Effect of physiotherapy on spinal mobility in ankylosing spondylitis.

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.     

Spinal mobility in ankylosing spondylitis: reliability, validity and responsiveness

OBJECTIVE: To evaluate the measurement properties of an evidence-based selection of measures of spinal mobility in patients with ankylosing spondylitis (AS). METHODS: Measurements of spinal mobility were taken by trained observers within a UK rheumatology centre. Inter-observer reliability was assessed. Intra-observer reliability was assessed in patients reporting no change in AS-specific health at 2 weeks. Validity was assessed and scores were correlated with responses to health transition questions. Responsiveness was evaluated for patients reporting change in health at 6 months. RESULTS: Reliability estimates support the use of all measures in individual evaluation (intraclass correlation>0.90). Correlations between measures of spinal mobility were in the hypothesized direction; the largest was between the modified Schober index (15 cm) (MSI) and the other measures. As hypothesized, small to moderate levels of correlation were found between mobility measures and patient-assessed health status. There was no significant linear relationship between mobility measures and self-reported health transition. Fingertip-to-floor distance following trunk forward flexion (FFD) was the most responsive mobility measure but was not as responsive as two AS-specific patient-assessed instruments, the Ankylosing Spondylitis Quality of Life Questionnaire (ASQoL) and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). The MSI and cervical rotation (Crot) also had evidence of responsiveness. Low levels of responsiveness were found for the remaining measures. CONCLUSION: All mobility measures had adequate levels of reliability and validity. The MSI had a strong relationship with all mobility measures, and the FFD and Crot were the most responsive to self-perceived changes in health at 6 months. The MSI, FFD and Crot are recommended for clinical practice and research.     

Neck movements in ankylosing spondylitis and their responses to physiotherapy.

Cervical spine movements were compared in 35 patients with ankylosing spondylitis (AS) and matched controls. In AS there were limitations of all movements and particularly of lateral flexion. These limitations could not be correlated with any particular features of AS except radiological involvement of the lower apophyseal joints. In 25 patients there were significant improvements in all measurements after 3 weeks of intensive inpatient physiotherapy. After discharge the patients were encouraged to perform unsupervised physiotherapy and in 11 patients seen at 3 months the improvements in neck movements were either maintained or increased further. In contrast no changes in movements were found in 9 patients assessed 3 weeks and immediately before starting physiotherapy.     

Adalimumab reduces pain, fatigue, and stiffness in patients with ankylosing spondylitis: results from the adalimumab trial evaluating long-term safety and efficacy for ankylosing spondylitis (ATLAS)

OBJECTIVE: To evaluate the effect of adalimumab on pain, fatigue, and stiffness in patients with active ankylosing spondylitis (AS). METHODS: The Adalimumab Trial Evaluating Long-Term Safety and Efficacy for Ankylosing Spondylitis (ATLAS) was an ongoing 5-year study that included an initial 24-week, randomized, placebo-controlled, double-blind period. Patients were randomized to adalimumab 40 mg or placebo by subcutaneous injection every other week. Pain was assessed by the bodily pain domain scores of the Medical Outcomes Study Short Form-36 Health Survey (SF-36) and also by total back pain and nocturnal pain using visual analog scales. Fatigue was measured by the SF-36 vitality domain and question 1 of the Bath AS Disease Activity Index (BASDAI). Morning stiffness was measured by the mean of BASDAI questions 5 and 6. RESULTS: Of 315 patients enrolled, 208 received adalimumab 40 mg and 107 received placebo. At Week 12, adalimumab-treated patients experienced significant improvement compared with placebo-treated patients in the SF-36 bodily pain score (p < 0.001), total back pain score (p < 0.001), nocturnal pain score (p < 0.001), fatigue (p < 0.01), and morning stiffness (p < 0.001). Pain, fatigue, and morning stiffness were significantly correlated (p < 0.001) with baseline values of patient-reported health-related quality of life (HRQOL), and physical function, and with improvements in these values at Week 12 by regression analysis. Treatment effects occurred rapidly (within 2 wks) and were maintained through 24 weeks of treatment. CONCLUSION: Adalimumab significantly improved symptoms of pain, fatigue, and stiffness in patients with AS. Improved symptoms were associated with improved physical function and HRQOL.     

