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Spinal Diseases: HELP
Articles by Hanne Dagfinrud
Based on 22 articles published since 2009
(Why 22 articles?)
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Between 2009 and 2019, H. Dagfinrud wrote the following 22 articles about Spinal Diseases.
 
+ Citations + Abstracts
1 Guideline 2018 EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis. 2018

Rausch Osthoff, Anne-Kathrin / Niedermann, Karin / Braun, Jürgen / Adams, Jo / Brodin, Nina / Dagfinrud, Hanne / Duruoz, Tuncay / Esbensen, Bente Appel / Günther, Klaus-Peter / Hurkmans, Emailie / Juhl, Carsten Bogh / Kennedy, Norelee / Kiltz, Uta / Knittle, Keegan / Nurmohamed, Michael / Pais, Sandra / Severijns, Guy / Swinnen, Thijs Willem / Pitsillidou, Irene A / Warburton, Louise / Yankov, Zhivko / Vliet Vlieland, Theodora P M. ·School of Health Professions, Institute of Physiotherapy, Zurich University of Applied Sciences, Winterthur, Switzerland. · Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, Netherlands. · Rheumazentrum Ruhrgebiet, Herne, Germany. · Ruhr University, Bochum, Germany. · Faculty of Health Sciences and Arthritis Research UK Centre of Excellence for Sport, Exercise and Osteoarthritis, University of Southampton, Southampton, UK. · Department of Orthopaedics, Danderyd University Hospital Corp., Stockholm, Sweden. · Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden. · National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. · PMR Department, Rheumatology Division, Marmara University, School of Medicine, Istanbul, Turkey. · Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet., Glostrup, Denmark. · Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark. · University Center of Orthopaedics and Traumatology, University Medicine at Technische Universität Dresden, Dresden, Germany. · Department Social Affaire and Health, ECORYS Nederland BV, Rotterdam, Netherlands. · Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark. · Departmentof Occupational and Physical Therapy, University of Copenhagen, Herlev and Gentofte Hospital, Copenhagen, Denmark. · School of Allied Health, Faculty of Education and Health Sciences and Health Research Institute, University of Limerick, Limerick, Ireland. · Department of Social Psychology, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland. · Department of Rheumatology, Amsterdam Rheumatology and immunology Center, VU University Medical Center, Amsterdam, The Netherlands. · Centre for Biomedical Research, University of Algarve, Faro, Portugal. · EULAR PARE Patient Research Partner, ReumaNet, Leuven, Belgium. · Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, KU Leuven, Leuven, Belgium. · Division of Rheumatology, University Hospitals Leuven, Leuven, Belgium. · EULAR Patient Research Partner, Cyprus League Against Rheumatism, Nicosia, Cyprus. · Primary Health Care Sciences, Keele University, Keele, UK. · PRP (Patient Research Partner EULAR), Bulgarian Ankylosing Spondylitis Patient Society, Sofia, Bulgaria and ASIF (Ankylosing Spondylitis International Federation), London, UK. ·Ann Rheum Dis · Pubmed #29997112.

ABSTRACT: Regular physical activity (PA) is increasingly promoted for people with rheumatic and musculoskeletal diseases as well as the general population. We evaluated if the public health recommendations for PA are applicable for people with inflammatory arthritis (iA; Rheumatoid Arthritis and Spondyloarthritis) and osteoarthritis (hip/knee OA) in order to develop evidence-based recommendations for advice and guidance on PA in clinical practice. The EULAR standardised operating procedures for the development of recommendations were followed. A task force (TF) (including rheumatologists, other medical specialists and physicians, health professionals, patient-representatives, methodologists) from 16 countries met twice. In the first TF meeting, 13 research questions to support a systematic literature review (SLR) were identified and defined. In the second meeting, the SLR evidence was presented and discussed before the recommendations, research agenda and education agenda were formulated. The TF developed and agreed on four overarching principles and 10 recommendations for PA in people with iA and OA. The mean level of agreement between the TF members ranged between 9.8 and 8.8. Given the evidence for its effectiveness, feasibility and safety, PA is advocated as integral part of standard care throughout the course of these diseases. Finally, the TF agreed on related research and education agendas. Evidence and expert opinion inform these recommendations to provide guidance in the development, conduct and evaluation of PA-interventions and promotion in people with iA and OA. It is advised that these recommendations should be implemented considering individual needs and national health systems.

2 Guideline 2016 update of the ASAS-EULAR management recommendations for axial spondyloarthritis. 2017

van der Heijde, Désirée / Ramiro, Sofia / Landewé, Robert / Baraliakos, Xenofon / Van den Bosch, Filip / Sepriano, Alexandre / Regel, Andrea / Ciurea, Adrian / Dagfinrud, Hanne / Dougados, Maxime / van Gaalen, Floris / Géher, Pál / van der Horst-Bruinsma, Irene / Inman, Robert D / Jongkees, Merryn / Kiltz, Uta / Kvien, Tore K / Machado, Pedro M / Marzo-Ortega, Helena / Molto, Anna / Navarro-Compàn, Victoria / Ozgocmen, Salih / Pimentel-Santos, Fernando M / Reveille, John / Rudwaleit, Martin / Sieper, Jochen / Sampaio-Barros, Percival / Wiek, Dieter / Braun, Jürgen. ·Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands. · Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands. · Department of Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands. · Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Herne, Germany. · Department of Rheumatology, Ghent University and Ghent University Hospital, Ghent, Belgium. · NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal. · Department of Rheumatology, University Hospital Zurich, Zurich Switzerland. · Diakonhjemmet Hospital, Oslo, Norway. · Paris Descartes University, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France. · INSERM (U1153), PRES Sorbonne Paris-Cité, Paris, France. · Semmelweis University, Budapest, Hungary. · Department of Rheumatology, VU University Medical Center, Amsterdam, The Netherlands. · University of Toronto, Toronto, Ontario, Canada. · Patient Research Partner, Amsterdam, The Netherlands. · Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. · Centre for Rheumatology & MRC Centre for Neuromuscular Diseases, University College London, London, UK. · NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, UK. · Leeds Institute of Rheumatic and Musculoskeletal Disease, University of Leeds, Leeds, UK. · Department of Rheumatology, University Hospital La Paz, IdiPaz, Madrid, Spain. · Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Erciyes University, Kayseri, Turkey. · NOVA Medical School, NOVA University of Lisbon, Lisboa, Portugal. · The University of Texas-Health McGovern Medical School, Dallas, USA. · Klinikum Bielefeld, Bielefeld, Germany. · Gent University, Gent, Belgium. · Charité University Medicine, Berlin, Germany. · Department of Rheumatology, Campus Benjamin Franklin, Charité, Berlin, Germany. · Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil. · EULAR PARE Patient Research Partner and Chair of EULAR PARE, Berlin, Germany. ·Ann Rheum Dis · Pubmed #28087505.

