Abstract
BackgroundThe management of the ankylosing spondylitis (AS) aims at relieving patients'pain, restoring their joint mobility and preventing structural damage which results in progressive deformity, in order to improve the functional status and quality of life of these patients, using various pharmacological and non-pharmacological means. The importance of the physiotherapy in patients with AS under biological treatment was reported in some studies, but the literature on this topic is still scarce.ObjectivesReport the experience, of our department of Physical and Rehabilitation Medicine, in the management of the AS, especially the effect of the combination of physiotherapy and biological therapy on pain, disease activity, spinal mobility, functional capacity and quality of life.MethodsProspective study on 20 patients diagnosed with AS, treated with tumor necrosis factor alpha inhibitors (TNFa inhibitors) and placed under physiotherapy for 3 months. At baseline and at the end of 3 months, we evaluated Bath AS Disease Activity Index (BASDAI), occiput-wall distance, Hirtz index, Schober index, Bath AS Functional Index (BASFI) and Visual Analog Scale (VAS) of patient's quality of life.ResultsThe 20 patients (9 females), aged 38.4 years±10.24 [range 19–55], treated with TNFa inhibitors (Etanercept in 35% and Adalimumab in 65%) and included in a physiotherapy program of 3 months (3 sessions/week), comprising muscle relaxation, flexibility exercises for cervical, thoracic and lumbar spine, range of motion exercises of coxofemoral joints, muscular strengthening, straight posture and respiratory exercises.After 3 months, all outcome parameters showed statistically significant improvements (P<0,05), as shown in the folliwing table.Paired Diffrences Mean P value Pair 1BASDAIbaseline – BASDAImonth33,446150,000Pair 2BASFIbaseline – BASFImonth32,96540,000Pair 3OWIbaseline – OWImonth31,71250,023Pair 4SCHOBERbaseline – SCHOBERmonth3-1,56670,000Pair 5HIRTZbaseline – HIRTZmonth3-0,72730,001Pair 6VASpatient_baseline - VASpatient_month34,08330,000ConclusionsAccording to our results, the combination of physiotherapy and biological therapy is an effective mean in increasing functional capacity and joint mobility, decreasing disease activity, improving quality of life for AS patients. Currently available data do not adequately address what role physiotherapy may have on patients with AS receiving biological drugs [1]. There are a few studies evaluating the effects of exercises in patients with AS receiving TNFa inhibitors [2,3].References Elyan M, Khan MA (2008) Does physical therapy still have a place in the treatment of ankylosing spondylitis? Curr Opin Rheumatol 20:282–286.Dubey SG, Leeder J, Gaffney K (2008) Physical therapy in anti-TNF treated patients with ankylosing spondylitis. Rheumatology (Oxford) 47:1100–1101.Lubrano E, D'Angelo S, Parsons WJ, Serino F, Tanzillo AT,Olivieri I, Pappone N (2006) Effects of a combination treatment of an intensive rehabilitation program and etanercept in patients with ankylosing spondylitis: a pilot study. J Rheumatol 33:2029–2034. Disclosure of InterestNone declared