Primary ankylosing spondylitis, psoriatic and enteropathic spondyloarthropathy: a controlled analysis

Within our ankylosing spondylitis (AS) population (n = 1331), 85% (n = 1128) had primary AS (1 degree AS), 9% (n = 121) had psoriatic AS (PsAS) and 6% (n = 82) enteropathic AS (IBDAS). In an attempt to explore further the relationship between 1 degree AS and the secondary spondyloarthritides, we evaluated 121 consecutive patients with PsAS and 82 with IBDAS, as well as 202 controls with primary disease. The patients were matched for sex and age at review PsAS:48.1 (SD 11.3) years vs 1 degree AS:48.4 (SD 11.5), and IBDAS:46.0 (SD 12.7) vs 1 degree AS:45.9 (SD 12.7). The sex distribution for IBDAS (M:F, 1:1), was significantly less (p less than 0.001) than that for PsAS (M:F, 3.5:1) or 1 degree AS (M:F, 2.4:1). Overall, compared to 1 degree AS the PsAS and IBDAS tended to have greater disease severity as defined by e.g., (1) those taking non-steroidal antiinflammatory drugs, 86 vs 72% (p less than 0.01) and 71 vs 60% (p less than 0.05), respectively; (2) decreased spinal mobility (scale 0-8) 5.0 (SD 2.0) vs 4.4 (SD 2.3); p = 0.029 and 4.9 (SD 2.0) vs 3.9 (SD 2.4); p = 0.024, respectively; and (3) PsAS resulted in a higher AIMS pain score; 4.9 (SD 2.5) vs 4.0 (SD 2.4): p = 0.042. By contrast, peripheral joint involvement, number of total hip replacements and capacity for employment were similar in all 3 groups. In conclusion (1) among the AS population the prevalence of 1 degree AS, PsAS and IBDAS is 90, 6 and 4%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)     

Fifteen months' follow-up of intensive inpatient physiotherapy and exercise in ankylosing spondylitis

Summary Long-term effects of three or four-week inpatient physiotherapy and exercise courses were studied in 141 adult patients with ankylosing spondylitis (AS). Eight cervical and thoracolumbar range of motion (ROM) measurements and straight leg raise test, vital capacity (VC) and fitness index were measured at the beginning and end of an intensive course and 15 months later.All nine mobility measurements, vital capacity and fitness index were significantly improved after the course. Fifteen months later only chest expansion and vital capacity had significantly deteriorated from the baseline, while CR, FFD and fitness index were still significantly better. Disease duration did not influence treatment results.We conclude that it is possible by means of intensive rehabilitation courses to prevent for more than one year deterioration of spinal function and fitness in AS patients irrespective of disease duration.     

Relationship between spinal mobility and radiographic damage in ankylosing spondylitis and psoriatic spondylitis: a comparative analysis

OBJECTIVE: To correlate measures of spinal mobility used in the assessment of spondyloarthritis with radiographic severity, and to compare ankylosing spondylitis (AS) and psoriatic spondylitis (Ps-Sp) in this clinical-radiographic correlation. METHODS: As part of the International SPondyloarthritis Interobserver Reliability Exercise (INSPIRE) study, 20 spondyloarthropathy (SpA) experts met for an examination exercise assessing 19 patients with SpA -- 10 with Ps-Sp (9 men, mean age 52 yrs, mean disease duration 17 yrs) and 9 with AS (7 men, mean age 38 yrs, mean disease duration 16 yrs). Spearman correlation with bias correction was used to correlate median values of the spinal measurements obtained in the INSPIRE study with modified Stoke AS spinal score (mSASSS) and Bath AS Radiology Index-spine (BASRI-s) scores calculated by consensus of 2 assessors. RESULTS: The 2 radiographic measures performed comparably in relation to clinimetrics in the SpA group as a whole. There was very good correlation between mSASSS and the occiput-to-wall distance, tragus-to-wall distance, modified Schober, and lateral spinal flexion in the entire group (rs > 0.64, p < 0.05 for each measure). There was also good correlation between mSASSS and cervical rotation and chest expansion (rs = 0.58 and 0.54, p <0.05, respectively). The clinical-radiographic correlations were comparable in the AS and Ps-Sp, except for cervical rotation, which correlated better with mSASSS in Ps-Sp than in AS. CONCLUSION: Our study documents the structure-function correlations in axial SpA and provides evidence supporting application of radiographic and clinical measures used in AS to studies of Ps-Sp.     

