Rehabilitation Treatment in Patients with Ankylosing Spondylitis Stabilized with Tumor Necrosis Factor Inhibitor Therapy. A Randomized Controlled Trial

Objective. To assess the 2- (T1) and 6-month (T2) followup effects on pain, spine mobility, physical function, and disability outcome of a rehabilitation intervention in patients with ankylosing spondylitis (AS) stabilized with tumor necrosis factor (TNF) inhibitor therapy. Methods. Sixty-two outpatients (49 men, 13 women, mean age 47.5 +/- 10.6 yrs) were randomized to rehabilitation plus an educational-behavioral (n = 20) program, to an educational-behavioral program only (n = 20), or to a control group (n = 22). The educational-behavioral program included 2 educational meetings and 12 rehabilitation exercise sessions (stretching, strengthening, chest and spine/hip joint flexibility exercises), which patients then performed at home. Outcome assessment at the end of rehabilitation training (T1) and at T2 was based on spinal pain intensity in the previous 4 weeks by self-report visual analog scale (VAS; 100 mm: 0 = no pain, 100 = maximum pain), BASMI, BASFI, BASDAI, and on chest expansion and the active range of motion of the cervical and lumbar spine measured by a pocket goniometer. Results. The 3 groups were comparable at baseline. On intragroup comparison at T, the rehabilitation group showed significant improvement in the BASMI and BASDAI ill chest expansion, and in most spinal active range of motion measurements. BASH and cervical and lumbar VAS scores improved in both the rehabilitation and educational-behavioral groups. The positive results achieved in the rehabilitation group were maintained at the 6-month followup. Conclusion. Combining intensive group exercise with an educational-behavioral program can provide promising results in the management of patients with clinically stabilized AS on TNF inhibitor treatment. (First Release April 1 2011; J Rheumatol 2011;38:1335-42; doi:10.3899/jrheum.100987)