ABSTRACT: To update and integrate the recommendations for ankylosing spondylitis and the recommendations for the use of tumour necrosis factor inhibitors (TNFi) in axial spondyloarthritis (axSpA) into one set applicable to the full spectrum of patients with axSpA. Following the latest version of the European League Against Rheumatism (EULAR) Standardised Operating Procedures, two systematic literature reviews first collected the evidence regarding all treatment options (pharmacological and non-pharmacological) that were published since 2009. After a discussion of the results in the steering group and presentation to the task force, overarching principles and recommendations were formulated, and consensus was obtained by informal voting. A total of 5 overarching principles and 13 recommendations were agreed on. The first three recommendations deal with personalised medicine including treatment target and monitoring. Recommendation 4 covers non-pharmacological management. Recommendation 5 describes the central role of non-steroidal anti-inflammatory drugs (NSAIDs) as first-choice drug treatment. Recommendations 6-8 define the rather modest role of analgesics, and disprove glucocorticoids and conventional synthetic disease-modifying antirheumatic drugs (DMARDs) for axSpA patents with predominant axial involvement. Recommendation 9 refers to biological DMARDs (bDMARDs) including TNFi and IL-17 inhibitors (IL-17i) for patients with high disease activity despite the use (or intolerance/contraindication) of at least two NSAIDs. In addition, they should either have an elevated C reactive protein and/or definite inflammation on MRI and/or radiographic evidence of sacroiliitis. Current practice is to start with a TNFi. Switching to another TNFi or an IL-17i is recommended in case TNFi fails (recommendation 10). Tapering, but not stopping a bDMARD, can be considered in patients in sustained remission (recommendation 11). The final two recommendations (12, 13) deal with surgery and spinal fractures. The 2016 Assessment of SpondyloArthritis international Society-EULAR recommendations provide up-to-date guidance on the management of patients with axSpA.

3 Guideline European League Against Rheumatism recommendations for the management of psoriatic arthritis with pharmacological therapies. 2012

Gossec, L / Smolen, J S / Gaujoux-Viala, C / Ash, Z / Marzo-Ortega, H / van der Heijde, D / FitzGerald, O / Aletaha, D / Balint, P / Boumpas, D / Braun, J / Breedveld, F C / Burmester, G / Cañete, J D / de Wit, M / Dagfinrud, H / de Vlam, K / Dougados, M / Helliwell, P / Kavanaugh, A / Kvien, T K / Landewé, R / Luger, T / Maccarone, M / McGonagle, D / McHugh, N / McInnes, I B / Ritchlin, C / Sieper, J / Tak, P P / Valesini, G / Vencovsky, J / Winthrop, K L / Zink, A / Emery, P / Anonymous2420706. ·Paris Descartes University, Paris, France. laure.gossec@cch.aphp.fr ·Ann Rheum Dis · Pubmed #21953336.

ABSTRACT: BACKGROUND: Psoriatic arthritis (PsA) is a clinically heterogeneous disease. Clear consensual treatment guidance focused on the musculoskeletal manifestations of PsA would be advantageous. The authors present European League Against Rheumatism (EULAR) recommendations for the treatment of PsA with systemic or local (non-topical) symptomatic and disease-modifying antirheumatic drugs (DMARD). METHODS: The recommendations are based on evidence from systematic literature reviews performed for non-steroidal anti-inflammatory drugs (NSAID), glucocorticoids, synthetic DMARD and biological DMARD. This evidence was discussed, summarised and recommendations were formulated by a task force comprising 35 representatives, and providing levels of evidence, strength of recommendations and levels of agreement. RESULTS: Ten recommendations were developed for treatment from NSAID through synthetic DMARD to biological agents, accounting for articular and extra-articular manifestations of PsA. Five overarching principles and a research agenda were defined. CONCLUSION: These recommendations are intended to provide rheumatologists, patients and other stakeholders with a consensus on the pharmacological treatment of PsA and strategies to reach optimal outcomes, based on combining evidence and expert opinion. The research agenda informs directions within EULAR and other communities interested in PsA.

4 Review Evidence of reduced parasympathetic autonomic regulation in inflammatory joint disease: A meta-analyses study. 2018

Provan, Sella A / Olstad, Daniela Schäfer / Solberg, Erik E / Smedslund, Geir / Dagfinrud, Hanne. ·Department of Rheumatology, Diakonhjemmet Hospital, PB 23 Vindern, 0319 Oslo, Norway. Electronic address: sellaprovan@gmail.com. · Department of Rheumatology, National Resource Centre for Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. · Department of Medicine, Diakonhjemmet Hospital, Oslo, Norway. ·Semin Arthritis Rheum · Pubmed #29291895.

ABSTRACT: BACKGROUND: Rheumatoid arthritis (RA) and spondyloarthritis (SpA) are inflammatory joint disorders (IJD) with increased risk of cardiovascular disease (CVD). Autonomic dysfunction (AD) is a risk factor for CVD, and parasympathetic AD is linked to key features of IJD such as inflammation, physical inactivity and pain. Heart-rate variability (HRV) is a marker of cardiac AD. The study objective was to compare parasympathetic cardiac AD, measured by HRV, between patients with IJD and healthy controls, using meta-analysis methodology, and to examine the impact of inflammation, physical inactivity and pain on HRV in IJD. METHODS: Medline, Embase and Amed were searched. Inclusion criteria were adult case-control studies published in English or a Scandinavian language, presenting HRV data in IJD. Two measures of HRV and 3 from the Ewing protocol were selected: square root of mean squared difference of successive R-R intervals (RMSSD), high frequency (HF), Ewing protocol; standing (E-S), breathing (E-B) and Valsalva (E-V). Patients with RA, SpA and healthy controls were compared separately using random-effects meta-analyses of standardized mean differences (SMD). RESULTS: In all, 35 papers were eligible for inclusion. For RMSSD the pooled SMD (95% CI) RA vs. controls was -0.90 (-1.35 to -0.44), for SpA vs. controls; -0.34 (-0.73 to 0.06). For HF pooled SMD RA vs. controls was -0.78 (-0.99 to -0.57), for SpA vs. controls; -0.04 (-0.22 to 0.13). All Ewing parameters were significantly lower in cases, except for E-V which was comparable between cases and controls in patients with RA. CONCLUSION: Patients with IJD have cardiac parasympathetic AD which is related to inflammation.