Vitamin D status in ankylosing spondylitis patients: Relation to bone health,disease activity,functional status,spine mobility and enthesitis

Aim of the workTo evaluate serum levels of vitamin D in ankylosing spondylitis (AS) patients in relation to bone mineral density, bone metabolism, and disease activity, functional status, spine mobility and extent of enthesitis.Patients and methodsSixty AS patients and 60 controls were included. Bath AS disease activity index (BASDAI), functional index (BASFI), metrology index (BASMI), AS disease activity score (ASDAS), and Maastricht AS enthesitis score (MASES) were assessed. Serum levels of vitamin D3, carboxy-terminal telopeptide of type-I collagen (CTX-1), alkaline phosphatase (ALP) and bone alkaline phosphatase (bALP) were measured. Dual-energy X-ray absorptiometry (DXA) was assessed.ResultsPatients mean age was 31.7 ± 9.1 years, disease duration 7.8 ± 4.4 years and were 46 males and 14 females. The mean BASDAI was 3.9 ± 1.02, ASDAS 2.7 ± 0.98, BASFI 3.6 ± 2.1, BASMI 4.5 ± 1.6 and MASES 4.4 ± 3.2. Patients had significantly (p = 0.001) lower levels of vitamin D (13 ± 7.8 vs 29.9 ± 9.5 ng/mL) and higher CTX-1 (547.5 ± 130.1 vs 230.1 ± 34.9 pg/mL), ALP (195.8 ± 100.8 vs 120.8 ± 10 IU/L) and bALP (48.4 ± 7.3 vs 21.03 ± 3.2 IU/L) compared to controls. Vitamin D significantly correlated with BMD (p = 0.04), inversely with CTX-1 (r = −0.22,p < 0.001), ALP (r = −0.03,p = 0.005), bALP (r = -0.22,p = 0.049), BASDAI (r = −0.57,p < 0.001), ASDAS (r =−0.37,p = 0.04), BASMI (r = −0.18,p = 0.03), MASES (r = −0.03,p = 0.008) and sacroiliitis grading (r = −2.4,p < 0.001). Vitamin D deficiency was associated with peripheral joints affection, enthesitis and not receiving sulfasalazine.ConclusionSerum vitamin D levels were decreased in patients with AS and were more deficient in relation to disease activity and bone turnover. Vitamin D may play a role in the pathogenesis and progression of AS in Egyptian patients which should be more comprehensively investigated.     

Effects of home-based daily exercise therapy on joint mobility, daily activity, pain, and depression in patients with ankylosing spondylitis

We investigated the effects of home-based daily exercise on joint mobility, functional capacity, pain, and depression in patients with ankylosing spondylitis (AS). The patients were randomly assigned to a wait-list control group or to an exercise-therapy group. The exercise-therapy group performed a 20-min exercise program once per day for 8 consecutive weeks. After 8 weeks, compared with the control group, the exercise group showed improvements in joint mobility (cervical flexion, extension, shoulder flexion, abduction, hip abduction, and knee flexion), finger–floor distance, and functional capacity. Pain and depression scores were significantly lower after the exercise program in the exercise group than in the control group. These findings indicate that exercise therapy increases joint mobility and functional capacity, and decreases pain and depression in patients with AS. Home-based exercise, which is easily accessible to patients, might be an effective intervention for AS.     

