Experts' beliefs on physiotherapy for patients with ankylosing spondylitis and assessment of their knowledge on published evidence in the field. Results of a questionnaire among international ASAS members. The effects of comprehensive home physiotherapy and supervision on patients with ankylosing spondylitis--a randomized controlled trial. Establishment of the minimum clinically important difference for the bath ankylosing spondylitis indices: a prospective study. Group treatment for pain and discomfort. Fifteen months' follow-up of intensive inpatient physiotherapy and exercise in ankylosing spondylitis The effects of comprehensive home physiotherapy and supervision on patients with ankylosing spondylitis--an 8-month followup. Is magnetotherapy applied to bilateral hips effective in Ankylosing spondylitis patients? A randomized, double-blind, controlled study Long-term benefits of radon spa therapy in rheumatic diseases: results of the randomised, multi-centre IMuRa trial The effectiveness of intensive group exercise on patients with ankylosing spondylitis The clinical application of etanercept in Chinese patients with rheumatic diseases A three-week multidisciplinary in-patient rehabilitation programme had positive long-term effects in patients with ankylosing spondylitis: randomized controlled trial. Ultrasound in the treatment of ankle sprains. Serum markers associated with clinical improvement in patients with ankylosing spondylitis treated with golimumab Chronic neck pain: a comparison of acupuncture treatment and physiotherapy. European Respiratory Society guidelines for the management of adult bronchiectasis Defining disease activity in ankylosing spondylitis: is a combination of variables (Bath Ankylosing Spondylitis Disease Activity Index) an appropriate instrument? Chronic disease management programme in people with severe knee osteoarthritis: efficacy and moderators of response One-Year Follow-up of Two Exercise Interventions for the Management of Patients with Ankylosing Spondylitis: A Randomized Controlled Trial Radiographic progression of ankylosing spondylitis after up to two years of treatment with etanercept. Sustained efficacy and safety, including patient-reported outcomes, with etanercept treatment over 5 years in patients with ankylosing spondylitis. Comparison of group-based exercise versus home-based exercise in patients with ankylosing spondylitis: effects on Bath Ankylosing Spondylitis Indices, quality of life and depression Rheumatic disorders associated with immune checkpoint inhibitors in patients with cancer—clinical aspects and relationship with tumour response: a single-centre prospective cohort study A randomised clinical trial of activity-focussed physiotherapy on patients with distal radius fractures Group education for people with arthritis. Flurbiprofen in the treatment of ankylosing spondylitis. A comparison with phenylbutazone.
AIM The aim of this study was to assess both the opinion of an international group of experts about the place and importance of physiotherapy in the management of ankylosing spondylitis ( AS ) as well as the awareness of the responders about scientific evidence on efficacy and cost-effectiveness of physiotherapy in AS . METHODS An e-mail question naire ' ' Experts ' Beliefs on Physiotherapy for Patients with Ankylosing Spondylitis ' ' has been sent to all 71 international ASsessment of Ankylosing Spondylitis ( ASAS ) members . Completion of the twenty-eight-item question naire was done through the ASAS website ( www.ASAS-group.org ) . RESULTS The number of responders was 53 ( response rate 73 % ) . Altogether 94 % of the responders regard themselves as experts in the field of clinical care for AS patients . There is almost unanimous ( 86 - 92 % ) consensus on the efficacy of physiotherapy ( widely defined , i.e. as physical therapy-including exercises , application of physical modalities and spa-therapy ) for patients with axial and peripheral joint manifestations of AS . Physiotherapy is considered to be indicated for both early AS ( less than 2 years after diagnosis ) ( 88 % ) and AS of longer duration ( 2 to 10 years ) ( 94 % ) , implying that this non-pharmaceutical intervention should be made available for or should be prescribed to AS patients . Also daily exercises at home are considered indicated for both early ( less than 2 years after diagnosis ) AS ( 90 % ) and AS of longer duration of disease ( 90 % ) . High-level evidence ( Cochrane review s or publications of one or more r and omized controlled clinical trials ) favoring efficacy of  physiotherapy  was considered available by 33 % of the participants , whereas 43 % replied ' ' no ' ' and 24 % did not know . Finally , excluding the costs of the intervention , 39 % of the participants reported that  Spa-therapy might reduce health care costs as usage of NSAIDs , physician visits and ability to work or sick leave , whereas 26 % said ' ' no ' ' and 35 % did not know . CONCLUSIONS The international ASAS experts hold a favorable opinion on the efficacy of physiotherapy in AS , including group exercises and spa therapy , almost irrespective of disease duration and type of articular involvement ( axial/peripheral ) . Awareness of published evidence on physiotherapy in AS is unsatisfactory Fifty-three patients