From the Guidelines
Rehabilitation for ankylosing spondylitis (AS) should prioritize a combination of physical therapy and exercise to maintain spinal mobility, improve posture, and reduce pain, as recommended by the most recent guidelines 1. The goals of rehabilitation in AS are to alleviate symptoms, improve functioning, maintain the ability to work, decrease disease complications, and forestall skeletal damage as much as possible.
- A comprehensive program should include:
- Daily stretching exercises targeting the spine, hips, and shoulders for 15-20 minutes
- Regular aerobic activities like swimming or walking for 30 minutes, 3-5 times weekly
- Specific exercises such as spinal extension movements, deep breathing exercises to maintain chest expansion, and postural training
- Physical therapy modalities like heat therapy before exercise and cold packs for acute inflammation can provide symptomatic relief.
- Patients should practice proper body mechanics during daily activities, maintain good posture while sitting and standing, and use ergonomic supports when needed.
- Water-based exercises are particularly beneficial as they reduce joint stress while allowing movement. The program should be individualized based on disease severity and modified during flare-ups to focus on gentle movement rather than intense exercise, as suggested by the American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network recommendations 1. Consistent adherence to these rehabilitation strategies, alongside appropriate medication management, helps prevent spinal fusion, maintains function, and improves quality of life for AS patients, ultimately reducing morbidity, mortality, and improving overall quality of life.
From the FDA Drug Label
4 Ankylosing Spondylitis Enbrel is indicated for reducing signs and symptoms in patients with active ankylosing spondylitis (AS).
3 Recommended Dosage in Adult Patients with Rheumatoid Arthritis, Ankylosing Spondylitis, Psoriatic Arthritis, and Plaque Psoriasis Enbrel is administered by subcutaneous injection (Table 1). Table 1 Recommended Dosage for Adult Patients with RA, AS, PsA and PsO Patient PopulationRecommended Dosage Adult RA, AS, and PsA50 mg weekly
The rehabilitation of ankylosing spondylitis involves the use of etanercept (Enbrel) to reduce signs and symptoms. The recommended dosage for adult patients with ankylosing spondylitis is 50 mg weekly. 2
From the Research
Ankylosing Spondylitis Rehabilitation
- Ankylosing spondylitis (AS) is a chronic inflammatory disease that can progress to severe damage of the spine, resulting in functional impairment, disability, and poor quality of life 3.
- Rehabilitation is a crucial aspect of AS management, and a multidisciplinary approach is recommended 4, 5.
- A three-week multidisciplinary in-patient rehabilitation program has been shown to have positive long-term effects on disease activity, pain, function, and well-being in patients with AS 4.
Non-Pharmacological Interventions
- Physiotherapy is an integral part of AS management, and regular lifelong exercise is the mainstay of rehabilitation 5.
- A systematic literature search and expert opinion have led to the development of six key recommendations for physiotherapy and rehabilitation in AS, covering early intervention, initial and follow-up assessments, contraindications, and precautions 5.
Pharmacological Interventions
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are recommended as first-line drug treatment for AS, and have been shown to be effective in reducing pain, disease activity, and improving function 6, 7.
- Both traditional and COX-2 NSAIDs have been found to be efficacious in treating AS, with no significant differences in benefits or harms between NSAID classes 7.
- Continuous NSAID use may reduce radiographic spinal progression, but this requires confirmation 7.
Key Recommendations
- Early intervention and regular lifelong exercise are essential for AS rehabilitation 4, 5.
- A multidisciplinary approach, including physiotherapy, is recommended for AS management 4, 5.
- NSAIDs should be used as first-line drug treatment for AS, with careful consideration of potential side effects and individual patient needs 6, 7.