Exercise in Ankylosing Spondylitis - PowerPoint PPT Presentation

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Exercise in Ankylosing Spondylitis

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Group - conducted exercise. 9 months, randomized, one center. ... regular exercise and individual and group physical therapy....(level C) ... – PowerPoint PPT presentation

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Title: Exercise in Ankylosing Spondylitis


1
Exercise in Ankylosing Spondylitis
  • Prof. Pál Géher MD

2
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3
Ankylosing Spondylitis
  • Prevalence 0.1 to 1.4.
  • Significant burden of disease, similar to RA.
  • HLA B27 association.
  • Diagnosed late.
  • Underdiagnosed.
  • Unsatisfactory treatment.

4
Milestones of AS therapy
  • 1921. X-ray treatment.
  • 1949. Phenylbutazon.
  • 1965. Indometacinum.
  • ? Exercise
  • 2000. Biologics.

5
Studies on exercise in AS
  • Individual conducted- exercise.
  • Group - conducted exercise.
  • Individual exercise.
  • No accepted protocol!
  • 4. Underwater exercise no study available.

6
ASessment in Ankylosing Spondylitis
1995.
7
ASAS 50 response criteria
At least ? 50 or in absolute value ? 10 mm (VAS
0-100 mm) improvement ? 3 domains
  • Patients opinion
  • Pain
  • Function BASFI
  • Inflammation BASDAI 5. 6.questions

8
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9
Outcomes in exercise in AS
  • Function.
  • Pain.
  • Spinal mobility.
  • Stiffness.
  • Patients opinion.

10
Individual- conducted - exercise
  • 4 months, randomized, one center.
  • 26 treated, 27 controll.
  • Function - 23 improvement.
  • Pain ?
  • Spinal mobility - 42 improvement (finger-floor
    distance).
  • Stiffness ?
  • Patients opinion ?

Kraag G et al J Rheumatol 1994 21 261-3.
11
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 ?
  • Patients opinion - 28 improvement.

Hidding A et al Arthritis Care Res 1994 790-6.
12
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.
13
ASAS/EULAR recommandations
14
ASAS/EULAR recommandations
  • 10 recommandations.
  • 3 general.
  • 5 pharma-therapy.
  • 1 surgery.
  • 1 non-pharmacological.

15
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.

16
Thank you for your attention.
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