with ankylosing spondylitis ( AS ) were r and omly allocated ; 26 experimental patients received physiotherapy and disease education , 27 control patients received neither . The primary treatment outcome was change in spinal mobility measured at 4 months by fingertip-to-floor distance . Experimental patients had more improvement in fingertip-to-floor distance ( p2 less than 0.004 ) and in function ( p2 less than 0.001 ) than control patients . Physiotherapy with disease education is effective in the treatment of patients with AS OBJECTIVE The minimum clinical ly important difference ( MCID ) is the minimum level of change of an outcome measure that is considered to be clinical ly relevant . This prospect i ve study was conducted to establish the minimum level of change in the Bath Ankylosing Spondylitis ( BAS ) indices that is meaningful for both the patient and the clinician . METHODS The BAS question naires [ i.e. , Bath Ankylosing Spondylitis Functional Index ( BASFI ) ; Bath Ankylosing Spondylitis Disease Activity Index ( BASDAI ) ; and Bath Ankylosing Spondylitis patient Global score ( BAS-G ) ] were administered to 125 patients with ankylosing spondylitis ( AS ) at baseline and at the end of a 2-week intensive physiotherapy program . Together with the final assessment , a global vali date d rating scale was used to examine each domain . Receiver operating characteristic ( ROC ) curves were plotted to determine the BAS change score that most accurately classified patients with respect to a clinical ly meaningful change . This analysis was repeated to investigate whether the estimate of change was dependent upon the patients ' baseline scores . RESULTS According to analyses of ROC curves , the MCID are 7 mm or 17.5 % for BASFI : sensitivity = 0.60/specificity = 0.85 ; 10 mm or 22.5 % for BASDAI : sensitivity = 0.65/specificity = 0.82 ; and 15 mm or 27.5 % for BAS-G : sensitivity = 0.61/specificity = 0.74 . MCID values were independent of the patients ' baseline scores ( p = 0.09 to 0.72 ) by regression analysis . CONCLUSION This prospect i ve study gives MCID values for BASFI , BASDAI , and BAS-G that allow translation from the BAS indices to readily understood values for both patients and clinicians Rheumatic patients very often suffer from chronic pain and impairment and show psychological reactions as a consequence of their physical condition . These reactions may vary from psychophysiological symptoms to anger , anxiety , or depression . We developed a cognitive-behavioral treatment programme in a group setting format with components of relaxation , cognitive restructuring , and the promotion of well-being .  Subjects included in the study were given diagnoses of low back pain , tension headache , rheumatoid arthritis , and ankylosing spondylitis . Treatment effects in different diagnostic groups were compared to each other , supporting the assumption that pain reduction is greatest in low back pain and least in ankylosing spondylitis . Subjects with inflammatory rheumatic diseases showed some improvement in self-reported physical complaints and in their feelings of well-being Summary Long-term effects of three or four-week inpatient physiotherapy and exercise courses were studied in 141 adult patients with ankylosing spondylitis ( AS ) . Eight cervical and thoracolumbar range of motion ( ROM ) measurements and straight leg raise test , vital capacity ( VC ) and fitness index were measured at the beginning and end of an intensive course and 15 months later . All nine mobility measurements , vital capacity and fitness index were significantly improved after the course . Fifteen months later only chest expansion and vital capacity had significantly deteriorated from the baseline , while CR , FFD and fitness index were still significantly better . Disease duration did not influence treatment results .We conclude that it is possible by means of intensive rehabilitation courses to prevent for more than one year deterioration of spinal function and fitness in AS patients irrespective of disease duration OBJECTIVE Our previous r and omized clinical trial showed a 4-month home physiotherapy program was effective for patients with ankylosing spondylitis . This followup study reports on 22 control patients who received the previously withheld treatment and 24 experimental patients who received followup treatment as needed . METHODS The primary outcome measure was spinal mobility measured by fingertip-to-floor distance using a portable measuring device specially design ed and vali date d for this study . RESULTS Following treatment , fingertip-to-floor distance did not change in control patients ( P2 = 0.145 ) . Between 4 and 8 months , fingertip-to-floor distance did not change in experimental patients ( P2 = 0.143 ) ; however , initial improvement achieved was maintained . The experimental group at 4 months was better than the control group at 8 months ( P2 = 0.038 ) . CONCLUSION The home physiotherapy treatment program must be delivered as rigorously as it was in the initial trial to be effective . The benefit from this treatment program can be maintained with very little intervention This double-blind , r and omized controlled study was conducted with the aim to investigate the effect of magnetic field therapy applied to the