5 Article Are gender-specific approaches needed in diagnosing early axial spondyloarthritis? Data from the SPondyloArthritis Caught Early cohort. 2018

Ortolan, Augusta / van Lunteren, Miranda / Ramiro, Sofia / Ramonda, Roberta / Landewé, Robert B M / Dagfinrud, Hanne / Jacobsson, Lennart T H / van der Heijde, Désirée / van Gaalen, Floris A. ·Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands. · Rheumatology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy. · Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, the Netherlands. · Department of Rheumatology, Zuyderland Medical Center, Heerlen, the Netherlands. · Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. · Department of Rheumatology, University of Gothenburg, Gothenburg, Sweden. · Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands. f.a.van_gaalen@lumc.nl. ·Arthritis Res Ther · Pubmed #30285842.

ABSTRACT: BACKGROUND: Although gender differences have been observed in the severity of axial spondyloarthritis (axSpA), gender differences in disease presentation of early axSpA have not been thoroughly investigated. In particular, their impact on the diagnostic process is unknown. METHODS: Baseline data from the SPondyloArthritis Caught Early cohort, which includes patients with chronic back pain (CBP; duration ≥ 3 months and ≤ 2 years, age of onset < 45 years), were analysed. Patients underwent a full diagnostic work-up, including MRI and radiograph of the sacroiliac joints (MRI-SIJ and X-SIJ), to establish a diagnosis of axSpA. Characteristics of male and female patients with a certain diagnosis of axSpA (confidence level by the physician ≥ 7 on a 0-10 rating scale) were compared. Regression models were built for: the whole CBP cohort stratified by gender, to study which SpA features were associated most with diagnosis in each gender; and for axSpA patients, to test whether gender was associated with imaging positivity (MRI-SIJ RESULTS: Of the 719 CBP patients, 275 were male. With 146/275 males and 155/444 females diagnosed as axSpA, males were more likely to be diagnosed with axSpA (OR 2.1, 95% CI 1.5-2.9). Despite similar symptom duration, male axSpA patients were younger at diagnosis (27.4 ± 7.5 vs 29.5 ± 7.8 years; p = 0.02). Presence of SpA features was similar in male and female axSpA patients, except for HLA-B27 and imaging positivity that were more common in male axSpA patients (80% vs 60%; p < 0.01 and 78% vs 64%; p = 0.01). Nevertheless, these SpA features were still more prevalent in female axSpA patients than in no-axSpA patients, both females (HLA-B27 CONCLUSIONS: While our data show clear gender differences in early axSpA, they highlight that HLA-B27 and imaging are still key elements for diagnosis in both genders. Our study does not suggest that separate diagnostic strategies for men and women are required.

6 Article High-intensity cardiorespiratory and strength exercises reduced emotional distress and fatigue in patients with axial spondyloarthritis: a randomized controlled pilot study. 2018

Sveaas, S H / Berg, I J / Fongen, C / Provan, S A / Dagfinrud, H. ·a Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology , Diakonhjemmet Hospital , Oslo , Norway. · b Department of Rheumatology , Diakonhjemmet Hospital , Oslo , Norway. · c Department of Health Sciences, Institute of Health and Society, Faculty of Medicine , University of Oslo , Oslo , Norway. ·Scand J Rheumatol · Pubmed #28891743.

ABSTRACT: OBJECTIVE: To investigate the effect of high-intensity exercise on emotional distress, fatigue, and ability to do a full day's activities in patients with axial spondyloarthritis (axSpA). METHOD: A total of 28 physically inactive axSpA patients were randomized to either an exercise group (EG), which performed 12 weeks of cardiorespiratory and strength exercises, or a control group (CG), which received treatment as usual. The outcomes reported in this paper are secondary outcomes in the trial and included emotional distress (General Health Questionnaire-12, 0-36, 36 = worst), fatigue [numeric rating scale (NRS), 0-10, 10 = worst], and ability to do a full day's activities (NRS, 0-10, 10 = worst). Post-intervention differences were assessed by analysis of covariance with baseline values as covariates. RESULTS: Twenty-four patients were included in the analyses. All patients in the EG followed the exercise protocol. The EG had a statistically significant beneficial effect [mean group differences (95% confidence interval)] on emotional distress [-5.8, (-9.7, -1.9), p < 0.01], fatigue [-2.4, (-4.3, -0.4), p = 0.02], and ability to do a full day's work [-2.2, (-3.9, -0.4), p = 0.02] compared to the CG. CONCLUSION: This pilot study showed promising effects of cardiorespiratory and strength exercises on emotional distress, fatigue, and ability to do a full day's activities in patients with axSpA. The findings need to be confirmed in a larger trial.

7 Article Prevalence and clinical significance of lumbosacral transitional vertebra (LSTV) in a young back pain population with suspected axial spondyloarthritis: results of the SPondyloArthritis Caught Early (SPACE) cohort. 2017

de Bruin, F / Ter Horst, S / Bloem, J L / van den Berg, R / de Hooge, M / van Gaalen, F / Dagfinrud, H / van Oosterhout, M / Landewé, R / van der Heijde, D / Reijnierse, M. ·Department of Radiology, Leiden University Medical Center, 2333, ZA, Leiden, The Netherlands. f.de_bruin@lumc.nl. · Department of Radiology, Leiden University Medical Center, 2333, ZA, Leiden, The Netherlands. · Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands. · Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. · Department of Rheumatology, Groene Hartziekenhuis, Gouda, The Netherlands. · Department of Rheumatology, Amsterdam Medical Center, Amsterdam, The Netherlands. ·Skeletal Radiol · Pubmed #28236124.

ABSTRACT: OBJECTIVE: To determine in a cohort of young patients with suspected axial spondyloarthritis (axSpA), the prevalence of lumbosacral transitional vertebra (LSTV), its association with local bone marrow edema (BME) and lumbar spine degeneration, and the potential relationship with MRI findings and clinical signs of axSpA. MATERIALS AND METHODS: Baseline imaging studies and clinical information of patients from the SPondyloArthritis Caught Early-cohort (back pain ≥3 months, ≤2 years, onset <45 years) were used. Two independent readers assessed all patients for LSTV on radiography, and BME-like and degenerative changes on MRI. Patients with and without LSTV were compared with regard to the prevalence of MRI findings and the results of clinical assessment using Chi-squared test or t test. RESULTS: Of 273 patients (35.1% male, mean age 30.0), 68 (25%) patients showed an LSTV, without statistical significant difference between patients with and without axSpA (p = 0.327). Local sacral BME was present in 9 out of 68 (13%) patients with LSTV and absent in patients without LSTV (p < 0.001). Visual analogue scale (VAS) pain score and spinal mobility assessments were comparable. CONCLUSIONS: LSTV is of low clinical relevance in the early diagnosis of axSpA. There is no difference between patients with and without LSTV regarding the prevalence of axSpA, pain and spinal mobility, and a BME-like pattern at the pseudoarticulation does not reach the SI joints.

