spine and joints, leading to temporary or permanent disability and poor quality of life for patients, mostly young. In recent years, much attention has been paid to the study of the effectiveness of kinesitherapy in patients with ankylosing spondylitis. Studies have been conducted that confirmed the positive effect on the function of the spine and joints of regular exercises performed at home, regular group exercise and their combination with physiotherapy methods. However, due to the imperfect methodology of conducting these studies and the lack of a standardized approach in evaluating the effectiveness of therapy in these patients, further detailed researches are needed to select the required amount of kinesitherapy for patients with ankylosing spondylitis and develop a standardized assessment of its effectiveness.

Atlas de Espondiloartritis Axial en España 2017

Book

Full-text available

Mar 2017

Marco Garrido-Cumbrera

Actualmente, existe abundante información sobre las Espondiloartritis, desde el punto de vista clínico y sobre los tratamientos farmacológicos más adecuados. Sin embargo, se detecta una escasez de información en relación a la legislación y planificación, los recursos existentes para su tratamiento, las razones del retraso diagnóstico, las limitaciones físicas, el estado psicológico de los pacientes, su situación laboral, las pérdidas de productividad y los costes asociados al manejo de la enfermedad. El Atlas de Espondiloartritis Axial en España 2017: Radiografía de la Enfermedad es una iniciativa que nace desde CEADE, realizado por el Grupo de Investigación Health & Territory Research (HTR) de la Universidad de Sevilla, el Instituto Max Weber y cuenta a su vez con la colaboración de la Sociedad Española de Reumatología (SER), la Liga Reumatológica y Novartis. La propuesta presente tiene como objetivo desarrollar un análisis de situación de las personas con EspA-ax en España, creando para ello un documento que profundice en el conocimiento de la enfermedad y que aporte nuevas evidencias encaminadas a la mejora de la atención y calidad de vida de los pacientes. Este informe se basa en la evaluación de la situación de las personas con EspA-ax a través de una encuesta a pacientes, la opinión de expertos, y el análisis de diversas fuentes de información e indicadores. Todo ello permite una aproximación global a la realidad y a los tipos de tratamiento más adecuados, con el fin de establecer propuestas y recomendaciones destinadas a mejorar la calidad de vida de los pacientes con EspA-ax.

Evaluation of a special concept of physical therapy in spondyloarthritis: German multimodal rheumatologic complex treatment for spondyloarthritis

Article

Jan 2020

Objectives Multimodal rheumatologic complex treatment (MRCT) is a specific concept of German inpatient care focusing on physical therapy for patients with rheumatic diseases suffering from exacerbated pain and functional impairment. As physical therapy is a key concept in the treatment of spondyloarthritis (SpA), we conducted a monocentric retrospective analysis of the effects of MRCT on pain and functional status in patients with SpA including patients with axial spondyloarthritis (axSpA), non-radiographic axial spondyloarthritis (nr-axSpA) and psoriatic arthritis with axial involvement (axPsA). Methods 134 treatment episodes provided to 100 patients with SpA between 2014 and 2017 were analysed. We evaluated changes in pain intensity, in functional status and in disease activity before and after a treatment episode. In addition, we assessed potential influences of various patient characteristics, the course of the disease and comorbidities. Results Overall, MRCT resulted in significant amelioration of pain (NRS: p < 0.001), significant improvement of functional capacity (FFbH: p = 0.03; HAQ: p = 0.02; BASFI: p < 0.001) and significant reduction of disease activity (BASDAI p < 0.001; DAS28: p = 0.009). In general, treatment effects on axSpA, nr-axSpA and axPsA were comparable. Different aspects of the disease and its previous course did not have a significant effect on the outcome parameters. Comorbidities (e.g. fibromyalgia) did not significantly influence treatment response. Conclusion MRCT not only decreases pain and improves function but also reduces disease activity in patients with axSpA, nr-axSpA and axPsA irrespective of the course of disease and comorbidities (e.g. fibromyalgia), thus underlining the importance of non-pharmacological and physical treatment in the treatment of SpA. Key Points • Physical treatment is a key component in treating SpA. • Multimodal rheumatologic complex treatment (MRCT) is a specific concept of German inpatient care focusing on physical therapy for patients with rheumatic diseases suffering from exacerbated pain and functional impairment. • MRCT not only decreases pain and improves function but also reduces disease activity in patients with axSpA, nr-axSpA and axPsA irrespective of the course of disease and comorbidities (e.g. fibromyalgia). • MRCT could be a role model of treating SpA by means of physical therapy as its effects are not influenced by therapy, disease duration or comorbidities and as it has no side effects.

Ankylosing spondylitis: etiology, pathogenesis, and treatments

Article

Full-text available

Dec 2019

Ankylosing spondylitis (AS), a common type of spondyloarthropathy, is a chronic inflammatory autoimmune disease that mainly affects spine joints, causing severe, chronic pain; additionally, in more advanced cases, it can cause spine fusion. Significant progress in its pathophysiology and treatment has been achieved in the last decade. Immune cells and innate cytokines have been suggested to be crucial in the pathogenesis of AS, especially human leukocyte antigen (HLA)‑B27 and the interleukin‑23/17 axis. However, the pathogenesis of AS remains unclear. The current study reviewed the etiology and pathogenesis of AS, including genome-wide association studies and cytokine pathways. This study also summarized the current pharmaceutical and surgical treatment with a discussion of future potential therapies.

