Tumour necrosis factor alpha inhibitor therapy and rehabilitation for the treatment of ankylosing spondylitis: A systematic review

Lubrano, Ennio; Spadaro, Antonio; Amato, Giorgio; Benucci, Maurizio; Cavazzana, Ilaria; Chimenti, Maria Sole; Ciancìo, Giovanni; Dalessandro, Giuseppe; Angelis, Rossella De; Lupoli, Salvatore; Lurati, Alfredomaria; Naclerio, Caterina; Russo, Romualdo; Semeraro, Angelo; Tomietto, Paola; Zuccaro, C.; Marco, Gabriele De

doi:10.1016/j.semarthrit.2014.09.012

Cited by 47 publications

(23 citation statements)

References 53 publications

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“…Further, exercise is a low-cost treatment that do not result in harmful effects. Moreover, it has been reported that the use of TNF-inhibitors can increase adherence to exercise 35. The optimal treatment for patients with axSpA is therefore likely to be a combination of pharmacological treatment and exercise.…”

Section: Discussionmentioning

confidence: 99%

High intensity exercise for 3 months reduces disease activity in axial spondyloarthritis (axSpA): a multicentre randomised trial of 100 patients

et al. 2019

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BackgroundExercise is considered important in the management of patients with rheumatic diseases, but the effect of high intensity exercises on disease activity is unknown.ObjectiveTo investigate the effectiveness of high intensity exercises on disease activity in patients with axial spondyloarthritis (axSpA).MethodAssessor blinded multicentre randomised controlled trial. 100 patients (aged from their 20s to their 60s) with axSpA were randomly assigned to an exercise group or to a no-intervention control group. The exercise group performed cardiorespiratory and muscular strength exercises at high intensity over 3 months. The control group received standard care and was instructed to maintain their usual physical activity level. Primary outcome was disease activity measured with the Ankylosing Spondylitis (AS) Disease Activity Scale (ASDAS, higher score=worst) and the Bath AS Disease Activity Index (BASDAI, 0–10, 10=worst). Secondary outcomes were inflammatory markers, physical function and cardiovascular (CV)-health. There was patient involvement in the design and reporting of this study.Results97 of the 100 (97%) randomised patients completed the measurements after the intervention. There was a significant treatment effect of the intervention on the primary outcome (ASDAS: −0.6 [–0.8 to –0.3], p<0.001 and BASDAI: −1.2 [–1.8 to –0.7], p<0.001). Significant treatment effects were also seen for inflammation, physical function and CV-health.ConclusionHigh intensity exercises reduced disease symptoms (pain, fatigue, stiffness) and also inflammation in patients with axSpA. It improves patients’ function and CV health. This debunks concerns that high intensity exercise might exacerbate disease activity in patients with axSpA.Trial registration numberNCT02356874.

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Section: Discussionmentioning

confidence: 99%

High intensity exercise for 3 months reduces disease activity in axial spondyloarthritis (axSpA): a multicentre randomised trial of 100 patients

et al. 2019

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“…According to international guidelines, the currently recommended treatment for AS is a combination of physical rehabilitation and therapy against the inflammatory protein tumour necrosis factor alpha [12]. In China, traditional herbal medicine is also often used.…”

Section: Introductionmentioning

confidence: 99%

Metagenome-wide association study of the alterations in the intestinal microbiome composition of ankylosing spondylitis patients and the effect of traditional and herbal treatment