8 Article Variation in fatigue may be poorly explained by pain: results from a longitudinal, exploratory study. 2016

Christie, Anne / Dagfinrud, Hanne / Mowinckel, Petter / Hagen, Kåre Birger. ·National Advisory Unit for Rehabilitation on Rheumatology (NKRR), Department of Rheumatology, Diakonhjemmet Hospital, PO Box 23, Vinderen, 0319, Oslo, Norway. achristie@live.no. · National Advisory Unit for Rehabilitation on Rheumatology (NKRR), Department of Rheumatology, Diakonhjemmet Hospital, PO Box 23, Vinderen, 0319, Oslo, Norway. ·Rheumatol Int · Pubmed #26350269.

ABSTRACT: It is frequently claimed that fatigue reflects pain and that strategies for alleviating fatigue in patients with ankylosing spondylitis (AS) should focus on pain management. The aim of this study was twofold: to investigate the correlation between fatigue and pain over time and to investigate the temporal relationship between fatigue and pain in patients with AS. Fatigue and pain were assessed twice a week for 35 weeks in 23 patients with AS. Data were reported with text messages on mobile phones, constituting around 70 repeated measurements per patient. To estimate correlation over time, the correlation coefficient within individuals was estimated. When estimating the temporal relationship, we lagged the independent variable and performed individual linear regression. In 16 (70 %) of the patients, ≤ 36 % of the variance in fatigue was explained by pain. The association between fatigue and pain was synchronous in time in 13 (57 %) patients, while 5 (22 %) patients reported that fatigue precedes pain by 1 week and 5 (22 %) that pain precedes fatigue by 1 week. Fatigue and pain may be two separate and independent symptoms in some patients with AS. The clinical implication is that the two symptoms should be targeted separately because it cannot always be expected that an improvement in one is followed by an improvement in the other.

9 Article CRP and ASDAS are associated with future elevated arterial stiffness, a risk marker of cardiovascular disease, in patients with ankylosing spondylitis: results after 5-year follow-up. 2015

Berg, Inger Jorid / Semb, Anne Grete / van der Heijde, Désirée / Kvien, Tore K / Olsen, Inge C / Dagfinrud, Hanne / Provan, Sella A. ·Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. · Department of Rheumatology, Preventive Cardio-Rheuma clinic, Diakonhjemmet Hospital, Oslo, Norway. · Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands. ·Ann Rheum Dis · Pubmed #25795906.

ABSTRACT: OBJECTIVE: To identify factors associated with elevated arterial stiffness in a 5-year follow-up of patients with ankylosing spondylitis (AS). METHODS: C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), Bath AS disease activity index (BASDAI) and AS disease activity score (ASDAS) were recorded in 2003, and arterial stiffness (Augmentation Index (AIx) and pulse wave velocity (PWV)) in 2008/2009. Patients were grouped into quartiles according to baseline CRP, ESR and BASDAI and four ASDAS groups. Trend analyses were performed using ANCOVA (AIx/PWV as dependent variable) with separate models for CRP, ESR, BASDAI and ASDAS (age and gender adjusted). Independent predictors of future AIx and PWV levels were identified in multivariate linear regression models. RESULTS: In total, 85 patients participated. Increasing baseline values of CRP, ESR and ASDAS were associated with elevated AIx on follow-up (p(trend) 0.01, 0.05 and 0.04, respectively). Similar non-significant patterns were seen for PWV. In the multivariate analyses, baseline CRP and ASDAS were independently associated with future elevated AIx (p=0.03 and0.02, respectively). In the multivariate PWV model, results for CRP and ASDAS were non-significant. CONCLUSIONS: Baseline CRP and ASDAS were associated with future elevated arterial stiffness measured as AIx, supporting that disease activity is related to future risk of cardiovascular disease in patients with AS.

10 Article Circulating levels of inflammatory cytokines and cytokine receptors in patients with ankylosing spondylitis: a cross-sectional comparative study. 2015

Sveaas, S H / Berg, I J / Provan, S A / Semb, A G / Olsen, I C / Ueland, T / Aukrust, P / Vøllestad, N / Hagen, K B / Kvien, T K / Dagfinrud, H. ·National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital , Oslo , Norway. ·Scand J Rheumatol · Pubmed #25756521.

ABSTRACT: OBJECTIVES: Insight into the most important inflammatory pathways in ankylosing spondylitis (AS) could be of importance in risk stratification and the development of treatment strategies. Therefore, we aimed to compare circulating levels of inflammatory biomarkers between AS patients and controls, and explore associations between these biomarkers and clinical measures of disease activity. METHOD: In a cross-sectional study, 143 AS patients were compared with 124 population controls. Blood samples were analysed by immunoassays for interleukin (IL)-6, IL-17a, IL-23, soluble tumour necrosis factor receptor 1 (sTNF-R1) and 2 (sTNF-R2), and osteoprotegerin (OPG). Disease activity was measured by the AS Disease Activity Score (ASDAS) and the Bath AS Disease Activity Index (BASDAI). RESULTS: Analysis of covariance (ANCOVA) demonstrated elevated plasma levels of sTNF-R1 [geometrical mean 0.94 (95% CI 0.88-1.00) vs. 0.83 (95% CI 0.78-0.89) ng/mL, p < 0.01] and OPG (2.3, 95% CI 2.1-2.4 vs. 2.0, 95% CI 1.9-2.2 ng/mL, p = 0.02) and, although not significant, of IL-23 (122, 95% CI 108-139 vs. 106, 95% CI 93-120 pg/mL, p = 0.07) in AS patients vs. CONTROLS: More AS patients had a high level of sTNF-R2 than controls (22 vs. 1, p < 0.01). No differences between the groups were seen for IL-6 and IL-17a. In patients, no significant associations were seen between inflammatory markers and disease activity measures after adjusting for personal characteristics. CONCLUSION: Significantly higher plasma levels of sTNF-R1, sTNF-R2, and OPG and numerically but non-significantly higher levels of IL-23 were found in AS patients compared to controls, indicating that these cytokines and cytokine receptors are important inflammatory pathways. Clinical measures of disease activity were not significantly correlated with circulating inflammatory markers.