Spinal mobility and its impact in Moroccan patients with ankylosing spondylitis

The main objective of this cross-sectional study was to assess spinal mobility and its relationship with disease-related parameters of activity, severity, and quality of life in Moroccan patients with ankylosing spondylitis (AS). One hundred patients with AS according to New York Classification criteria were recruited. Chest expansion, Schober index, occiput-to-wall distance, and the combined index of Bath Ankylosing Spondylitis Metrology Index (BASMI) were used to assess spinal mobility. Assessment criteria included the evaluation of disease activity (Bath Ankylosing Spondylitis Disease Activity index), functional status (Bath Ankylosing Spondylitis Functional Index), and radiographic damage (Bath Ankylosing Spondylitis Radiologic Index).The short form-36 (SF-36) generic instrument was used to assess health-related quality of life. The mean age of patients was 38?±?13?years. There were 67% of males in our data. Our patients had moderate disease activity, severe functional disability, and important radiological damage. The mean value of occiput-to-wall distance was 4?±?6.2?cm, chest expansion was 3.4?±?1.2?cm, Schober index was 2.7?±?1.2?cm, and BASMI was 4?±?3. Impaired spinal mobility, corresponding to higher scores of BASMI, had good statistically significant correlations with prolonged disease duration, severe functional disability (BASFI), important radiological damage (BASRI) and with the deterioration of most domains of SF-36 (p?相似文献   

Penicillamine in ankylosing spondylitis: a double blind placebo controlled trial

A double blind placebo controlled trial was carried out over a 6-month period on 17 patients with ankylosing spondylitis (AS) to assess the effect of the second line antirheumatic drug, D-penicillamine. The patients included 13 with peripheral joint involvement. No significant improvement over placebo was detected in a variety of clinical and laboratory indices in the patients receiving active treatment. This controlled trial would not support a use for penicillamine in AS.     

Comparison of PA spine, lateral spine, and femoral BMD measurements to determine bone loss in ankylosing spondylitis

To evaluate bone loss in the early- and late-stage ankylosing spondylitis (AS) patients using posteroanterior (PA) and lateral lumbar and femoral bone mineral density (BMD) measurement methods. Eighty-six AS patients and 50 control subjects were enrolled. PA spine, lateral spine, and femur BMD values of patients and controls were measured. The presence of any syndesmophytes or compression fractures was determined. Patients were divided as early (<10 years) and late stage (≥10 years) according to the onset of the inflammatory pain. Mean PA spinal BMD was similar in patients and controls (p = 0.460). Femoral and lateral spine BMD values were significantly lower in patients (p = 0.012 and p = 0.001). When comparing early- and late-stage AS groups, mean PA spinal BMD was found to be lower in the early group (p = 0.005), while femoral and lateral spinal values were lower (although statistically not significant) in the late group. At least one compression fracture was present in 28 % of patients. Although not statistically significant, mean PA spinal BMD was higher in those with fractures. Femoral and lateral spinal BMD values were significantly lower in the fracture group (p = 0.034 and p = 0.004). Lateral spinal BMD values were significantly lower in patients with syndesmophytes (p = 0.004). Bone loss is increased in AS compared with control subjects. The BMD measurement at the lateral lumbar spine reflects bone loss and fracture risk better than PA spine and femoral measurements.     

Association between arterial stiffness,disease activity and functional impairment in ankylosing spondylitis patients: a cross-sectional study

Cardiovascular risk is an important factor for increased morbidity and mortality in patients with ankylosing spondylitis. The aim of this study is to assess arterial stiffness in relation to the disease activity and functional limitation in patients with ankylosing spondylitis. Twenty-four patients (mean age 45.8?±?11.7 years) suffering of ankylosing spondylitis (disease duration 11.1?±?5.1 years) and 24 gender and age-matched healthy controls were included in the study. Clinical, biological, and functional status of ankylosing spondylitis patients was recorded. Arterial stiffness was assessed by measuring pulse wave velocity (PWV) and pulse wave analysis (PWA) was performed using applanation tonometry. We found significant differences between ankylosing spondylitis patients and healthy controls in regard to PWV (p?=?0.047), aortic augmentation pressure—AP (p?=?0.028), augmentation index—AIx (p?=?0.038) and aortic augmentation index adjusted for heart rate—AIx75 (p?=?0.011). PWV and AIx75 were significantly associated with the disease functioning score—BASFI (p?=?0.012, r?=?0.504; p?=?0.041, r?=?0.421). Aortic AP and augmentation indexes (AIx and AIx75) were all associated to ASDAS score (p?=?0.028, r?=?0.448; p?=?0.005, r?=?0.549; p?=?0.025, r?=?0.455). Our study showed that ankylosing spondylitis patients have a higher arterial stiffness than the age-matched controls, leading to an increased cardiovascular risk. We found that arterial stiffness is positively associated with disease activity and functional impairment. Chronic spondiloarthropaties should be screened for arterial stiffness, even in the absence of traditional cardiovascular risk factors, in order to benefit from primary prevention measures.     

