Exercise in Ankylosing Spondylitis: Discrepancies Between Recommendations and Reality

Objective.To determine the type and extent of exercise used by an ankylosing spondylitis (AS) cohort and to examine patients’ perceptions of exercise. Recommendations for the management of AS identify exercise as the cornerstone of comprehensive management.Methods.An exercise inventory questionnaire and the Exercise Benefits and Barriers Scale (EBBS) were administered to patients attending the AS clinic of a large teaching hospital. Benefits and barriers subscales of the EBBS were analyzed to identify the perceived benefits of, and barriers to, exercise. Higher benefits scores (range 29–116) indicate a more positive perception of exercise. Higher barriers scores (range 14–56) indicate a greater perception of barriers to exercise.Results.Sixty-one patients with AS completed the questionnaires. Mean age was 38.0 years, and mean disease duration was 14.7 years. Walking (3 times/week) and stretching (3 times/week) were the most commonly reported types of exercise and were reported in 35.0% and 32.8%, respectively. The mean benefits EBBS score was 87.1 ± 12.5. The most frequently reported benefits of exercise were that it “increases my level of physical fitness” (96.4%) and “improves functioning of my cardiovascular system” (96.4%). The mean barriers EBBS score was 29.2 ± 5.3, and the most frequently reported barrier to exercise was that it “tires me” (71.4%).Conclusion.Patients with AS perceive the benefits of exercise, with average EBBS benefits scores comparable to historical controls with similar conditions. Despite positive perceptions, the majority of patients with AS did not report participating in exercise on a frequent basis.</jats:sec

Analysis of the Effect of the Oral Contraceptive Pill on Clinical Outcomes in Women with Ankylosing Spondylitis

Objective.There are unexplained sex-specific changes in the clinical expression of ankylosing spondylitis (AS). We sought to examine the potential effect of exogenous estrogen in the form of oral contraceptive pills (OCP) on AS initiation and severity.Methods.This cross-sectional study consisted of women with AS from the membership of the Spondylitis Association of America. Measures of disease severity included use of biological agents and hip replacement surgery, while Bath AS Functional Index (BASFI) scores served as a surrogate marker of disability. Information was obtained using a patient questionnaire on patient demographics, OCP use, pregnancy history, AS duration, medication use, and hip replacement.Results.There were 571 women with AS who participated in our study, consisting of 448 OCP ever-users and 123 non-OCP users. The mean age of OCP users was 42.7 yrs (± 11.5) and of non-OCP users, 48.4 yrs (± 12.1). No difference was noted in the age at initial onset of back pain. However, OCP users were significantly younger at the time of diagnosis of AS (36.5 yrs vs 39.1 yrs, p = 0.02). There were no significant differences between the 2 groups in tumor necrosis factor inhibitor or opioid use, BASFI scores, pregnancy complications, or hip surgery.Conclusion.The use of exogenous estrogens in the form of OCP is not associated with a measurable effect on initiation or severity of AS. Biologic and social factors may contribute to earlier diagnosis of AS in OCP users. This is the largest study to date investigating the potential effect of exogenous estrogens in women with AS.</jats:sec

Advancing Early Identification of Axial Spondyloarthritis: An Interobserver Comparison of Extended Role Practitioners and Rheumatologists

Objective.To compare clinical impression and confidence of extended role practitioners (ERP) with those of rheumatologists experienced in axial spondyloarthritis (axSpA) according to (1) evaluation of patients with chronic back pain assessed for axSpA; and (2) magnetic resonance imaging (MRI) recommendation for further investigation of these patients.Methods.Patients with ≥ 3 months of back pain and age of onset &lt; 45 years were referred for axSpA evaluation. An ERP assessed consecutive patients and recorded standardized clinical information in written form. Three rheumatologists subsequently evaluated each patient based on the recorded information. Patients were classified as having axSpA or mechanical back pain based on clinical and investigative findings. Level of confidence was noted for classification and MRI indication. Agreement between assessors was evaluated using percentage agreement and κ coefficient.Results.Fifty-seven patients were assessed. Interobserver agreement of clinical impression for all raters was moderate (κ = 0.52). Agreement of clinical impression between ERP and rheumatologists ranged between 71.2% (κ = 0.41) and 79.7% (κ = 0.57). Agreement of clinical impression among rheumatologists ranged from 74.1% (κ = 0.49) to 79.7% (κ = 0.58). All rater agreement for MRI indication was fair (κ = 0.37). ERP agreement with rheumatologist for MRI recommendation ranged from 64.2% (κ = 0.32) to 75% (κ = 0.48). Agreement for MRI indication among rheumatologists ranged from 62.9% (κ = 0.27) to 74% (κ = 0.47). Confidence in clinical impression was similar among all practitioners.Conclusion.ERP with specialty training in inflammatory arthritis demonstrate clinical impressions comparable with those of rheumatologists in the assessment of axSpA. Incorporation of such roles into existing models of care may assist in early detection of axSpA.</jats:sec