11 Article Disease activity in ankylosing spondylitis and associations to markers of vascular pathology and traditional cardiovascular disease risk factors: a cross-sectional study. 2015

Berg, Inger Jorid / van der Heijde, Désirée / Dagfinrud, Hanne / Seljeflot, Ingebjørg / Olsen, Inge Christoffer / Kvien, Tore K / Semb, Anne Grete / Provan, Sella A. ·From the Department of Rheumatology, Diakonhjemmet Hospital, and Department of Cardiology, Center for Clinical Heart Research, Oslo University Hospital Ullevål, and University of Oslo, Oslo, Norway; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.I.J. Berg, MD; H. Dagfinrud, PhD; I.C. Olsen, PhD; T.K. Kvien, MD, PhD; A.G. Semb, MD, PhD; S.A. Provan, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; D. van der Heijde, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital and Department of Rheumatology, Leiden University Medical Center; I. Seljeflot, PhD, Department of Cardiology, Center for Clinical Heart Research, Oslo University Hospital Ullevål, and Faculty of Medicine, University of Oslo. ·J Rheumatol · Pubmed #25641897.

ABSTRACT: OBJECTIVE: To compare the risk of cardiovascular disease (CVD) in ankylosing spondylitis (AS) and population controls, and to examine the associations between disease activity and CVD risk. METHODS: A cross-sectional study was done of patients with AS grouped according to Ankylosing Spondylitis Disease Activity Score (ASDAS) into ASDAS-high and ASDAS-low. Markers of vascular pathology, impaired endothelial function [asymmetric dimethylarginine (ADMA)], and arterial stiffness [augmentation index (AIx) and pulse wave velocity (PWV)], and traditional CVD risk factors [blood pressure, lipids, body mass index (BMI), CVD risk scores] were compared between AS and controls as well as across ASDAS-high versus ASDAS-low versus controls using ANCOVA analyses. RESULTS: Altogether, 151 patients with AS and 134 controls participated. Patients had elevated ADMA (µmol/l) and AIx (%) compared to controls: mean difference (95% CI): 0.05 (0.03, 0.07), p < 0.001 and 2.6 (0.8, 4.3), p = 0.01, respectively. AIx increased with higher ASDAS level, p(trend) < 0.04. There were no significant group differences of PWV. BMI was higher in ASDAS-high compared to ASDAS-low (p = 0.02). Total cholesterol was lower in AS compared to controls, and lower with higher ASDAS, p(trend) = 0.02. CVD risk scores were similar across groups except for Reynolds Risk Score, where the ASDAS-high group had a significantly higher score, compared to both ASDAS-low and controls. CONCLUSION: Elevated ADMA and AIx in AS support a higher CVD risk in AS. Elevated AIx and BMI in AS with high ASDAS indicate an association between disease activity and CVD risk. Lower total cholesterol in AS may contribute to underestimation of CVD risk.

12 Article Barriers and Facilitators for Being Physically Active in Patients with Ankylosing Spondylitis: A Cross-sectional Comparative Study. 2015

Fongen, Camilla / Sveaas, Silje Halvorsen / Dagfinrud, Hanne. ·Diakonhjemmet Hospital, Oslo, Norway. · University of Oslo, Oslo, Norway. ·Musculoskeletal Care · Pubmed #25370164.

ABSTRACT: OBJECTIVES: The aims of the present study were to explore the barriers and facilitators for being physically active and the perceived health benefits of physical activity in a group of patients with ankylosing spondylitis (AS), and to compare the findings with those in population controls. METHODS: A total of 148 patients and 133 controls were included in a cross-sectional study. Barriers, facilitators and perceived health benefits were registered in a structured interview. RESULTS: Patients were significantly more likely to report barriers to being physically active compared with controls (78% versus 58%; p ≤ 0.001). The barriers most frequently reported by patients were pain (48%), stiffness (36%), fatigue (30%) and disability (21%). A similar proportion of patients (62%) and controls (61%) reported that they had the potential to become more physically active (p = 0.12). Time and motivation were the most frequently reported facilitators in both groups. Patients also reported stable disease (15%) and individually adapted physical activity (8%) as facilitators. An equal proportion of patients (96%) and controls (96%) reported that physical activity had a positive effect on their health (p = 0.94). Improved fitness and increased vitality were the most frequently reported health benefits in both groups. Patients also reported greater disease stability (37%) and reduced pain (33%) as benefits. CONCLUSIONS: A larger proportion of patients than controls reported barriers to being physically active. In addition to regular barriers, facilitators and health benefits, patients reported that disease-related factors influenced their participation in physical activity.

13 Article Efficacy of high intensity exercise on disease activity and cardiovascular risk in active axial spondyloarthritis: a randomized controlled pilot study. 2014

Sveaas, Silje Halvorsen / Berg, Inger Jorid / Provan, Sella Aarrestad / Semb, Anne Grete / Hagen, Kåre Birger / Vøllestad, Nina / Fongen, Camilla / Olsen, Inge C / Michelsen, Annika / Ueland, Thor / Aukrust, Pål / Kvien, Tore K / Dagfinrud, Hanne. ·National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Department of Health Sciences, University of Oslo, Oslo, Norway. · Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. · Department of Health Sciences, University of Oslo, Oslo, Norway. · National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. · Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway. · Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway. · Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway; K.G. Jebsen Inflammatory Research Center, University of Oslo, Oslo, Norway. ·PLoS One · Pubmed #25268365.

ABSTRACT: BACKGROUND: Physical therapy is recommended for the management of axial spondyloarthritis (axSpA) and flexibility exercises have traditionally been the main focus. Cardiovascular (CV) diseases are considered as a major health concern in axSpA and there is strong evidence that endurance and strength exercise protects against CV diseases. Therefore, the aim of this study was to investigate the efficacy of high intensity endurance and strength exercise on disease activity and CV health in patients with active axSpA. METHODS: In a single blinded randomized controlled pilot study the exercise group (EG) performed 12 weeks of endurance and strength exercise while the control group (CG) received treatment as usual. The primary outcome was the Ankylosing Spondylitis (AS) Disease Activity Score (ASDAS). Secondary outcomes included patient reported disease activity (Bath AS Disease Activity Index [BASDAI]), physical function (Bath AS Functional Index [BASFI]), and CV risk factors measured by arterial stiffness (Augmentation Index [Alx]) and Pulse Wave Velocity [PWV]), cardiorespiratory fitness (VO2 peak) and body composition. ANCOVA on the post intervention values with baseline values as covariates was used to assess group differences, and Mann Whitney U-test was used for outcomes with skewed residuals. RESULTS: Twenty-eight patients were included and 24 (EG, n = 10, CG, n = 14) completed the study. A mean treatment effect of -0.7 (95%CI: -1.4, 0.1) was seen in ASDAS score. Treatment effects were also observed in secondary outcomes (mean group difference [95%CI]): BASDAI: -2.0 (-3.6, -0.4), BASFI: -1.4 (-2.6, -0.3), arterial stiffness (estimated median group differences [95% CI]): AIx (%): -5.3 (-11.0, -0.5), and for PVW (m/s): -0.3 (-0.7, 0.0), VO2 peak (ml/kg/min) (mean group difference [95%CI]: 3.7 (2.1, 5.2) and trunk fat (%): -1.8 (-3.0, -0.6). No adverse events occurred. CONCLUSION: High intensity exercise improved disease activity and reduced CV risk factors in patients with active axSpA. These effects will be further explored in a larger trial. TRIAL REGISTRATION: ClinicalTrials.gov NCT01436942.