Ankylosing Spondylitis

Chapter

May 2019

Ankylosing spondylitis (AS) represents a common, highly heritable prototype of an interrelated group of chronic inflammatory rheumatic diseases now referred to as spondyloarthritis (SpA), which characteristically affects the axial skeleton in the spine and bilateral sacroiliac joints, resulting in structural and functional impairments, such as inflammatory back pain, asymmetrical peripheral oligoarthritis (predominantly of lower limbs), enthesitis, and specific organ involvement including psoriasis, acute anterior uveitis (AAU), inflammatory bowel disease (IBD), and the so-called extra-articular manifestations (EAM) [1–4]. The past decade yields major advances in the recognition of AS as an entity, the understanding of genetic and pathophysiological mechanisms, and the management due to the new clinical and imaging techniques or therapies [3]. Proteomic and genomic findings while in an early stage have potential both as diagnostic/prognostic tools to investigate the pathogenesis of AS [5]. The strongest known contributing factor is the main histocompatibility complex (MHC) class I molecule human leukocyte antigen-B27 (HLA-B27); several other genes and genetic regions still remain to be identified [4, 6]. The blockers of tumor necrosis factor (TNF), a major therapeutic advance, have allowed patients refractory to conventional treatment [3]. However, whether the available nonsteroidal anti-inflammatory drugs and the treatment with physiotherapy or the other biological treatments is as yet unclear [7]. In addition, the development of defining better strategies and techniques for early diagnosis, therapeutic modulation, and induction of drug-free remission remains one of the major challenges in AS for clinical practice for the next decade.

Effect of hippotherapy simulator on pain, disability and range of motion of the spinal column in subjects with mechanical low back pain: A randomized single-blind clinical trial

Article

Full-text available

Jul 2018
J BACK MUSCULOSKELET

Background: Hippotherapy is a form of therapeutic exercise for conservative treatment of lumbar spine segmental instability and/or hypomobility in subjects with low back pain (LBP). Objective: The current study evaluates the effects of a hippotherapy simulator on pain, disability, and range of motion (ROM) of the spinal column in subjects with mechanical LBP. Methods: In a randomized clinical trial, 80 subjects were randomly assigned to either the control or intervention groups. All subjects underwent routine physiotherapy. In addition, the intervention group underwent hippotherapy with a hippotherapy simulator for 15 sessions, each lasting 15 minutes. Pain, disability, and ROM of the lumbar spinal column of the subjects were measured in the first and last physiotherapy sessions respectively. Results: Improvement in pain intensity was higher in the hippotherapy simulator group over the first eight days of treatment (Hippotherapy vs. Control Point changes: Day 12: p= 0.010; after treatment: p= 0.005). The hippotherapy simulator group had significantly higher improvement in disability score in comparison to the control group (p< 0.001); mean changes in the modified Schober test were not significant (p= 0.423). Conclusion: The hippotherapy simulator decreased pain and disability in subjects with LBP; however, no additional improvement in lumbar spine ROM was observed.

The Thoracic Spine and Rib Cage

Chapter

Dec 2013

Fiona Wilson

Associations de patients atteints de spondylarthrite ankylosante – quelles différences entre membres et non-membres ?

Article

Mar 2017
Rev Rhum

Résumé Objectifs Il est recommandé aux personnes atteintes de spondylarthrite ankylosante (SA) d’adhérer à une association de patients. L’objectif de ce travail a été de comparer des patients atteints de SA membres d’une association de soutien réciproque avec des non-membres, en ce qui concerne les caractéristiques de la maladie et la personnalité, pour en déduire des hypothèses sur les avantages potentiels d’une telle adhésion. Méthodes Un questionnaire exhaustif portant sur les caractéristiques démographiques, le tabagisme, l’obtention d’informations sur la maladie, l’activité de la maladie, la capacité fonctionnelle, la satisfaction des patients, le traitement, les congés pour maladie, l’incapacité de travail et le niveau d’éducation a été remis à des patients membres de l’association allemande de la SA et à des non-membres. Résultats Au total, 1273 patients ont répondu. Des différences significatives d’âge et de durée de la maladie nous ont conduits à apparier les membres et les non-membres selon un ratio de 2:1. Dans la population appariée (n = 549), les membres étaient plus instruits, s’estimaient souvent mieux informés sur la maladie, exerçaient moins souvent une profession pénible et fumaient moins que les non-membres. Les membres étaient plus souvent traités par AINS et moins souvent par anti-TNF, ce qui suggère que la maladie était plus grave chez les non-membres. Malgré une activité de la maladie similaire (BASDAI 4,1 contre BASDAI 4,2), les membres présentaient une meilleure capacité fonctionnelle (BASFI 3,5 contre BASFI 3,9) et beaucoup moins de jours d’absence pour maladie au cours de l’année écoulée (15,1 jours contre 31,2 jours). Les absences pour maladie augmentaient considérablement plus avec la hausse du score BASFI chez les non-membres que chez les membres. Conclusion Les patients atteints de SA qui adhèrent à une association d’entraide de la SA sont plus instruits et beaucoup mieux informés sur la maladie. Toutefois, les corollaires sur les indicateurs de résultats de la maladie sont brouillés par des facteurs parasites éventuels.

Association of HLA-DP/DQ and STAT4 polymorphisms with ankylosing spondylitis in Southwest China

Article

Jul 2016

Ankylosing spondylitis (AS) is a highly heritable complex inflammatory arthritis disease. Genetic factors are thought to be crucial in the pathogenesis of AS. However, few data are available on the relationship between HLA-DP/DQ and STAT4 polymorphisms and AS susceptibility in the Chinese population. Therefore, we examined HLA-DP/DQ and STAT4 polymorphisms (rs3077, rs9277535, rs7453920 and rs7574865) in a total of 779 subjects, including 400 AS and 379 age- and sex-matched healthy controls in Chinese. No significant difference was observed between AS patients and healthy controls in the allele frequency of rs3077, rs9277535 and rs7574865. However, there was a significant association between the HLA-DQ rs7453920 G/A variant and AS patients, with minor allele A correlated with a reduced risk of AS (allelic frequency, adjusted OR=0.66, 95% CI=0.55-0.78, p=4.0E-06; dominant model, adjusted OR=0.75, 95% CI=0.66-0.85, p=1.1E-05). Moreover, the haplotypes block AAA and GGA in the HLA gene significantly correlated with reduced risk of AS. This is the first study demonstrating the significant associations of SNP rs7453920 and the haplotypes in the HLA gene with the risk of AS in Southwest Chinese population. This research sheds new light on the significant relationship between HLA polymorphisms and AS.