hip region on clinical and functional status in ankylosing spondylitis ( AS ) patients . Patients with AS ( n = 66 ) who were diagnosed according to modified New York criteria were enrolled in this study . Patients were r and omly divided in two groups . Participants were r and omly assigned to receive magnetic field therapy ( 2 Hz ) ( n = 35 ) , or placebo magnetic field therapy ( n = 31 ) each hip region for 20 min . Patients in each group were given heat pack and short-wave treatments applied to bilateral hip regions . Both groups had articular range of motion and stretching exercises and strengthening exercises for surrounding muscles for the hip region as well as breathing and postural exercises by the same physical therapist . These treatment protocol s were continued for a total of 15 sessions ( 1 session per day ) , and patients were examined by the same physician at months 1 , 3 and 6 . Visual analogue scale ( VAS ) pain , VAS fatigue , Bath Ankylosing Spondylitis Disease Activity Index ( BASDAI ) , Bath Ankylosing Spondylitis Functional Index ( BASFI ) , Bath Ankylosing Spondylitis Metrologic Index ( BASMI ) , DFI , Harris hip assessment index and Ankylosing Spondylitis Quality of Life scale ( ASQOL ) were obtained at the beginning of therapy and at month 1 , month 3 and month 6 for each patient . There were no significant differences between groups in the VAS pain , VAS fatigue , morning stiffness , BASDAI , BASFI , BASMI , DFI , Harris hip assessment index and ASQoL at baseline , month 1 , month 3 or month 6 ( p > 0.05 ) . Further r and omized , double-blind controlled studies are needed in order to establish the evidence level for the efficacy of modalities with known analgesic and anti-inflammatory action such as magnetotherapy , particularly in rheumatic disorders associated with chronic pain In chronic rheumatic diseases , recent treatment regimens comprise multimodal concepts including pharmacologic , physical/exercise , occupational and psychological therapies . Rehabilitation programmes are used for long-term management of disease . Spa therapy is often integrated in various middle and south European and Asian countries . Here , we investigated radon spa therapy as applied in health resorts compared to a control intervention in rheumatic out- patients . R and omised , blinded trial enroling 681 patients [ mean age 58.3 ( st and ard deviation 11.1 ) ; female 59.7 % ] in 7 health resorts in Germany and Austria with chronic back pain ( n1 = 437 ) , osteoarthritis ( OA ) ( n2 = 230 ) , rheumatoid arthritis ( n3 = 98 ) , and /or ankylosing spondylitis ( n4 = 39 ) ; multiple nominations in 146 cases ) . Outcomes were pain ( primary ) , quality of life , functional capacity , and medication measured before start , after end of treatment , and 3 times thereafter in 3 monthly intervals . Adverse events were documented . To analyse between-group differences , repeated- measures analysis of covariance was performed in metric endpoints and Fisher ’s exact test in rates . Two-sided significance level of 5 % was chosen . Until end of follow-up , superiority of radon therapy was found regarding pain relief ( p = 0.032 ) and analgesic drug consumption ( p = 0.007 ) , but not regarding quality of life . Functional capacity was assessed specific to the underlying indication . Significant benefits were found in radon-treated OA patients until 6-month follow-up ( p = 0.05 ) , but not until end of study ( p = 0.096 ) . Neither the back pain sub- population nor the two smaller patient population s with inflammatory indications benefited significantly in functional capacity . Results suggest beneficial analgesic effects of radon spa therapy in rheumatic diseases until 9 months post-intervention Objective : To compare , in patients with ankylosing spondylitis ( AS ) , the effectiveness on pain , functional and psychological status of an intensive group exercise programme under the supervision of a physiotherapist and a home physiotherapy programme . Design : Fifty-one patients with AS were r and omly allocated into study and control groups . The study was design ed as a prospect i ve , double-blind study . Setting : Outpatient department , Istanbul Medical Faculty . Subjects : Patients who consulted with complaints of pain , morning stiffness and restricted range of movement with a confirmed diagnosis of ankylosing spondylitis . Interventions : Before exercise , both groups were given an education programme about AS . For group I patients an intensive exercise programme was organized under the supervision of a physiotherapist for six weeks . Group II patients had to practise exercises individually at home . Main outcome measures : Both groups were evaluated and compared for pain , functional and psychological status before treatment , at the end of treatment and three months after treatment using a visual analogue scale ( VAS ) for pain , Beck Depression Scale and Bath Ankylosing Spondylitis Functional Index ( BASFI ) . Results : Six patients withdrew , four from group I. Results from the remaining 45 showed more positive changes in the patients undertaking group exercise at six weeks and three months after treatment . Values showed a statistical significant difference in favour of group I. Conclusion : Group exercise in hospital