14 Article Uveitis is associated with hypertension and atherosclerosis in patients with ankylosing spondylitis: a cross-sectional study. 2014

Berg, Inger Jorid / Semb, Anne Grete / van der Heijde, Désirée / Kvien, Tore K / Hisdal, Jonny / Olsen, Inge C / Dagfinrud, Hanne / Provan, Sella A. ·Department of Rheumatology, Diakonhjemmet Hospital, Box 23 Vinderen, Oslo N-0319, Norway. Electronic address: ingerjoridberg@gmail.com. · Department of Rheumatology, Diakonhjemmet Hospital, Box 23 Vinderen, Oslo N-0319, Norway. · Department of Rheumatology, Diakonhjemmet Hospital, Box 23 Vinderen, Oslo N-0319, Norway; Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands. · Section of Vascular Investigations, Oslo University Hospital Aker, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway. ·Semin Arthritis Rheum · Pubmed #24968705.

ABSTRACT: OBJECTIVES: Uveitis is the most common extra-articular manifestation in patients with ankylosing spondylitis (AS), but the literature describing AS patients with a history of uveitis is limited. The objective was to examine if a history of uveitis in patients with AS is associated with increased disease activity and functional impairment and to investigate whether uveitis is associated with an increased frequency of cardiovascular comorbidities, defined here as hypertension and atherosclerosis. METHODS: Data were recorded cross-sectionally through patient interviews, blood samples, clinical examination, and questionnaires. Carotid plaques were identified by ultrasonography. AS disease activity and function were compared across categories of uveitis using ANCOVA analyses. Associations between uveitis and hypertension and atherosclerosis [atherosclerotic cardiovascular disease (CVD) and/or carotid plaque] were analyzed in multivariate logistic regression models. RESULTS: Of 159 patients with AS (61.6% male, mean age 50.5 years), 84 (52.8%) had experienced one or more episodes of uveitis. AS disease activity was higher in patients with a history of uveitis, statistically significant for functional impairment [Bath AS Functional Index (BASFI)] [mean difference (95% CI)] lnBASFI = 0.2 (0.0-0.3), p = 0.05. Patients with uveitis had an increased odds ratio [OR (95% CI)] for hypertension [3.29 (1.29-8.41), p = 0.01] and atherosclerosis [2.57 (1.15-5.72), p = 0.02]. CONCLUSIONS: AS patients with a history of uveitis had non-significantly higher disease activity and significantly higher functional impairment. A history of uveitis was associated with hypertension as well as atherosclerosis. These results may be important in identifying AS patients with elevated risk of CVD but should be confirmed in longitudinal cohorts.

15 Article High disease activity is related to low levels of physical activity in patients with ankylosing spondylitis. 2013

Fongen, Camilla / Halvorsen, Silje / Dagfinrud, Hanne. ·National Resource Center for Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, P.O. Box 23, Vinderen, 0319, Oslo, Norway, camilla.fongen@diakonsyk.no. ·Clin Rheumatol · Pubmed #23900575.

ABSTRACT: This study aims to compare physical activity (PA) level and exercise habits in patients with ankylosing spondylitis (AS) who have high disease activity with those who have low disease activity and, further, to compare both groups with population controls. Cross-sectional study design was used. The participants include 149 patients (mean age 49.3 (SD 11.1), 61% men, 54% high disease activity) and 133 controls (mean age 52.7 (SD11.3), 58% men). PA was reported with the International PA Questionnaire-Long and results were presented as weekly energy expenditure (metabolic equivalent, MET) in different intensities, domains, and proportion reaching health enhancing physical activity (HEPA). Types of PA were registered in a structured interview. The AS Disease Activity Score was used to assess patients' disease activity. Patients with high disease activity reported significantly lower total weekly energy expenditure (MET) than patients with low disease activity and controls (p = 0.02, p = 0.01, respectively) and lower amounts of walking (p < 0.01, p = 0.02, respectively) and vigorous activity (p = 0.06, p = 0.06, respectively). Only 41% of the patients with high disease activity reached HEPA compared to 61% of the patients with low disease activity (p = 0.02). Patients in general participated less in leisure PA performed outdoor and with higher intensities (MET ≥ 6) than controls.AS patients with high disease activity had lower weekly energy expenditure in PA than patients with low disease activity and controls, and were less likely to reach HEPA than patients with low disease activity. For optimal management, health professionals should focus on physical activity in their consultations with AS patients, especially those with high disease activity.

16 Article Effect of cardiovascular training on fitness and perceived disease activity in people with ankylosing spondylitis. 2013

Niedermann, Karin / Sidelnikov, Eduard / Muggli, Claudia / Dagfinrud, Hanne / Hermann, Matthias / Tamborrini, Giorgio / Ciurea, Adrian / Bischoff-Ferrari, Heike. · ·Arthritis Care Res (Hoboken) · Pubmed #23836515.

ABSTRACT: OBJECTIVE: Several studies suggest that patients with ankylosing spondylitis (AS) have an increased risk of cardiovascular disease. This study aimed to evaluate the effects of a 12-week, individually monitored, with moderate heart rate level intensity cardiovascular training on cardiovascular fitness and perceived disease activity in AS patients. METHODS: Patients diagnosed with AS according to the modified New York criteria were randomized to either cardiovascular training or attention control. The training group performed 3 cardiovascular training units per week. All participants attended 1 weekly usual care flexibility training session. Attention control contained regular discussion groups on coping strategies. Adherence was self-monitored. Assessments were performed at baseline and after the intervention period of 3 months. Physical fitness was the primary end point, measured in watts using a submaximal bicycle test following the physical work capacity 75% protocol. All analyses controlled for sex, age, body mass index,baseline fitness and physical activity levels, and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). RESULTS: Of 106 AS patients enrolled, 40% were women and the mean ± SD age was 49 ± 12 years. A total of 74.6% of the training group reported exercising at least 3 times a week. At the 3-month followup, the fitness level in the training group was significantly higher than in the control group (mean ± SE 90.32W ± 4.52W versus 109.84W ± 4.72W; P = 0.001), independent of other covariates. The mean BASDAI total score was 0.31 points lower (P = 0.31) in the training group, reaching significance for the peripheral pain subscore (1.19; P = 0.01) but not for back pain or fatigue. CONCLUSION: Cardiovascular training, in addition to flexibility exercise, increased fitness in AS patients and reduced their peripheral pain.