Philadelphia Panel Evidence-Based Clinical Practice Guidelines on Selected Rehabilitation Interventions for Low Back Pain

Article

Full-text available

Oct 2001

Introduction. A structured and rigorous methodology was developed for the formulation of evidence-based clinical practice guidelines (EBCPGs), then was used to develop EBCPGs for selected rehabilitation interventions for the management of low back pain. Methods. Evidence from randomized controlled trials (RCTs) and observational studies was identified and synthesized using methods defined by the Cochrane Collaboration that minimize bias by using a systematic approach to literature search, study selection, data extraction, and data synthesis. Meta-analysis was conducted where possible. The strength of evidence was graded as level I for RCTs or level II for nonrandomized studies. Developing Recommendations. An expert panel was formed by inviting stakeholder professional organizations to nominate a representative. This panel developed a set of criteria for grading the strength of both the evidence and the recommendation. The panel decided that evidence of clinically important benefit (defined as 15% greater relative to a control based on panel expertise and empiric results) in patient-important outcomes was required for a recommendation. Statistical significance was also required, but was insufficient alone. Patient-important outcomes were decided by consensus as being pain, function, patient global assessment, quality of life, and return to work, providing that these outcomes were assessed with a scale for which measurement reliability and validity have been established. Validating the Recommendations. A feedback survey questionnaire was sent to 324 practitioners from 6 professional organizations. The response rate was 51%. Results. Four positive recommendations of clinical benefit were developed. Therapeutic exercises were found to be beneficial for chronic, subacute, and postsurgery low back pain. Continuation of normal activities was the only intervention with beneficial effects for acute low back pain. These recommendations were mainly in agreement with previous EBCPGs, although some were not covered by other EBCPGs. There was wide agreement with these recommendations from practitioners (greater than 85%). For several interventions and indications (eg, thermotherapy, therapeutic ultrasound, massage, electrical stimulation), there was a lack of evidence regarding efficacy. Conclusions. This methodology of developing EBCPGs provides a structured approach to assessing the literature and developing guidelines that incorporates clinicians' feedback and is widely acceptable to practicing clinicians. Further well-designed RCTs are warranted regarding the use of several interventions for patients with low back pain where evidence was insufficient to make recommendations.

The Bath Ankylosing Spondylitis patient Global score (BAS-G)

Article

Full-text available

Jan 1996

In the absence of an ideal objective measure for assessing ankylosing spondylitis (AS), self-administered measures of disease activity (the Bath Ankylosing Spondylitis Disease Activity Index, BASDAI) and function (the Bath Ankylosing Spondylitis Functional Index, BASFI) have been developed, in addition to an objective measure of spinal mobility (the Bath Ankylosing Spondylitis Metrology Index, BASMI). However, a more global assessment is also desirable. We report on the design and validation of a global measure (the Bath Ankylosing Spondylitis Patient Global Score, BAS-G) which reflects the effect of AS on the patient's well-being. A pilot study was performed to select the most appropriate wording for BAS-G. Using 392 patients with AS, BAS-G's construct and predictive validity and test-retest reliability were assessed. Correlations between BAS-G and BASDAI/BASFI were calculated, and multiple regression was used to examine the significant correlates. The distribution of the responses covered the whole scale. As predicted, BAS-G correlated best with BASDAI (r=0.73), followed by BASFI (r=0.54). The best fitting regression equation included these scales as well as patients' gender and current age. One week and 6 month scores were significantly different (P<0.001). Construct validity was good: BAS-G correlated more strongly with each component of BASDAI and BASFI than with BASMI or with gender. Predictive validity was satisfactory: there was an improvement (mean=29%) in in-patient BAS-G scores over a 2 week treatment period (P<0.001). Test-retest reliability was excellent (1 week r=0.84, 6 months r=0.93). BAS-G correlates well with both BASDAI and BASFI, suggesting that disease activity and functional ability play a major role in patients' well-being, whereas metrology does not. The score is sensitive to change, reliable, and meets face, predictive and construct validity criteria.

Physiotherapy in akylosing spondylitis: What is the evidence?

Article

Full-text available

Nov 2002

Evidence on the value of some current physiotherapeutic practices and the ineffectiveness of others is accumulating. This paper addresses the best evidence available on the efficacy and effectiveness of physiotherapeutic modalities in ankylosing spondylitis. General issues in the assessment of physiotherapy in this disease are briefly discussed. Core sets for assessments are nowadays available. A recent Cochrane review on this topic supports the (at least short-term) positive effects of physiotherapy in particular exercise, in the management of ankylosing spondylitis. Some details of the included studies are provided.

The effectiveness of intensive group exercise on patients with ankylosing spondylitis

Article

Full-text available

Sep 2003

Objective: 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. Design: Fifty-one patients with AS were randomly allocated into study and control groups. The study was designed as a prospective, double-blind study. Setting: Outpatient department, Istanbul Medical Faculty. Subjects: Patients who consulted with complaints of pain, morning stiffness and restricted range of movement with a confirmed diagnosis of ankylosing spondylitis. Interventions: 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. Main outcome measures: 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). Results: 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. Conclusion: Group exercise in hospital may be more effective than home-based exercises at reducing impairment associated with ankylosing spondylitis.

Is group physical therapy superior to individualized therapy in ankylosing spondylitis? A randomized controlled trial

Article

Jan 1993

Purpose. To study the effects of adding supervised group physical therapy to unsupervised individualized therapy in ankylosing spondylitis. Methods. One hundred forty-four patients were randomized to exercises at home, or the same plus weekly group physical therapy for 9 months. Endpoints were spinal mobility, fitness (maximum work capacity by ergometry), functioning (Sickness Impact Profile, Health Assessment Questionnaire for the Spondylarthropathies, and Functional Index), and patient's global assessment of change on a 10-cm visual analogue scale. Results. Thoracolumbar flexion and extension increased by an average of 0.5 cm (9%) after home exercises, and by 0.9 cm (16%) after group therapy. Maximum load in ergometry decreased by 2 W (1%) after home exercises, but increased by 7 W (4%) after group therapy. Global assessment improved by 0.3 (6%) after home exercises, and by 1.7 (34%) after group therapy. These three differences were statistically significant. There were no significant differences in chest expansion, cervical rotation, or the self-assessments of functioning. Conclusions. Group physical therapy proved superior to individualized therapy in improving thoracolumbar mobility and fitness, and had an important effect on global health reported by the patients.

