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Exercise in Ankylosing Spondylitis Prof. Pál Géher MD
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Ankylosing Spondylitis Prevalence: 0.1% to 1.4%. Prevalence: 0.1% to 1.4%. Significant burden of disease, similar to RA. Significant burden of disease, similar to RA. HLA B27 association. HLA B27 association. Diagnosed late. Diagnosed late. Underdiagnosed. Underdiagnosed. Unsatisfactory treatment. Unsatisfactory treatment.
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Milestones of AS therapy 1921. X-ray treatment. 1921. X-ray treatment. 1949. Phenylbutazon. 1949. Phenylbutazon. 1965. Indometacinum. 1965. Indometacinum. ? Exercise ? Exercise 2000. Biologics. 2000. Biologics.
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Studies on exercise in AS 1. Individual – conducted- exercise. 2. Group - conducted – exercise. 3. Individual exercise. No accepted protocol! 4. Underwater exercise – no study available.
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ASessment in Ankylosing Spondylitis 1995.
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ASAS 50 % response criteria 1. Patient’s opinion 2. Pain 3. Function = BASFI 4. Inflammation = BASDAI 5.& 6.questions At least 50% or in absolute value 10 mm (VAS 0-100 mm) improvement 3 domains:
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Outcomes in exercise in AS Function. Function. Pain. Pain. Spinal mobility. Spinal mobility. Stiffness. Stiffness. Patient’s opinion. Patient’s opinion.
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Individual- conducted - exercise 4 months, randomized, one center. 4 months, randomized, one center. 26 treated, 27 controll. 26 treated, 27 controll. Function - 23 % improvement. Function - 23 % improvement. Pain ? Pain ? Spinal mobility - 42 % improvement (finger- floor distance). Spinal mobility - 42 % improvement (finger- floor distance). Stiffness ? Stiffness ? Patient’s opinion ? Patient’s opinion ? Kraag G et al: J Rheumatol 1994; 21: 261-3.
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Group - conducted – exercise 9 months, randomized, one center. 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. 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). Function - 32 % difference (4% improvement). Pain ? Pain ? Spinal mobility - 7 % improvement (Schöber). Spinal mobility - 7 % improvement (Schöber). Stiffness ? Stiffness ? Patient’s opinion - 28 % improvement. Patient’s opinion - 28 % improvement. Hidding A et al: Arthritis Care Res 1994; 7:90-6.
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Evidence based studies 3 trials, 241 patients. 3 trials, 241 patients. Supervised vs. Individualised= supervised 50 % better (pain, stiffness) Supervised vs. Individualised= supervised 50 % better (pain, stiffness) Individual vs. None individual better. Individual vs. None individual better. Dagfinrud H et al: The Cochrane Library, 2003.
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ASAS/EULAR recommandations
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10 recommandations. 10 recommandations. 3 general. 3 general. 5 pharma-therapy. 5 pharma-therapy. 1 surgery. 1 surgery. 1 non- pharmacological. 1 non- pharmacological.
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Non-pharmacological recommandation Should include education, regular exercise and individual and group physical therapy….(level C) 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.
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Thank you for your attention.
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