Efficacy of methotrexate in ankylosing spondylitis: a randomized, double blind, placebo controlled trial

OBJECTIVE: To evaluate the efficacy and safety of methotrexate (MTX) compared with placebo in patients with active ankylosing spondylitis (AS). METHODS: This 24 week, double bind, randomized, placebo controlled trial compared the response between MTX 7.5 mg/week or placebo in patients with active AS. The primary outcome measure was a composite index of improvement in 5 of the following scales: severity of morning stiffness, physical well being, the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Functional Index (BASFI), the Health Assessment Questionnaire for Spondyloarthropathies (HAQ-S), and physician and patient global assessment of disease activity. RESULTS: Seventeen patients received MTX and 18 placebo. In the intention-to-treat analysis at 24 weeks, 53% of patients in the MTX group had a treatment response, compared with 17% in the placebo group (p = 0.03). We observed significant improvements with MTX in physical well being (p = 0.009), BASDAI (p = 0.02), BASFI (p = 0.02), physician global assessment (p < 0.001), patient global assessment (p = 0.03), and HAQ-S (p = 0.02). In the adjusted analysis only MTX determined the improvement in the primary outcome. At the end of the trial, one patient with MTX withdrew due to a lack of compliance, and one with placebo due to a lack of efficacy. We did not observe significant differences in rates of side effects between the 2 groups. CONCLUSION: MTX is safe and effective for patients with AS. Longterm studies are needed to evaluate the permanence of its benefit.     

Home-based exercise therapy in patients with ankylosing spondylitis: effects on pain, mobility, disease activity, quality of life, and respiratory functions

The home-based exercise therapy recommended to the patients with ankylosing spondylitis (AS) is a simply applicable and cheap method. The aim of this study was to investigate the effects of home-based exercise therapy on pain, mobility, function, disease activity, quality of life, and respiratory functions in patients with AS. Eighty patients diagnosed with AS according to the modified New York criteria were included in the study. Home-based exercise program including range of motion, stretching, strengthening, posture, and respiratory exercises was practically demonstrated by a physiotherapist. A training and exercise manual booklet was given to all patients. Patients following home-based exercise program five times a week at least 30 min per session (exercise group) for 3 months were compared with those exercising less than five times a week (control group). Visual analog scale pain (VASp) values at baseline were significantly higher in the exercise group. The exercise group showed improvements in VASp, tragus–wall distance, morning stiffness, finger–floor distance, modified Schober's test, chest expansion, the Bath Ankylosing Spondylitis Disease Activity Index, the Bath Ankylosing Spondylitis Functional Index, Ankylosing Spondylitis Quality of Life Questionnaire (ASQoL), forced expiratory volume in first second, and forced vital capacity at third month. There was significant difference in ASQoL scores between the two groups in favor of the exercise group at third month. Regular home-based exercise therapy should be a part of main therapy in patients with AS. Physicians should recommend that patients with AS do exercise at least five times a week at least 30 min per session.     

Arachnoid ossificans of thoracolumbosacral spine in the advanced ankylosing spondylitis: a case report

Arachnoid ossificans is a rare type of chronic arachnoiditis characterised by the presence of calcification or ossification of the dura and arachnoid. There are a few reports of these findings in relation to various disease entities, but only one case has been reported in relation to ankylosing spondylitis. We describe a 76-year-old man of ankylosing spondylitis with arachnoiditis ossificans, who has suffered from low back pain and neuropathic leg pain.