Continuation of group physical therapy is necessary in ankylosing spondylitis. Results of a randomized controlled trial

Article

Jan 1994

Purpose. Group physical therapy in patients with ankylosing spondylitis was studied to determine whether beneficial effects persisted after cessation of the intervention. Methods. After a 9-month period of supervised group physical therapy, 68 patients were randomized for another 9 months to unsupervised daily exercises at home (discontinuation group) or continuation of weekly sessions of supervised group physical therapy (continuation group). Endpoints were spinal mobility (thoraco-lumbar flexion and extension, chest expansion, cervical rotation), fitness (maximum work capacity), functioning (Sickness Impact Profile (SIP), Health Assessment Questionnaire for the Spondylarthropathies [HAQ-S], Functional Index [FI]), and patient's global health assessment on a visual analogue scale. Results. Time for exercises at home was significantly higher in the continuation than in the discontinuation group (mean duration 1.9 versus 1.2 hr per week, P < 0.05). The continuation group improved in global health (mean improvement 1.6, 32%) and in SIP score. Scores for thoraco-lumbar mobility and HAQ-S did not change very much, whereas chest expansion, cervical rotation, fitness, and FI deteriorated. The average attendance for group therapy sessions was 62%. The discontinuation group improved only marginally (0.2; 4%) in global health, whereas all other endpoints decreased. Only for global health and HAQ-S were the differences statistically significant in favor of the continuation group. Conclusions. Global health and functioning are sustained or even improved further if group physical therapy is continued. Spinal mobility decreased slightly in both groups.

Grading quality of evidence and strength of recommendationsGRADEBMJ20043281490

Article

Jan 2004

GRADE_Working_Group

Rheumatological Physiotherapy

Article

Jul 2001

Judy Robinson MCSP Diane Simpson MCSP

Combined spa-exercise therapy is effective in patients with ankylosing spondylitis: A randomized controlled trial

Article

Oct 2001
ARTHRIT RHEUM-ARTHR

Objective To determine the efficacy of combined spa–exercise therapy in addition to standard treatment with drugs and weekly group physical therapy in patients with ankylosing spondylitis (AS).MethodsA total of 120 Dutch outpatients with AS were randomly allocated into 3 groups of 40 patients each. Group 1 (mean age 48 ± 10 years; male:female ratio 25:15) was treated in a spa resort in Bad Hofgastein, Austria; group 2 (mean age 49 ± 9 years; male:female ratio 28:12) in a spa resort in Arcen, The Netherlands. The control group (mean age 48 ± 10 years; male:female ratio 34:6) stayed at home and continued their usual drug treatment and weekly group physical therapy during the intervention weeks. Standardized spa–exercise therapy of 3 weeks duration consisted of group physical exercises, walking, correction therapy (lying supine on a bed), hydrotherapy, sports, and visits to either the Gasteiner Heilstollen (Austria) or sauna (Netherlands). After spa–exercise therapy all patients followed weekly group physical therapy for another 37 weeks. Primary outcomes were functional ability, patient's global well-being, pain, and duration of morning stiffness, aggregated in a pooled index of change (PIC).ResultsAnalysis of variance showed a statistically significant time–effect (P < 0.001) and time-by-treatment interaction (P = 0.004), indicating that the 3 groups differed over time with respect to the course of the PIC. Four weeks after start of spa–exercise therapy, the mean difference in PIC between group 1 and controls was 0.49 (95% confidence interval [CI] 0.16–0.82, P = 0.004) and between group 2 and controls was 0.46 (95% CI 0.15–0.78, P = 0.005). At 16 weeks, the difference between group 1 and controls was 0.63 (95% CI 0.23–1.02, P = 0.002) and between group 2 and controls was 0.34 (95% CI − 0.05–0.73; P = 0.086). At 28 and 40 weeks, more improvement was found for group 1 compared with controls (P = 0.012 and P = 0.062, respectively) but not for group 2 compared with controls.Conclusion In patients with AS, a 3-week course of combined spa–exercise therapy, in addition to drug treatment and weekly group physical therapy alone, provides beneficial effects. These beneficial effects may last for at least 40 weeks.

Management Principles of Physiotherapy in Ankylosing Spondylitis — Which Treatments are Effective?

Article

Jun 1995
PHYSIOTHERAPY

Physiotherapy is one of the most important modes of therapeutic intervention in the course of ankylosing spondylitis (AS), playing a dominant role in the prevention of functional impairment. Despite their great importance the methodology for using physiotherapy modalities has not yet been established and the potential of physiotherapy is, in many respects, poorly understood. A résumé of actual biomechanical and pathophysiological knowledge is presented as a basis for the future development of clinical practice in AS and in addition, a review of published evaluations of physiotherapy outcome.Intensive in-patient courses and out-patient programmes for people with AS have been shown to be effective, although varying greatly in results, but few studies so far have been controlled and reliably analysed.

A Randomised Trial of Three Different Physiotherapy Regimes in Ankylosing Spondylitis

Article

Feb 1996
PHYSIOTHERAPY

SummaryWe randomised 44 patients with ankylosing spondylitis to receive (a) intensive in-patient physiotherapy, (b) out-patient hydrotherapy and home exercises, or (c) home exercises alone. Assessments were made at two time points prior to treatment, immediately after treatment, and two, four and six months after treatment. The hydrotherapy regimes produced significantly better short-term improvement in cervical rotation than the exercise only regime, and both in-patient and hydrotherapy patients reported more subjective improvement. However, at six months, there were no differences in outcomes between the three groups.

Epidemiology of the rheumatic diseases

Article

Jan 2002

F Guillemin

Effect of Physiotherapy on Spinal Mobility in Ankylosing Spondylitis

Article

Feb 1992

The efficacy of intensive inpatient physiotherapy was retrospectively analysed in 505 adult patients with ankylosing spondylitis (AS). Eight different measures of thoracic and spinal mobility were collected from the patients' medical records. Recovery in terms of the following measures was 7 to 37% when results after rehabilitation were compared to those taken before: thoracolumbar flexibility (TLF) 15%, the Schober test 12.4%, occiput to wall distance (OWD) 30.8%, cervical rotation 22.6%, chin to chest distance (CCD) 21.7%, finger to floor distance (FFD) 36.6%, chest expansion (CE) 31.3%, vital capacity (VC) 7.4%. Changes in all measures were statistically significant (p less than 0.001). OWD, CE and FFD showed greatest improvement. The average increase in CE was about 1 cm in both sexes and the average increase in VC200 ml in men and 270 ml in women, which indicates improvement in ventilatory capacity. Mobility in the majority of patients improved, though in 2 to 8% range of motion (ROM) deteriorated during the course.