17 Article Cardiorespiratory fitness and cardiovascular risk in patients with ankylosing spondylitis: a cross-sectional comparative study. 2013

Halvorsen, Silje / Vøllestad, Nina Køpke / Provan, Sella Arrestad / Semb, Anne Grete / van der Heijde, Désirée / Hagen, Kåre Birger / Dagfinrud, Hanne. ·University of Oslo and Diakonhjemmet Hospital, Oslo, Norway. silje.halvorsen@medisin.uio.no ·Arthritis Care Res (Hoboken) · Pubmed #23281265.

ABSTRACT: OBJECTIVE: To investigate the associations between cardiorespiratory fitness (CRF) and the level of cardiovascular (CV) risk factors in patients with ankylosing spondylitis (AS) and controls. METHODS: In a cross-sectional comparative study, CRF was measured with a maximal treadmill test for estimation of peak oxygen uptake. Metabolic syndrome (MS), body composition, traditional CV risk factors, and inflammatory markers were assessed. Multivariable linear regression models were used to study the associations between CRF and CV risk factors. All models were adjusted for age, sex, and smoking, and for inflammation when C-reactive protein (CRP) level or erythrocyte sedimentation rate (ESR) were not already included as dependent variables. RESULTS: A total of 126 patients (mean ± SD age 47.9 ± 10.8 years) and 111 controls (mean ± SD age 52.1 ± 11.1 years) were included. There were significant inverse associations between CRF and body mass index, waist circumference, triglycerides, CRP level, and ESR (P < 0.001-0.03) for patients and controls. Also, significant associations were found between CRF and high-density lipoprotein (HDL) cholesterol (β = 0.03, P < 0.001) and blood pressure (BP; β = -0.9 for systolic and β = -0.6 for diastolic; P < 0.01) in controls, but these associations were not found in patients (β = 0, P = 0.69 for HDL cholesterol; β = -0.04, P = 0.87 for systolic pressure; and β = -0.14, P = 0.34 for diastolic pressure) (additional adjustments for medication). Higher CRF was associated with a lower risk for MS in both patients (odds ratio [OR] 0.91, P = 0.03) and controls (OR 0.89, P = 0.01). CONCLUSION: CRF was associated with favorable levels of CV risk factors and lower risk of MS in both AS patients and controls. However, established findings of an association between CRF and BP and HDL cholesterol in healthy adults were not confirmed in AS patients.

18 Article A three-week multidisciplinary in-patient rehabilitation programme had positive long-term effects in patients with ankylosing spondylitis: randomized controlled trial. 2013

Kjeken, Ingvild / Bø, Ingvild / Rønningen, Aud / Spada, Cristina / Mowinckel, Petter / Hagen, Kåre Birger / Dagfinrud, Hanne. ·National Resource Center for Rehabilitation in Rheumatology, Diakonhjemmets Hospital, Oslo, Norway. ingvild.kjeken@diakonsyk.no ·J Rehabil Med · Pubmed #23138412.

ABSTRACT: OBJECTIVE: To evaluate the mean overall effects over a 1-year period of a multidisciplinary in-patient rehabilitation programme for patients with ankylosing spondylitis. DESIGN: Observer-blinded, randomized controlled trial, with assessments made after 4 and 12 months. PATIENTS: Forty-six patients received a 3-week in-patient rehabilitation programme and 49 patients received treatment as usual. METHODS: Primary outcomes were disease activity measured with the Bath Ankylosing Spondylitis Disease Activity Scale (BASDAI), and function measured with the Bath Ankylosing Spondylitis Functional Index (BASFI). Secondary outcomes included well-being, spinal and hip mobility, and health-related quality of life measured with the Medical Outcome Study Short Form-36. Overall treatment effects were estimated with Mixed models repeated measures analyses. RESULTS: Significant overall treatment effects in favour of the rehabilitation group were found in the BASDAI score (mean difference over the 1-year period -10.0, 95% confidence interval: -3.7 to -16.3), in well-being (-7.3, 95% confidence interval: -1.0 to -14.7), and in the Medical Outcome Study Short Form-36 variables social functioning, role physical, role mental and bodily pain (mean differences ranging from 5.8 (pain) to 10.7 (role physical)). CONCLUSION: A 3-week in-patient rehabilitation programme had positive overall effects on disease activity, pain, function and well-being, and should be considered an important complement to medical disease management in persons with ankylosing spondylitis.

19 Article Restrictive pulmonary function is more prevalent in patients with ankylosing spondylitis than in matched population controls and is associated with impaired spinal mobility: a comparative study. 2012

Berdal, Gunnhild / Halvorsen, Silje / van der Heijde, Désirée / Mowe, Morten / Dagfinrud, Hanne. ·National Resource Center for Rehabilitation in Rheumatology, Diakonhjemmet Hospital, PO Box 23 Vinderen, No-0319 Oslo, Norway. gunnhild.berdal@diakonsyk.no ·Arthritis Res Ther · Pubmed #22277377.

ABSTRACT: INTRODUCTION: Pulmonary involvement is a known manifestation in patients with ankylosing spondylitis (AS). However, previous studies have been based on small samples and the reported prevalence and associations with typical clinical features vary. The purpose of this study was to compare pulmonary function (PF) in patients with AS and population controls, and to study associations between PF and disease related variables, cardio-respiratory fitness and demographic variables in patients with AS. METHODS: In a cross-sectional controlled study, 147 AS patients and 121 controls underwent examinations, including demographic variables, laboratory (C-reactive protein (CRP), erythrocyte sedimentation rate (ESR)) and clinical measures (disease activity (AS disease activity score, ASDAS), physical function (Bath ankylosing spondylitis functional index, BASFI), spinal mobility (Bath ankylosing spondylitis metrology index, BASMI), chest expansion, cardio-respiratory fitness (peak oxygen uptake, VO(2peak) and pulmonary function test (PFT) (spirometry)). Cumulative probability plots were used to visualize associations between the ASDAS and BASMI scores and the corresponding forced vital capacity (FVC%, percentage of predicted value controlled for the influence of confounding factors) score for each patient. Univariate ANCOVAs were performed to explore group differences in PF adjusting for relevant variables, and a multiple regression model was used to estimate the explanatory power of independent variables (demographic, disease related, VO(2peak) on restrictive ventilatory impairment (FVC%). RESULTS: AS patients showed significantly lower PF values compared with controls, and significantly more patients were categorized with restrictive pattern (18% vs. 0%, P < 0.001). Cumulative probability plots showed significant associations between spinal mobility measures (BASMI) and FVC% for individual patients. BASMI, chest expansion and male gender contributed significantly and independently in a multiple regression model predicting the variation of FVC% in AS patients, whereas disease activity, physical function and VO(2peak) did not contribute significantly. The final model explained 45% of the variance in FVC% (P < 0.001). CONCLUSIONS: This study showed significantly impaired pulmonary function in the AS patients compared to controls and reference data, and demonstrated a clear relationship between reduced spinal mobility and restrictive PF in AS patients. The results support the assumption of an association between musculoskeletal limitations and restrictive respiratory impairment in AS, emphasizing the importance of maintaining spinal flexibility in the management of the disease. Further, patients with severely reduced spinal mobility should be referred for pulmonary function examination and relevant follow-up treatment.