may be more effective than home-based exercises at reducing impairment associated with ankylosing spondylitis Over a 2-year period , to evaluate the efficacy and safety of biologic agents , etanercept ( 25 mg twice per week , s.c . ) was used to treat 57 rheumatoid arthritis ( RA ) patients , 9 ankylosing spondylitis ( AS ) patients , 6 psoriatic arthritis ( PSA ) patients , and 4 juvenile rheumatoid arthritis ( JRA ) patients . In addition to inflammatory arthritis , I have used this tumor necrosis factor ( TNF ) blocker in other rheumatic diseases including idiopathic thrombocytopenic purpura ( ITP ) , Behçet 's disease with intractable oral ulcer , fibromyalgia syndrome , and systemic lupus erythematosis with intractable pleural effusion and acute lumbar disc herniation . For RA , after 6 months of etanercept treatment , all the parameters including number of swollen joints , number of tender joints , disease activity score , erythrocyte sedimentation rate , C-reactive protein , and global health status were rapidly improved ( P < 0.001 or P < 0.0001 ) . The anticyclic citrullinated peptide ( anti-CCP ) antibody and rheumatoid factor also significantly declined . For spondyloarthropathy , it also gave a similar effect as to RA . Both Bath Ankylosing Spondylitis Disease Activity Index and Bath Ankylosing Spondylitis Functional Index also improved . One of the two cases with Behçet 's disease with intractable oral ulcer had a long-term remission after etanercept . The other Behçet 's disease patient with oral ulcer and another with ITP obtained a good response temporarily . The short-term use of etanercept ( <3 months ) did not bring a significant effect for cases of fibromyalgia syndrome , pleural effusion , and lumbar disc herniation . In conclusion , a dramatic and rapid clinical response in different kinds of arthritis patients can be achieved by etanercept . Moreover , the TNF-α inhibitor also can treat other severe rheumatic-related symptoms . In general , except for a few cases with infection and two cases with malignancy , etanercept was safe in our arthritis patients . We need to study a larger number of patients in order to better underst and the efficacy and safety of etanercept OBJECTIVE To evaluate the mean overall effects over a 1-year period of a multidisciplinary in-patient rehabilitation programme for patients with ankylosing spondylitis . DESIGN Observer-blinded , r and omized controlled trial , with assessment s made after 4 and 12 months . PATIENTS Forty-six patients received a 3-week in-patient rehabilitation programme and 49 patients received treatment as usual .  METHODS Primary outcomes were disease activity measured with the Bath Ankylosing Spondylitis Disease Activity Scale ( BASDAI ) , and function measured with the Bath Ankylosing Spondylitis Functional Index ( BASFI ) . Secondary outcomes included well-being , spinal and hip mobility , and health-related quality of life measured with the Medical Outcome Study Short Form-36 . Overall treatment effects were estimated with Mixed models repeated measures analyses . RESULTS Significant overall treatment effects in favour of the rehabilitation group were found in the BASDAI score ( mean difference over the 1-year period -10.0 , 95 % confidence interval : -3.7 to -16.3 ) , in well-being ( -7.3 , 95 % confidence interval : -1.0 to -14.7 ) , and in the Medical Outcome Study Short Form-36 variables social functioning , role physical , role mental and bodily pain ( mean differences ranging from 5.8 ( pain ) to 10.7 ( role physical ) ) . CONCLUSION A 3-week in-patient rehabilitation programme had positive overall effects on disease activity , pain , function and well-being , and should be considered an important complement to medical disease management in persons with ankylosing spondylitis Ultrasound is commonly used in association with other forms of treatment in the management of sprains of the lateral ligament of the ankle . Despite its widespread use there is little scientific evidence to support its role in the management of sprained ankles . We have conducted a prospect i ve , r and omized , double-blind trial to compare the results of physiotherapy for sprains of the lateral ligament of the ankle  without the use of ultrasound with physiotherapy which included ultrasound . The results in the 154 patients who entered the trial demonstrate that there was no significant difference between the results achieved by the group treated with ultrasound and by those managed without Objective Identify serum biomarkers modulated by golimumab treatment and associated with clinical response in patients with ankylosing spondylitis ( AS ) . Methods Sera were collected at weeks 0 , 4 and 14 from 100 patients with active AS in the GO – RAISE study . Patients were r and omly assigned subcutaneous injections of placebo , golimumab 50 mg , or golimumab 100 mg every 4 weeks . Sample s were tested for select inflammatory , bone and cartilage markers , and protein profiling was also performed . Results Golimumab treatment result ed in significant decreases in several serum proteins at weeks 4 and 14 compared with placebo . Patients who achieved clinical response at week 14 , as assessed by a ≥20 % improvement in the Assessment in SpondyloArthitis international Society response