Is there sexual inequality in ankylosing spondylitis? A study of 498 women and 1202 men

Article

Jan 1991

The responses of 1700 members (1202 men) of the National Ankylosing Spondylitis Society to a self-administered questionnaire were analyzed. The male:female ratios for primary ankylosing spondylitis, psoriatic spondylitis and spondylitis associated with inflammatory bowel disease were 2.4:1, 3.5:1 and 1:1, respectively. A positive family history was significantly less prevalent in men than women as were hand, elbow, shoulder and knee symptoms. In a parallel radiographic study, 100 men matched for age of onset and disease duration with 50 women demonstrated similar sacroiliac, cervical and hip disease but worse involvement of the lumbar spine.

The effects of comprehensive home physiotherapy and supervision on patients with ankylosing spondylitis - A randomized controlled trial

Article

Mar 1990

Fifty-three patients with ankylosing spondylitis (AS) were randomly allocated; 26 experimental patients received physiotherapy and disease education, 27 control patients received neither. The primary treatment outcome was change in spinal mobility measured at 4 months by fingertip-to-floor distance. Experimental patients had more improvement in fingertip-to-floor distance (p2 less than 0.004) and in function (p2 less than 0.001) than control patients. Physiotherapy with disease education is effective in the treatment of patients with AS.

Publication Bias and Clinical Trials

Article

Jan 1988
Contr Clin Trials

A study was performed to evaluate the extent to which the medical literature may be misleading as a result of selective publication of randomized clinical trials (RCTs) with results showing a statistically significant treatment effect. Three hundred eighteen authors of published trials were asked whether they had participated in any unpublished RCTs. The 156 respondents reported 271 unpublished and 1041 published trials. Of the 178 completed unpublished RCTs with a trend specified, 26 (14%) favored the new therapy compared to 423 of 767 (55%) published reports (p less than 0.001). For trials that were completed but not published, the major reasons for nonpublication were "negative" results and lack of interest. From the data provided, it appears that nonpublication was primarily a result of failure to write up and submit the trial results rather than rejection of submitted manuscripts. The results of this study imply the existence of a publication bias of importance both to meta-analysis and the interpretation of statistically significant positive trials.

The role of passive stretching in the treatment of ankylosing spondylitis

Article

Mar 1987

A controlled study of 39 consecutively-admitted patients with ankylosing spondylitis was conducted to assess the effects of daily passive stretching of the hip joints during a 3-week in-patient physiotherapy course. Measurements were performed by an independent assessor on admission, at discharge and six months after discharge. Results showed that passive stretching resulted in a significant increase in the range of all movements of the hip joints except flexion during the physiotherapy course. Follow-up at 6 months in seven patients suggested that this increase in range of movement could be maintained by patients who had been performing the stretching exercises regularly. We suggest that the inclusion of passive stretching of the hip joint in the treatment of patients with ankylosing spondylitis will increase the range of movement and thus improve function and influence posture.

New York clinical criteria for ankylosing spondylitis. A statistical evaluation

Article

Aug 1973

The New York clinical criteria for ankylosing spondylitis have been evaluated. In a study of 412 subjects, clinical examination was carried out subjectively and objectively. Criterion evaluation was applied to both subjective and objective data. The following points emerged from the investigation: (a) No overall difference was found between subjective and objective results; (b) Calculated in terms of frequency of positive and false nagative tests, sensitivity, and the Youden index (sensitivity + specificity - 100), criteria were listed in the following order of value: (i) Thoraco lumbar pain, (ii) Limited chest expansion, (iii) Limited back movement. However, in terms of false positive tests and specificity, the reverse order was obtained. It was calculated that individual criteria in their present form fail to provide a satisfactory diagnostic index of ankylosing spondylitis. Thoraco lumbar pain is too sensitive and too non specific, and limited chest and back mobility are too insensitive and too specific. In order to obviate this problem it is suggested that criteria should be numerically weighted.

Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York Criteria

Article

May 1984

The New York and the Rome diagnostic criteria for ankylosing spondylitis (AS) and the clinical history screening test for AS were evaluated in relatives of AS patients and in population control subjects. The New York criterion of pain in the (dorso) lumbar spine lacks specificity, and the chest expansion criterion is too insensitive. The Rome criterion of low back pain for more than 3 months is very useful. Our study showed the clinical history screening test for AS to be moderately sensitive, but it might be better in clinical practice. As a modification of the New York criteria, substitution of the Rome pain criterion for the New York pain criterion is proposed.

A new approach to defining disease status in AS: the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI)

Article

Dec 1994

Disease status, in terms of disease activity, disease progression and prognosis is difficult to define in ankylosing spondylitis (AS). No gold standard exists. Therefore, the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), a self-administered instrument, has been developed as a new approach to defining disease activity in patients with AS. The index, designed by a multidisciplinary team with input from patients, consists of six 10 cm horizontal visual analog scales to measure severity of fatigue, spinal and peripheral joint pain, localized tenderness and morning stiffness (both qualitative and quantitative). The final BASDAI score has a range of 0 to 10. The index was distributed to a cross section of patients, including inpatients receiving 3 weeks of intensive physiotherapy treatment and hospital outpatients. BASDAI was completed by a total of 154 patients. Validation of the new instrument was achieved through analysis of user friendliness, reliability (consistency), score distribution and sensitivity to change. Comparisons were made with a previous Bath disease activity index (DAI) and the Newcastle Enthesis Index. The BASDAI was found by patients to be quick and simple to complete (mean: 67 s). Test-retest reliability was good (r = 0.93; p < 0.001), as was the distribution of scores across the scale (score range: 0.5-10; mean: 4.31). BASDAI was sensitive to change, reflecting a 16% (mean) improvement in inpatient scores after 3 weeks of treatment. It is superior to the DAI in terms of construct and content validity and to the Enthesis Index in all aspects. In summary, BASDAI is user friendly, reliability, sensitive to change and reflects the entire spectrum of disease. It is a comprehensive self-administered instrument for assessing disease activity in AS.

