Assessment of quality of life and clinical status in active ankylosing spondylitis patients treated with biologics and physical therapy

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Background: According to the current 2009 Assessment in SpondyloArthritis international Society (ASAS) classification criteria, ankylosing spondylitis (AS) is classified as radiographic axial inflammatory spondyloarthropathy. AS is a chronic, progressive inflammatory disease involving primarily the spine and sacroiliac joints, less commonly the peripheral joints, tendinous attachments and internal organs. According to current ASAS and European Alliance of Associations for Rheumatology (EULAR) recommendations, optimal treatment of AS patients needs a combination of pharmacotherapy and non-pharmacological treatment, based on education and rehabilitation treatment. Modern pharmacotherapy for AS, based on anticytokine therapy (biologics), significantly reduces the clinical activity of the disease, reduces active inflammation and inhibits radiographic progression. The aim of this study is to evaluate the effect of physical therapy on functional status, disease activity and quality of life in AS patients treated with biologics. Material and methods: The study included fifty active AS patients treated with biologics, who were randomly allocated to two groups. Group I patients, in addition to treatment with a tumor necrosis factor alpha (TNF-α) inhibitor, received a course of physical therapy twice with a 6-month interval, which consisted of hydro-air massage and rehabilitation exercises. Group II patients were treated with a TNF-α inhibitor only. In both groups, the study lasted 10 months. At follow-up visits, all participants underwent a physical examination, laboratory tests and the following questionnaire-based studies: Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI) and Short Form Health Survey (SF-36) v.2. Results: The applied physical therapy programme did not improve physical performance in the patients studied. There was no improvement in any of the physical parameters studied. Therefore, the functional status did not improve and disease activity did not decrease in the patients studied. However, some domains from the quality-of-life assessment improved. Conclusions: Physical therapy and education should be the primary form of non-pharmacological treatment in AS patients treated with biologics.