Managing Ankylosing Spondylitis
Cards (9)
- From IBP to AS:
- Not all patients with nr-axSpA develop Ankylosing Spondylitis
- Nr-axSpa develops to AS at a rate of 12% a year
- Strongest predictors for developing AS include:
- males
- HLA b27
- Goals of management - Primary goals of overall management:
- Control of symptoms and inflammation
- Prevention of progressive structural damage
- Preservation of function and social participation
- Goals of management - Physiotherapy goals:
- Improve maintain/posture
- Improve/maintain functional ROM
- Improve/maintain strength and mobility
- Pain management
- Management - Pharmacological:
- NSAIDS
- Occasionally DMARDS (methotrexate) for peripheral joints
- Biologics, eg adalimumab
- Management - Non-Pharmacological:
- Exercise is the most important part of treatment
- Education
- Support
- Management - Surgery:
- Total hip replacement
- spinal osteotomies/fusions
- Key points for exercise regimes:
- Lumbar spine mobility – all directions but especially extension
- Thoracic spine mobility – all directions, especially extension (and rotation for function)
- Hips – all directions, especially abduction and extension
- Muscles (length) – hamstrings, gastrocnemius, hip flexors, adductors, quadriceps
- Muscles (strength) – spinal and hip extensors
- CVS and thoracic expansion
- Cardiovascular exercise - the issues:
- Recommended amount of exercise for CV fitness:
- 3 - 5 days a week, 30 minutes of moderate exercise
- May have stopped usual form of CV exercise
- Pain, fatigue, bad advice, risk factors
- Increased risk of CVD in rheumatic diseases
- related to systemic inflammation
- Also linked to reduced activity
- Exercise can reduce disease activity (reduced inflammatory markers)
- Mechanical impact of AS on costovertebral joints can limit thoracic expansion and vital capacity
- CV exercise suggestions:
- cycling
- swimming
- nordic walking
- gym equipment - cross training, step machine, spin bike