Background Ankylosing spondylitis (AS) is chronic inflammatory disease that affects primarily the spine and the sacroiliac joints. ASAS/EULAR guidelines describe regular exercise as the cornerstone of non-pharmacological treatment and pharmacological treatments including non-steroidal anti-inflammatory drugs as first-line therapy, and a tumour necrosis factor (TNF) alpha inhibitor (anti-TNFα) as second-line medication in patients with persistently high disease activity despite conventional pharmacological treatment in patients with AS.
Objectives The purpose of this study was to investigate the effects of combination therapy with global postural reeducation exercise (GPR) and Anti-TNF treatments on pain, disease activity, mobility, fatigue, sleep quality, and depression in patients with active AS.
Methods 60 active AS patients who meet the criteria of Modified New York and/or ASAS axial spondyloarthropathy were included in the study. Patients were divided into 3 groups. The first group was given anti-TNF therapy plus GPR exercise program. The 2nd group was given anti-TNF and conventional exercise therapy. The 3rd group was given routine exercise program along with their existing treatments (NSAIDs and/or SLZ). Following inventories are used for clinical evaluation: for disease activity – Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), for functionality – Bath Ankylosing Spondylitis Functional Index (BASFI), for mobility – lumbar Schober, chest expansion, hand-finger to floor distance, for fatigue – fatigue Multidimensional Assessment Questionnaire (MAF), for sleep quality – Pittsburgh sleep quality index (PSQI), for depression – Beck depression Inventory (BDI). All patients were evaluated before treatment and at 3 months.
Results The demographic characteristics of the patients were compared and there was no significant difference between the groups. The improvements in all parameters were better in both groups receiving exercise and anti-TNF therapy than in the control group after treatment compared with baseline. The Anti-TNF + GPR exercise therapy resulted in greater improvements than the anti TNF+ conventional exercise therapy in pain, and mobility parameters.
Conclusions Anti-TNF therapy and exercise were efficient in both groups on improving pain, disease activity, fatigue, sleep quality, and depression. However, the improvements in pain and mobility were greater in the active AS patients with GPR exercise method. Therefore motivated patients should be encouraged to perform this exercise program.
Lubrano E, Spadaro A, Amato S, et al. Tumour necrosis factor alpha inhibitor therapy and rehabilitation for the treatment of ankylosing spondylitis: A systematic review. Seminars in Arthritis and Rheumatism. 44(2015)542–550.
Disclosure of Interest None declared