A new approach to defining functional ability in ankylosing spondylitis: the development of the Bath Ankylosing Spondylitis Functional Index

Article

Dec 1994

After pain and stiffness, one of the most important complaints of patients with ankylosing spondylitis (AS) is disability. The main aims of treatment are to control pain but also to improve function. Various methods of assessing function exist but are either not specific for the disease or have not been adequately validated. As a result of this deficiency we developed the Bath Ankylosing Spondylitis Functional Index (BASFI) as a new approach to defining and monitoring functional ability in patients with AS. This self-assessment instrument was designed by a team of medical professionals in conjunction with patients, and consists of 8 specific questions regarding function in AS and 2 questions reflecting the patient's ability to cope with everyday life. Each question is answered on a 10 cm horizontal visual analog scale, the mean of which gives the BASFI score (0-10). The questionnaire was completed 257 times in total: once by 116 outpatients and by 47 inpatients on 3 occasions over a 3-week intensive physiotherapy course. In addition, the instrument was compared with the Dougados functional index. Patients scores covered 95% of the BASFI range, giving a normal distribution of results. In contrast only 65% of the Dougados functional index scale was used. Furthermore, over the 3 week period of inpatient treatment, the BASFI revealed a significant improvement in function (20%, p = 0.004) while there was a less impressive change in the Dougados functional index (6%, p = 0.03). This demonstrates the superior sensitivity of the BASFI: Consistency was good for both indices (p < 0.001), as was the relationship between patient perception of function and function as assessed by an external observer (p < 0.001). The BASFI satisfies the criteria required of a functional index: it is quick and easy to complete, is reliable and is sensitive to change across the whole spectrum of disease.

Exercise in the spondyloarthropathies

Article

Dec 1994

Victoria Gall

Continuation of group physical therapy is necessary in ankylosing spondylitis. Results of a randomized controlled trial

Article

Jun 1994

Group physical therapy in patients with ankylosing spondylitis was studied to determine whether beneficial effects persisted after cessation of the intervention. After a 9-month period of supervised group physical therapy, 68 patients were randomized for another 9 months to unsupervised daily exercises at home (discontinuation group) or continuation of weekly sessions of supervised group physical therapy (continuation group). Endpoints were spinal mobility (thoraco-lumbar flexion and extension, chest expansion, cervical rotation), fitness (maximum work capacity), functioning (Sickness Impact Profile (SIP), Health Assessment Questionnaire for the Spondylarthropathies [HAQ-S], Functional Index [FI]), and patient's global health assessment on a visual analogue scale. Time for exercises at home was significantly higher in the continuation than in the discontinuation group (mean duration 1.9 versus 1.2 hr per week, P < 0.05). The continuation group improved in global health (mean improvement 1.6; 32%) and in SIP score. Scores for thoraco-lumbar mobility and HAQ-S did not change very much, whereas chest expansion, cervical rotation, fitness, and FI deteriorated. The average attendance for group therapy sessions was 62%. The discontinuation group improved only marginally (0.2; 4%) in global health, whereas all other endpoints decreased. Only for global health and HAQ-S were the differences statistically significant in favor of the continuation group. Global health and functioning are sustained or even improved further if group physical therapy is continued. Spinal mobility decreased slightly in both groups.

Is group physical therapy superior to individualized therapy in ankylosing spondylitis? A randomized controlled trial

Article

Sep 1993

To study the effects of adding supervised group physical therapy to unsupervised individualized therapy in ankylosing spondylitis. One hundred forty-four patients were randomized to exercises at home, or the same plus weekly group physical therapy for 9 months. Endpoints were spinal mobility, fitness (maximum work capacity by ergometry), functioning (Sickness Impact Profile, Health Assessment Questionnaire for the Spondylarthropathies, and Functional Index), and patient's global assessment of change on a 10-cm visual analogue scale. Thoracolumbar flexion and extension increased by an average of 0.5 cm (9%) after home exercises, and by 0.9 cm (16%) after group therapy. Maximum load in ergometry decreased by 2 W (1%) after home exercises, but increased by 7 W (4%) after group therapy. Global assessment improved by 0.3 (6%) after home exercises, and by 1.7 (34%) after group therapy. These three differences were statistically significant. There were no significant differences in chest expansion, cervical rotation, or the self-assessments of functioning. Group physical therapy proved superior to individualized therapy in improving thoracolumbar mobility and fitness, and had an important effect on global health reported by the patients.

The effects of comprehensive home physiotherapy and supervision on patients with ankylosing spondylitis - An 8-month followup

Article

Mar 1994

Our previous randomized clinical trial showed a 4-month home physiotherapy program was effective for patients with ankylosing spondylitis. This followup study reports on 22 control patients who received the previously withheld treatment and 24 experimental patients who received followup treatment as needed. The primary outcome measure was spinal mobility measured by fingertip-to-floor distance using a portable measuring device specially designed and validated for this study. Following treatment, fingertip-to-floor distance did not change in control patients (P2 = 0.145). Between 4 and 8 months, fingertip-to-floor distance did not change in experimental patients (P2 = 0.143); however, initial improvement achieved was maintained. The experimental group at 4 months was better than the control group at 8 months (P2 = 0.038). The home physiotherapy treatment program must be delivered as rigorously as it was in the initial trial to be effective. The benefit from this treatment program can be maintained with very little intervention.

The epidemiology of ankylosing spondylitis

Article

May 1993
SEMIN ARTHRITIS RHEU

This review focuses on various epidemiological aspects of ankylosing spondylitis (AS). Diagnostic criteria currently available are described, and their use in scientific studies as opposed to everyday clinical practice is discussed. Present knowledge of the prevalence of AS is addressed in detail with particular emphasis on discrepancies caused by variations in population frequencies of HLA B27 and those caused by differences in study designs.