criteria ( ASAS 20 ) , demonstrated a distinct biomarker profile with lower levels of acute phase reactants and inflammatory biomarkers compared with patients who did not . Notably , combinations of two or three biomarkers assessed at baseline were predictive of various clinical outcomes ( ASAS 20 , Bath ankylosing spondylitis disease activity index 50 or Bath ankylosing spondylitis functional index ) using a logistic regression analysis , and the overall predictive values for these combined biomarkers were greater than observed for C-reactive protein ( CRP ) alone . Conclusion Golimumab modulated acute phase reactants and inflammatory markers in patients with active AS . Specific combinations of biomarkers at baseline demonstrated a stronger prediction for clinical efficacy than CRP alone . These data provide insights into the mechanism of golimumab on inflammatory processes driving AS pathology , and may have utility in managing the treatment of patients with AS OBJECTIVE To evaluate the effectiveness of acupuncture , as compared with physiotherapy , in the management of  chronic neck pain .  DESIGN Seventy adult patients with non-inflammatory neck pain of > 6 weeks duration and with no abnormal neurology were r and omly assigned to receive either of the treatments . Thirty-five patients were included in each group . OUTCOME MEASURES Pain by visual analogue scale and neck pain question naire , improvement in range of movement of neck relative to baseline , and well-being ( general health question naire ) . Measurements were recorded at the start of treatment , at 6 weeks and at 6 months . RESULTS Both treatment groups improved in all criteria . Acupuncture was slightly more effective in patients who had higher baseline pain scores . CONCLUSIONS Both acupuncture and physiotherapy are effective forms of treatment . Since an untreated control group was not part of the study design , the magnitude of this improvement can not be quantified Bronchiectasis in adults is a chronic disorder associated with poor quality of life and frequent exacerbations in many patients . There have been no previous international guidelines . The European Respiratory Society guidelines for the management of adult bronchiectasis describe the appropriate investigation and treatment strategies determined by a systematic review of the literature . A multidisciplinary group representing respiratory medicine , microbiology , physiotherapy , thoracic surgery , primary care , methodology and patients considered the most relevant clinical questions ( for both clinicians and patients ) related to management of bronchiectasis . Nine key clinical questions were generated and a systematic review was conducted to identify published systematic review s , r and omised clinical trials and observational studies that answered these questions . We used the GRADE approach to define the quality of the evidence and the level of recommendations . The result ing guideline addresses the investigation of underlying causes of bronchiectasis , treatment of exacerbations , pathogen eradication , long term antibiotic treatment , anti-inflammatories , mucoactive drugs , bronchodilators , surgical treatment and respiratory physiotherapy . These recommendations can be used to benchmark quality of care for people with bronchiectasis across Europe and to improve outcomes . The publication of the first ERS guidelines for bronchiectasis OBJECTIVE Disease activity has been defined using a self-administered instrument , focusing on fatigue , axial pain , peripheral pain , enthesopathy and morning stiffness [ Bath Ankylosing Spondylitis Disease Activity Index ( BASDAI ) ] . This vali date d instrument is simple and takes 40 s to complete , but whether the index is an accurate expression of the component parts , or whether additional weighting would enhance its efficacy , is unclear . METHODS Four hundred and seventy-three patients with ankylosing spondylitis received placebo or active non-steroidal anti-inflammatory drug ( NSAID ) for 6 weeks , and changes between entry and completion were captured by BASDAI and the individual components . Principle component analysis ( PCA ) was used to explore the best combinations of variables in decreasing order of explained total dispersion and to assess whether a single sum ( or algebraic expression ) best defined disease activity status . RESULTS At entry , the correlation between BASDAI and the first axis was 0.99 , 0.11 with the second , and zero thereafter . Data at study end and relating to change revealed a 100 % correlation ( R = 1 ) between the first axis and the sum , with zero for the remainder . CONCLUSIONS The data support BASDAI as being a valid and appropriate composite to define disease activity in ankylosing spondylitis . Developed as a simple sum of its components , BASDAI has excellent content validity Aims : To establish ( 1 ) the efficacy of a six-week chronic disease management programme for knee osteoarthritis and ( 2 ) whether previous physiotherapy or being wait listed for surgery moderated the outcome of the programme . Design : A pretest , posttest design with multivariate statistical modelling . Participants : One hundred and twenty-one people with severe osteoarthritis who were waiting , or being considered , for surgery . Methods and measures : Western Ontario Osteoarthritis Index ( WOMAC ) scores , arthritis self-efficacy , distress and a patient-rated global indicator of response were collected at baseline , 6 and 12 weeks . History of previous physiotherapy , waiting list status , symptom duration , New Zeal and disease severity score , radiographic changes and self-perceived need for surgery were recorded at baseline . Results : There were moderate improvements in most outcomes ; WOMAC function decreased by 0.29 , WOMAC pain by 0.27 , pain self-efficacy by 4.4 , function self-efficacy by 5.6 and visual analogue scale ( VAS ) distress by 0.2 ( effect sizes ranging from 0.3 to 0.5 at 12 weeks ) . Waiting list status was a significant modifier for function , pain , distress and self-related outcomes . Participants on the waiting list for surgery experienced lesser improvements . Previous physiotherapy was associated with greater improvements in WOMAC scores at six weeks , but not at 12 weeks . Conclusion : The chronic disease management programme could be considered for people with severe knee osteoarthritis  , but should be given prior to referral and placement on the waiting list for surgery . Previous physiotherapy should not preclude people from participating in a chronic disease management programme Fernández-de-las-Peñas C , Alonso-Blanco C , Alguacil-Diego IM , Miangolarra-Page JC : One-year follow-up of two exercise interventions for the management of patients with ankylosing spondylitis : A r and omized controlled trial . Am J Phys Med Rehabil 2006;85:559–567 . Objective : To assess the long-term effects on functional and mobility outcomes of two exercise interventions for the management of patients with ankylosing spondylitis . Design : In an extended 12-mo follow-up of a r and omized controlled trial , 40 patients who were diagnosed with ankylosing spondylitis according to the modified criteria of New York , allocated to control or experimental groups using a r and om numbers table , and who performed their respective exercise program at least three times per month , were included in this long-term study . The control group was treated during 15 sessions with a conventional exercise regimen in ankylosing spondylitis , whereas the experimental group received 15 sessions of exercises based on the treatment of the shortened muscle chains following the guidelines described by the Global Posture Reeducation method . These patients were followed up and assessed again 1 yr after entering the study , reapplying the same vali date d indexes : BASMI ( Bath Ankylosing Spondylitis Metrology Index [ tragus to wall distance , modified Schober test , cervical rotation , lumbar side flexion , and intermalleolar distance ] ) , BASDAI ( Bath Ankylosing Spondylitis Disease Activity Index ) , and BASFI ( Bath Ankylosing Spondylitis Functional Index ) . Results : The intragroup comparison between follow-up and postintervention data showed that both groups decrease their clinical and functional measures during the follow-up period . This decrease was only significant for lumbar side flexion and intermalleolar distance measurements , being more significant in the control group ( P = 0.001 and P = 0.002 , respectively ) . Intragroup differences between follow-up and preintervention assessment s revealed that improvements in all mobility measures of the BASMI index and in the BASFI index were partially maintained at the 12-mo follow-up in the experimental group but not in the control group . The intergroup comparison ( unpaired t test analysis ) between changes on each outcome during the long-term follow-up ( post – follow-up ; and pre – follow-up ) showed no significant differences in the decrease between postintervention and follow-up data between the study groups . On the other h and , the intergroup comparison between preintervention and follow-up data revealed significant differences in almost all mobility measures of the BASMI index ( except for cervical rotation ) and in the BASFI index , in favor of the experimental group . Conclusions : An exercise regimen based on the Global Posture Reeducation method and focusing on specific strengthening and flexibility exercises of the shortened muscle chains offers promising short- and long-term results in the management of patients who have ankylosing spondylitis OBJECTIVE To investigate the effect of etanercept therapy on radiographic progression in patients with ankylosing spondylitis ( AS ) . METHODS Patients with AS who had previously participated in a 24-week r and omized , double-blind , placebo-controlled trial of etanercept therapy were enrolled in a 72-week open-label extension . Radiographs of the cervical and lumbar spine from patients who received etanercept ( 25 mg twice weekly ) for up to 96 weeks were compared with radiographs from patients in a large prevalence cohort ( Outcome Assessment s in Ankylosing Spondylitis International Study [ OASIS ] ) who had not been treated with anti-tumor necrosis factor alpha ( anti-TNFalpha ) agents . Radiographs obtained at 2 time points up to 96 weeks apart from patients in both study population s were digitized and read by 2 independent readers who were blinded with regard to patient group and sequence . The primary end point was the 96-week change in