Exercise is Effective for Disease Activity Control with Various Effects on Entheses: An Ultrasound-Based Study

Introduction.The effect of physical activity on disease activity and enthesitis in patients with spondyloarthritis is unknown.We aimed to describe clinical and enthesis features and disease activity of spondyloarthritis patients and to assess the association between physical activity and disease activity.Methods.We conducted a cross-sectional study including consecutive patients followed for radiographic axial spondyloarthritis.For each patient, we performed ultrasonography of entheses and assessed disease activity.Physical activity level was assessed using the University of California and Los Angeles (UCLA) activity scale and the Tegner activity scale.Results.We examined 518 entheses in 37 patients.There were 29 men (78%) and 8 women (22%).The mean age was 44.62 ± 12.31 years.Exercise was performed in 51% of patients.The median (IQR 25%-75%) UCLA activity scale was 4 (4-5) and the median (IQR 25%-75%) Tegner physical activity scale was 3 (3-5).Exercise was associated with a lower risk of disease activity (OR 0.123, p = 0.022, 95%CI 0.020-0.742).We didn't find a significant difference in enthesis ultrasound characteristics between the patients practicing or not practicing exercise.Patients doing exercise had a significantly lower risk of having ≥ 3 ultrasonographic enthesophytes and plantar aponeurosis enthesophytes.Nevertheless, those who engage in physical activity have a significantly higher risk of hypoechogenicity in the lateral epicondylar tendons.Conclusions.Our study showed that exercise was associated with lower clinical disease activity.Physical activity can be responsible for ultrasonographic tendon insertion damage, but it doesn't accentuate the structural damage.The promotion of physical activity should be considered a healthcare priority.