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Exercise in Ankylosing Spondylitis

Exercise in Ankylosing Spondylitis. Prof. Pál Géher MD. Ankylosing Spondylitis. Prevalence: 0.1% to 1.4% . Significant burden of disease, similar to RA . HLA B27 association . Diagnosed late . Underdiagnosed . Unsatisfactory treatment. Milestones of AS therapy. 1921. X-ray treatment.

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Exercise in Ankylosing Spondylitis

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  1. Exercise in Ankylosing Spondylitis Prof. Pál Géher MD

  2. Ankylosing Spondylitis • Prevalence: 0.1% to 1.4%. • Significant burden of disease, similar to RA. • HLA B27 association. • Diagnosed late. • Underdiagnosed. • Unsatisfactory treatment.

  3. Milestones of AS therapy • 1921. X-ray treatment. • 1949. Phenylbutazon. • 1965. Indometacinum. • ? Exercise • 2000. Biologics.

  4. Studies on exercise in AS • Individual – conducted- exercise. • Group - conducted – exercise. • Individual exercise. No accepted protocol! 4. Underwater exercise – no study available.

  5. ASessment in Ankylosing Spondylitis 1995.

  6. ASAS 50 % response criteria At least  50% or in absolute value  10 mm(VAS 0-100 mm)improvement  3 domains: • Patient’s opinion • Pain • Function = BASFI • Inflammation = BASDAI 5.& 6.questions

  7. Outcomes in exercise in AS • Function. • Pain. • Spinal mobility. • Stiffness. • Patient’s opinion.

  8. Individual- conducted - exercise • 4 months, randomized, one center. • 26 treated, 27 controll. • Function - 23 % improvement. • Pain ? • Spinal mobility - 42 % improvement (finger-floor distance). • Stiffness ? • Patient’s opinion ? Kraag G et al: J Rheumatol 1994; 21: 261-3.

  9. Group - conducted – exercise • 9 months, randomized, one center. • 6 weeks, individual-conducted- exercise, 68 patients individual exercise at home, once weekly group exercise,76 patients individual exercise at home. • Function - 32 % difference (4% improvement). • Pain ? • Spinal mobility - 7 % improvement (Schöber). • Stiffness ? • Patient’s opinion - 28 % improvement. Hidding A et al: Arthritis Care Res 1994; 7:90-6.

  10. Evidence based studies • 3 trials, 241 patients. • Supervised vs. Individualised= supervised 50 % better (pain, stiffness) • Individual vs. None individual better. Dagfinrud H et al: The Cochrane Library, 2003.

  11. ASAS/EULAR recommandations

  12. ASAS/EULAR recommandations • 10 recommandations. • 3 general. • 5 pharma-therapy. • 1 surgery. • 1 non-pharmacological.

  13. Non-pharmacological recommandation • Should include education, regular exercise and individual and group physical therapy….(level C) C= directly based on category III evidence or extrapolated recommendation from category I or II evidence.

  14. Thank you for your attention.

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