the modified Stoke AS Spine Score ( mSASSS ) . RESULTS A total of 257 patients treated with etanercept were compared with 175 unselected patients from the OASIS study . There was no significant difference in the change in the mSASSS from baseline among patients who received etanercept ( mean + /- SD 0.91 + /- 2.45 ) versus those from the OASIS group ( 0.95 + /- 3.18 ) . CONCLUSION Unlike other inflammatory rheumatic diseases such as rheumatoid arthritis and psoriatic arthritis , structural progression in AS seems to be independent of TNF , despite the fact that TNF is responsible for the signs and symptoms due to inflammation in this disease OBJECTIVES To assess long-term safety and clinical efficacy of etanercept 25 mg subcutaneously twice weekly up to 5 years in subjects with ankylosing spondylitis ( AS ) . METHODS An open-label ( OL ) , multicentre , phase 4 , 156-week extension study of subjects with AS who had completed a 12-week r and omised , placebo-controlled study ( N=84 ; n=45 etanercept , n=39 placebo ) followed by a 96-week OL study ( n=81 ; n=42 etanercept/etanercept ; n=39 placebo/etanercept ) ; 59 subjects who completed the 96-week OL extension enrolled in the current OL trial and continued etanercept 25 mg BIW for an additional 156 weeks ( total duration : 264 weeks , original etanercept group ; 252 weeks , original placebo group ) . Safety was based on spontaneous reports of adverse events ( AEs ) . Last observation carried forward was used for imputation of missing values . RESULTS Thirty-seven of 59 subjects ( 63 % ) completed 5 years of etanercept treatment . Serious non infectious AEs and serious infections occurred at a rate of 0.17 and 0.03 events per subject years , respectively ; inflammatory bowel disease and uveitis ( including iritis and iridiocyclitis ) occurred at 0.01 and 0.14 , respectively . No cases of tuberculosis or opportunistic infections were reported . Assessment in Ankylosing Spondylitis ( ASAS ) responses and improvements in Bath Ankylosing Spondylitis Functional Index and spinal mobility were sustained from week 108 through week 264 . CONCLUSIONS Etanercept was well tolerated with no new safety signals detected in subjects with AS over 5 years . Clinical efficacy and improvements in function and mobility seen during the double-blind and first OL study were sustained . These results support etanercept therapy for the long-term management of this chronic disease The objective of this non-r and omised controlled trial was to evaluate the impact of group-based exercise programme and a home-based exercise programme on Bath Ankylosing Spondylitis Indices , depression and quality of life in patients with ankylosing spondylitis ( AS ) . Approximately 41 patients in a rehabilitation unit were divided into two groups , either group- or home-based exercise programme . Exercise sessions were performed three times a week for a period of 6 weeks . The patients were compared before and after the rehabilitation programme , with respect to Bath Ankylosing Spondylitis Functional Index ( BASFI ) , Bath Ankylosing Spondylitis Disease Assessment Index ( BASDAI ) , Bath Ankylosing Spondylitis Metrology Index ( BASMI ) , Beck Depression Inventory ( BDI ) and The Nottingham Health Profile ( NHP ) . A statistically significant improvement was observed on BASDAI , BASMI and energy , pain , reaction of emotional and sleep subscores of NHP in both exercise groups after the exercise programme ( p < 0.05 ) . No statistically significant changes were detected in BASFI , BDI and social and mobility subscores of NHP in both exercise groups ( p > 0.05 ) . No statistically significant differences were found between the two exercise programmes ( p > 0.05 ) . Group and home-based exercise programmes are efficient in improving symptoms and mobility and had an important effect on quality of life in patients with AS . Home-based exercise programme , as it is cheaper , more easily performed and efficient , may be preferable for the management programme in AS Objectives To evaluate the prevalence and type of rheumatic immune-related adverse events ( irAEs ) in patients receiving immune checkpoint inhibitors ( ICIs )  , as well as the correlation with tumour response . Methods This was a single-centre prospect i ve observational study including all cancer patients receiving ICIs .  The occurrence of irAEs and tumour response was assessed on a regular basis . Patients who experienced musculoskeletal symptoms were referred to the department of rheumatology for clinical evaluation and management . Results From September 2015 to May 2017 , 524 patients received ICIs and 35 were referred to the department of rheumatology ( 6.6 % ) . All but one of the rheumatic irAEs occurred with anti-programmed cell death protein 1(PD-1)/PD-1 lig and 1(PD-L1 ) antibodies , with a median exposure time of 70 days . There were two distinct clinical presentations : ( 1 ) inflammatory arthritis ( 3.8 % ) mimicking either rheumatoid arthritis ( n=7 ) , polymyalgia rheumatica ( n=11 ) or psoriatic arthritis ( n=2 ) and ( 2 ) non-inflammatory musculoskeletal conditions ( 2.8 % ; n=15 ) . One patient with rheumatoid arthritis was anti-cyclic citrullinated peptide ( anti-CCP ) positive . Nineteen patients required glucocorticoids , and methotrexate was