Ankylosing spondylitis. Clinical features

Article

Dec 1998
RHEUM DIS CLIN N AM

The association between ankylosing spondylitis and human leukocyte antigen (HLA) B27 was reported for the first time in 1973.34 This finding has stimulated quite a lot of research in many aspects of ankylosing spondylitis. However, the cause of the disease is still largely unknown. It has been postulated that an infectious agent ( possibly Klebsiella), in some way interacting with HLA-B27, may trigger the disease.17 This theory is analogous to the situation in reactive arthritis or Reiter's syndrome where bowel infection owing to certain Shigella, Salmonella, Yersinia, or Campylobacter strains may cause disease. Also, the association between ankylosing spondylitis and chronic inflammatory bowel diseases (Crohn's disease and ulcerative colitis) has stimulated the idea that the causative agent in ankylosing spondylitis might belong to the (ubiquitous) bowel flora. This article briefly reviews the state of the art one quarter of a century later. It focuses on those topics that are most relevant from the clinical point of view.

Selection of instruments in the core set for DC-ART, SMARD, physical therapy, and clinical record keeping in ankylosing spondylitis. Progress report of the ASAS Working Group

Article

May 1999

To select specific instruments for each domain of the core set for endpoints in ankylosing spondylitis (AS), we gathered all instruments described in the literature to assess the domains chosen as endpoints in AS and sent them to 43 members of the Assessments in Ankylosing Spondylitis (ASAS) Working Group. The following domains were taken into account: function, pain, spinal mobility, patient global assessment, morning stiffness, peripheral joints and entheses, acute phase reactants, x-ray spine, x-ray hips, fatigue. For each instrument the members were asked to judge if the instrument was feasible and relevant. If an instrument was judged to be not feasible or not relevant by more than 50% of the respondents the instrument was deleted from the list. These data were presented during an ASAS workshop and the final decisions were about which instruments to include in the core set. This process was repeated separately for the settings disease controlling antirheumatic therapy (DC-ART), symptom modifying antirheumatic drugs (SMARD) and physical therapy, and clinical record keeping. The response rate to the questionnaire was 72%. For each domain one or more instruments were selected, except for Entheses and Fatigue. The chosen instruments were similar for the 3 above settings. Core sets of specific instruments were selected for the OMERACT filter test for relevance and feasibility. For all these instruments the remaining aspects of the OMERACT filter (truth and discrimination) should be assessed by literature review and if needed by additional research. It is recommended to use these instruments in all research projects in AS.

Clinical aspects, outcome assessment, and management of ankylosing spondylitis and postenteric reactive arthritis

Article

Aug 2000

The cause of ankylosing spondylitis remains unclear. Proof that this disorder is an autoimmune disease attributable to crossreactivity between bacteria and HLA-B27 is still lacking. Differences in endogenous peptide presentation by HLA-B27 subtypes might be relevant in the etiopathogenesis. Fractures of the osteoporotic spine contribute to morbidity. Spinal cord injury may occur. MR imaging enables identifying sacroiliitis earlier than plain radiography. Sweet syndrome has now been described in patients with ankylosing spondylitis and Crohn disease. Progress has been made in the assessment of ankylosing spondylitis. There are now core sets for different settings and validated instruments for functioning and disease activity that will enable demonstrating efficacy of new therapeutic interventions. The debate continues on classification of postinfectious and reactive arthritis. Bacterial antigens may be found in the inflamed joints; occasionally 16S ribosomal RNA is also demonstrated. Antibiotics seem not to be effective in postenteric reactive arthritis. More than 25 years have now elapsed since the association between ankylosing spondylitis and HLA-B27 was first described in 1973. The cause of this disease is still unknown, but a lot of progress has been made regarding the molecular structure of HLA-B27, the spectrum of disease, the clinical and radiographic assessment of ankylosing spondylitis, and its treatment. Recent advances in research on ankylosing spondylitis are reviewed here.

Combined spa-exercise therapy is effective in patients with ankylosing spondylitis: A randomized controlled trial

Article

Nov 2001

To determine the efficacy of combined spa-exercise therapy in addition to standard treatment with drugs and weekly group physical therapy in patients with ankylosing spondylitis (AS). A total of 120 Dutch outpatients with AS were randomly allocated into 3 groups of 40 patients each. Group 1 (mean age 48 +/- 10 years; male:female ratio 25:15) was treated in a spa resort in Bad Hofgastein, Austria; group 2 (mean age 49 +/- 9 years; male:female ratio 28:12) in a spa resort in Arcen, The Netherlands. The control group (mean age 48 +/- 10 years; male:female ratio 34:6) stayed at home and continued their usual drug treatment and weekly group physical therapy during the intervention weeks. Standardized spa-exercise therapy of 3 weeks duration consisted of group physical exercises, walking, correction therapy (lying supine on a bed), hydrotherapy, sports, and visits to either the Gasteiner Heilstollen (Austria) or sauna (Netherlands). After spa-exercise therapy all patients followed weekly group physical therapy for another 37 weeks. Primary outcomes were functional ability, patient's global well-being, pain, and duration of morning stiffness, aggregated in a pooled index of change (PIC). Analysis of variance showed a statistically significant time-effect (P < 0.001) and time-by-treatment interaction (P = 0.004), indicating that the 3 groups differed over time with respect to the course of the PIC. Four weeks after start of spa-exercise therapy, the mean difference in PIC between group 1 and controls was 0.49 (95% confidence interval [CI] 0.16-0.82, P = 0.004) and between group 2 and controls was 0.46 (95% CI 0.15-0.78, P = 0.005). At 16 weeks, the difference between group 1 and controls was 0.63 (95% CI 0.23-1.02, P = 0.002) and between group 2 and controls was 0.34 (95% CI--0.05-0.73; P = 0.086). At 28 and 40 weeks, more improvement was found for group 1 compared with controls (P = 0.012 and P = 0.062, respectively) but not for group 2 compared with controls. In patients with AS, a 3-week course of combined spa-exercise therapy, in addition to drug treatment and weekly group physical therapy alone, provides beneficial effects. These beneficial effects may last for at least 40 weeks.