Huang

Zhou

et al. 2020

Journal of Medical Microbiology

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Introduction. Ankylosing spondylitis (AS) is a systemic progressive disease with an unknown etiology that may be related to the gut microbiome. Therefore, a more thorough understanding of its pathogenesis is necessary for directing future therapy. Aim. We aimed to determine the differences in intestinal microbial composition between healthy individuals and patients with AS who received and who did not receive treatment interventions. In parallel, the pathology of AS in each patient was analysed to better understand the link between AS treatment and the intestinal microbiota of the patients. Methodology. Sixty-six faecal DNA samples, including 37 from healthy controls (HCs), 11 from patients with untreated AS (NM), 7 from patients treated with nonsteroidal anti-inflammatory drugs (e.g. celecoxib; WM) and 11 from patients treated with Chinese herbal medicine (CHM), such as the Bushen–Qiangdu–Zhilv decoction, were collected and used in the drug effect analysis. All samples were sequenced using Illumina HiSeq 4000 and the microbial composition was determined. Results. Four species were enriched in the patients with AS: Flavonifractor plautii , Oscillibacter , Parabacteroides distasonis and Bacteroides nordii (HC vs. NM, P<0.05); only F. plautii was found to be significantly changed in the NM-HC comparison. No additional species were found in the HC vs. CHM analysis, which indicated a beneficial effect of CHM in removing the other three strains. F. plautii was found to be significantly increased in the comparison between the HC and WM groups, along with four other species ( Clostridium bolteae , Clostridiales bacterium 1_7_47FAA, C. asparagiforme and C. hathewayi ). The patients with AS harboured more bacterial species associated with carbohydrate metabolism and glycan biosynthesis in their faeces. They also had bacterial profiles less able to biodegrade xenobiotics or synthesize and transport vitamins. Conclusion. The gut microbiota of the patients with AS varied from that of the HCs, and the treatment had an impact on this divergence. Our data provide insight that could guide improvements in AS treatment.

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“…It was reported in various studies on exercise intolerance developing in AS that reduction of respiratory functions and respiratory muscle strength is an important factor in development of intolerance. [3,25,34–36] …”

Section: Discussionmentioning

confidence: 99%

Determining the relationship of kinesiophobia with respiratory functions and functional capacity in ankylosing spondylitis

Angın

2017

Medicine

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Ankylosing spondylitis (AS) is a common inflammatory rheumatic disease that affects the axial skeleton, causes inflammatory lower back pain, and structural and functional disorders, which affect quality of life negatively.The purpose of this study is to investigate the effects of kinesiophobia in AS on pulmonary function tests (PFTs) and functional performance.Thirty-one individuals with AS (n = 19 male, n = 12 female) who were suitable on the basis of the Modified New York (MNY) criteria were included in the study. The participants were given the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Functional Index (BASFI), the Bath Ankylosing Spondylitis Metrology Index (BASMI), in addition to the Tampa Scale for Kinesiophobia (TKS), PFTs, respiratory muscle strength, pain evaluation, and 6-minute walking test (6MWT).The mean values were found as the following: TKS, 41.65 ± 7.59; pain visual analog scale (VAS) score, 6.23 ± 2.86; forced vital capacity (%) (FVC), 75.35% ± 17.92%; forced expiratory volume in first second (%) (FEV1), 73.45% ± 17.20%; FEV1/FVC (%), 75.58% ± 15.99%; peak expiratory flow (%) (PEF), 54,90% ± 20.21%; forced expiratory flow at 25% to 75% (FEF25–75), 77.71% ± 27.05%; maximal inspiratory pressure (MIP), 62.06 ± 31.68; maximal expiratory pressure (MEP), 95.94 ± 36.60; 6MWT, 445.88 ± 99.48. The scores obtained in TKS were found related to the values of FVC (%), FEV1 (%), chest expansion, BASFI, modified Schober test, lumbar lateral flexion, cervical rotation, and total BASMI score (r = −0.43, −0.36, −0.41, 0.42, −0.49, −0.56, −0.52, 0.56, respectively; P < .05).Kinesiophobia is a condition that may arise in individuals with AS, which has negative effects. Physiotherapists have a responsibility to eliminate kinesiophobia beliefs and prefer therapy method in line with this responsibility.

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Tumour necrosis factor alpha inhibitor therapy and rehabilitation for the treatment of ankylosing spondylitis: A systematic review

Cited by 47 publications

References 53 publications

High intensity exercise for 3 months reduces disease activity in axial spondyloarthritis (axSpA): a multicentre randomised trial of 100 patients

High intensity exercise for 3 months reduces disease activity in axial spondyloarthritis (axSpA): a multicentre randomised trial of 100 patients

Metagenome-wide association study of the alterations in the intestinal microbiome composition of ankylosing spondylitis patients and the effect of traditional and herbal treatment

Determining the relationship of kinesiophobia with respiratory functions and functional capacity in ankylosing spondylitis

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