started in two patients . Non-inflammatory disorders were managed with non-steroidal anti-inflammatory drugs , analgesics and /or physiotherapy . ICI treatment was pursued in all but one patient . Patients with rheumatic irAEs had a higher tumour response rate compared with patients without irAEs ( 85.7 % vs 35.3 % ; P<0.0001 ) . Conclusion Since ICIs are used with increasing frequency , knowledge of rheumatic irAEs and their management is of major interest . All patients were responsive either to low-to-moderate doses of prednisone or symptomatic therapies and did not require ICI discontinuation . Furthermore , tumour response was significantly higher in patients who experienced rheumatic irAEs Introduction : Physiotherapy is considered by some authorities to be an important aspect of management in patients following distal radius fractures . There is evidence of improvement in impairment with physiotherapy ; however , there is no evidence to support early return of functional activity . Traditional physiotherapy management has focussed on improving impairment ; however , there are no trials with emphasis on skill acquisition via motor re-learning principles . Material s and methods : Forty-one participants with conservatively managed distal radius fractures were studied in a r and omised , single-blinded , prospect i ve trial . Two treatment options were compared : exercise and advice versus activity-focussed physiotherapy with measurement periods of 6 weeks after removal of cast and follow-up at 24 weeks . Results : Participants allocated to the exercise and advice group consulted a physiotherapist an average of 0.9 ( SD 0.4 ) times , while the participants allocated to the more intensive activity-focussed group consulted with physiotherapy a mean of 4.4 ( SD 2.3 ) times . At both 6 and 24 weeks there were no significant differences between the groups for change in impairment ( as measured by grip strength , range of motion of wrist flexion and extension and pain intensity ) , activity limitation and participation restriction , as measured by the Patient-Rated Wrist Evaluation ( PRWE ) .  Exercise and advice given by a physiotherapist were equally as effective as  activity-focussed physiotherapy  in recovery both at 6 and 24 weeks . Conclusion : The results suggest that after removal of cast from fracture of distal radius , patients may routinely require no more than a single session of advice and exercise provided by a physiotherapist Arthritis is a common chronic disease causing pain and progressive disability to millions of people . The purpose of the study was to examine the effectiveness of group patient education for people with one form of arthritis , ankylosing spondylitis ( AS ) , in terms of change in : arthritis self-efficacy ; psychological well-being ; physical well-being ; and home exercise activities . The Self-Management Course-Ankylosing Spondylitis ( SMC-AS ) demonstrated positive effects on arthritis self-efficacy and psychological well-being at 6-month follow-up . Analysis of change over time in the intervention group showed improvements in depression , self-efficacy and severity at 3 weeks , with trends towards continued improvement evident at 6 months . In contrast , the positive effects on range and frequency of home exercise activities at 3 weeks were not maintained at 6 months . In conclusion , the effectiveness of short , intensive patient education courses was demonstrated . However , the need for strategies to sustain improvements in exercise behaviour need to be explored Flurbiprofen ( Ansaid , Upjohn ) , a potent new analgesic and anti-inflammatory agent , was compared with phenylbutazone in 90 patients with ankylosing spondylitis . In this double-blind , r and omized , 26-week study , a total daily dose of 200 mg of flurbiprofen , administered three times daily , was as effective as 300 mg of phenylbutazone in controlling the pain and other symptoms of ankylosing spondylitis . In some patients , symptoms were adequately controlled by 150 mg of flurbiprofen per day , administered twice daily . There were no statistically significant differences between flurbiprofen and phenylbutazone in the investigators ' and patients ' assessment s of improvement at all key follow-up periods . In addition , there were no consistently significant differences between drugs in the efficacy pain scales and quantitative measurements studied . Flurbiprofen was well tolerated in doses of up to 300 mg per day , and no clinical ly significant laboratory abnormalities were detected . Flurbiprofen appears to be an excellent alternative to phenylbutazone in the management of patients with ankylosing spondylitis
The results of this review suggest that an individual home-based or supervised exercise program is better than no intervention ; that supervised group physiotherapy is better than home exercises ; and that combined inpatient spa-exercise therapy followed by group physiotherapy is better than group physiotherapy alone
BACKGROUND Ankylosing spondylitis ( AS ) is a chronic , inflammatory rheumatic disease .
Physiotherapy is considered an important part of the overall management of AS .
OBJECTIVES To summarise the available scientific evidence on the effectiveness of physiotherapy interventions in the management of AS .