Physiotherapy interventions for Ankylosing Spondylitis

Article

Feb 2001

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.

The effect of a home based exercise intervention package on outcome in ankylosing spondylitis: A randomized controlled trial

Article

Apr 2002

Home based self-care is essential for successful management of ankylosing spondylitis (AS). We designed an intervention package aimed at promoting self-care and regular longterm exercise and evaluated its effect on outcome. Members of our database (n = 4569) were randomly selected and randomized to an intervention group (IG) or a followup control group (CG). The intervention consisted of an exercise/information video, exercise progress chart, patient education booklet, and AS exercise reminder stickers. The outcome measures were function (BASFI), disease activity (BASDAI), global well being (BAS-G), exercise self-efficacy (ESE), arthritis self-efficacy (SES), and quantity of AS mobility/aerobic exercise assessed at baseline and 6 months. Of the 200 subjects, 155 completed the study (75 IG and 80 CG). Baseline analysis showed no differences between the CG and the IG. At 6 months, analysis revealed no statistically significant between-group differences for the BASFI, BASDAI, and BAS-G. although the p value of 0.08 for function approached significance. Self-efficacy for exercise showed a significant improvement in the IG (p = 0.045). There were no between-group differences for the SES pain and other symptoms subscales. Finally, there was a significant increase in self-reported AS mobility (p < 0.001) and aerobic exercise (p < 0.05) in the IG. An exercise intervention package designed to promote self-management in AS (1) significantly improves self-efficacy for exercise; (2) significantly improves self-reported levels of exercise; (3) reveals a trend for improvement in function (BASFI).

Cost effectiveness of combined spa-exercise therapy in ankylosing spondylitis: A randomized controlled trial

Article

Oct 2002

To evaluate the cost effectiveness and cost utility of a 3-week course of combined spa therapy and exercise therapy in addition to standard treatment consisting of antiinflammatory drugs and weekly group physical therapy in ankylosing spondylitis (AS) patients. A total of 120 Dutch outpatients with AS were randomly allocated into 3 groups of 40 patients each. Group 1 was treated in a spa resort in Bad Hofgastein, Austria; group 2 in a spa resort in Arcen, The Netherlands. The control group stayed at home and continued their usual activities and standard treatment during the intervention weeks. After the intervention, all patients followed weekly group physical therapy. The total study period was 40 weeks. Effectiveness of the intervention was assessed by functional ability using the Bath Ankylosing Spondylitis Function Index (BASFI). Utilities were measured with the EuroQoL (EQ-5D(utility)). A time-integrated summary score defined the clinical effects (BASFI-area under the curve [AUC]) and utilities (EQ-5D(utility)-AUC) over time. Both direct (health care and non-health care) and indirect costs were included. Resource utilization and absence from work were registered weekly by the patients in a diary. All costs were calculated from a societal perspective. A total of 111 patients completed the diary. The between-group difference for the BASFI-AUC was 1.0 (95% confidence interval [95% CI] 0.4-1.6; P = 0.001) for group 1 versus controls, and 0.6 (95% CI 0.1-1.1; P = 0.020) for group 2 versus controls. The between-group difference for EQ-5D(utility)-AUC was 0.17 (95% CI 0.09-0.25; P < 0.001) for group 1 versus controls, and 0.08 (95% CI 0.00-0.15; P = 0.04) for group 2 versus controls. The mean total costs per patient (including costs for spa therapy) in Euros (euro;) during the study period were euro;3,023 for group 1, euro;3,240 for group 2, and euro;1,754 for the control group. The incremental cost-effectiveness ratio per unit effect gained in functional ability (0-10 scale) was euro;1,269 (95% CI 497-3,316) for group 1, and euro;2,477 (95% CI 601-12,098) for group 2. The costs per quality-adjusted life year gained were euro;7,465 (95% CI 3,294-14,686) for group 1, and euro;18,575 (95% CI 3,678-114,257) for group 2. Combined spa-exercise therapy besides standard treatment with drugs and weekly group physical therapy is more effective and shows favorable cost-effectiveness and cost-utility ratios compared with standard treatment alone in patients with AS.

Clinical care in the rheumatic diseases

Jan 2001

L Robbins
Cs Burckhardt
Mt Hannan
De

Robbins L, Burckhardt CS, Hannan MT, De Horatius, editors. Clinical care in the rheumatic diseases. 2nd ed. Atlanta: Association of Rheumatology Health Professionals; 2001.

Ankylosing spondylitis

Jan 1998

M Khan
Klippel Jh
Dieppe

Khan M. Ankylosing spondylitis. In: Klippel JH, Dieppe PA. Rheumatology. 2nd ed. London: Mosby; 1998.

Cochrane Musculoskeletal Group methods; draft guidelines

Jan 2003

Cochrane Musculoskeletal

Cochrane Musculoskeletal Group. Cochrane Musculoskeletal Group methods; draft guidelines. Cochrane Musculoskeletal Group; 2003.

Two arm clinical trial evaluating exercise in ankylosing spondylitis with a metrology index as the primary outcome variable [abstract]

Jan 2000
548

K Pickering

Pickering K. Two arm clinical trial evaluating exercise in ankylosing spondylitis with a metrology index as the primary outcome variable [abstract]. Aust NZ J Med 2000;30:548.

Publication bias and clinical trials Dagfinrud, et al: Cochrane review Personal non-commercial use only All rights reserved APPENDIX The RCT included in this review. Personal non-commercial use only All rights reserved

Jan 1905
343-5310

K Dickersin
Chalmers S Chan
Tc
Hs Sacks
Smith

Dickersin K, Chan S, Chalmers TC, Sacks HS, Smith H Jr. Publication bias and clinical trials. Control Clin Trials 1987;8:343-53. 1905 Dagfinrud, et al: Cochrane review Personal non-commercial use only. The Journal of Rheumatology Copyright © 2005. All rights reserved. 1906 The Journal of Rheumatology 2005; 32:10 APPENDIX The RCT included in this review. Personal non-commercial use only. The Journal of Rheumatology Copyright © 2005. All rights reserved.

The Cochrane review of physiotherapy interventions for ankylosing spondylitis

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