20 Article Physical fitness in patients with ankylosing spondylitis: comparison with population controls. 2012

Halvorsen, Silje / Vøllestad, Nina K / Fongen, Camilla / Provan, Sella A / Semb, Anne G / Hagen, Kåre B / Dagfinrud, Hanne. ·Department of Health Sciences, University of Oslo, PO Box 1074, Blindern, Oslo 0316, Norway. silje.halvorsen@medisin.uio.no ·Phys Ther · Pubmed #22095208.

ABSTRACT: BACKGROUND: Although flexibility traditionally has been the main focus for physical therapy in patients with ankylosing spondylitis (AS), there is now evidence for an increased risk of cardiovascular diseases (CVDs) in this group. OBJECTIVE: The purposes of this study were: (1) to compare physical fitness (cardiorespiratory fitness, muscular capacity, flexibility, and balance) in patients with AS and controls and (2) to explore associations between physical fitness and disease activity in the patient group. DESIGN: This was a cross-sectional study. METHODS: The physical fitness variables were cardiorespiratory fitness (treadmill test for estimation of peak oxygen uptake [V(O(2))peak]), muscular capacity (push-ups test), balance (30-second single-leg stand and walking in a figure-of-eight pattern), and flexibility (Bath Ankylosing Spondylitis Metrology Index [BASMI]). The Ankylosing Spondylitis Disease Activity Score (ASDAS) was used to assess disease activity. Group differences and associations were tested with the chi-square test for categorical variables, the Mann-Whitney U test for ordinal variables, and analysis of covariance for continuous variables. RESULTS: One hundred forty-nine of 250 of the invited patients with AS and 133 of 329 of the invited controls were included in the study. The mean ASDAS score of the patient group was 2.3 (range=0.5-4.7), and the median disease duration was 23 years (range=7-55). The patient group had significantly lower V(O(2)) peak values, with a mean difference of -2.7 mL·kg(-1)·min(-1) (95% confidence interval=-4.3, -1.1), and higher BASMI scores, with a mean difference of 1.6 (95% confidence interval=1.5, 1.8), compared with the control group. No group differences were found in balance or muscular capacity. In the patient group, significant inverse associations were found between ASDAS scores and V(O(2))peak and muscular capacity. LIMITATIONS: The response rate was lower in the control group (40.4%) than in the patient group (59.6%). CONCLUSION: The lower cardiorespiratory fitness and reduced flexibility in the AS group indicate that physical therapy programs should include cardiorespiratory fitness exercises as a basic component to reduce the risk of cardiovascular disease.

21 Article 2010 update of the ASAS/EULAR recommendations for the management of ankylosing spondylitis. 2011

Braun, J / van den Berg, R / Baraliakos, X / Boehm, H / Burgos-Vargas, R / Collantes-Estevez, E / Dagfinrud, H / Dijkmans, B / Dougados, M / Emery, P / Geher, P / Hammoudeh, M / Inman, R D / Jongkees, M / Khan, M A / Kiltz, U / Kvien, Tk / Leirisalo-Repo, M / Maksymowych, W P / Olivieri, I / Pavelka, K / Sieper, J / Stanislawska-Biernat, E / Wendling, D / Ozgocmen, S / van Drogen, C / van Royen, Bj / van der Heijde, D. ·Rheumazentrum Ruhrgebiet, Landgrafenstrasse 15, 44652 Herne, Germany. j.braun@rheumazentrum-ruhrgebiet.de ·Ann Rheum Dis · Pubmed #21540199.

ABSTRACT: This first update of the ASAS/EULAR recommendations on the management of ankylosing spondylitis (AS) is based on the original paper, a systematic review of existing recommendations and the literature since 2005 and the discussion and agreement among 21 international experts, 2 patients and 2 physiotherapists in a meeting in February 2010. Each original bullet point was discussed in detail and reworded if necessary. Decisions on new recommendations were made - if necessary after voting. The strength of the recommendations (SOR) was scored on an 11-point numerical rating scale after the meeting by email. These recommendations apply to patients of all ages that fulfill the modified NY criteria for AS, independent of extra-articular manifestations, and they take into account all drug and non-drug interventions related to AS. Four overarching principles were introduced, implying that one bullet has been moved to this section. There are now 11 bullet points including 2 new ones, one related to extra-articular manifestations and one to changes in the disease course. With a mean score of 9.1 (range 8-10) the SOR was generally very good.

22 Article Exercise programs in trials for patients with ankylosing spondylitis: do they really have the potential for effectiveness? 2011

Dagfinrud, Hanne / Halvorsen, Silje / Vøllestad, Nina K / Niedermann, Karin / Kvien, Tore K / Hagen, Kåre B. ·Diakonhjemmet Hospital and University of Oslo, Oslo, Norway. h.s.dagfinrud@medisin.uio.no ·Arthritis Care Res (Hoboken) · Pubmed #21452270.

ABSTRACT: OBJECTIVE: To evaluate if exercise programs in trials for patients with ankylosing spondylitis (AS) have the potential for effectiveness. METHODS: A systematic literature search was performed and randomized trials examining the effectiveness of exercise programs for AS patients were analyzed according to 3 elements: whether the exercise programs were designed according to the American College of Sports Medicine (ACSM) recommendations for developing cardiorespiratory fitness, muscular strength, and flexibility; whether physiologic responses were properly measured; and whether adherence to programs was monitored. RESULTS: Twelve trials with a total of 826 AS patients were evaluated. Five trials included cardiorespiratory exercise as a part of the exercise programs. One of these met the ACSM recommendations for intensity, duration, frequency, and length of the exercise period. This trial showed the greatest within-group improvement in aerobic capacity (effect size [ES] 2.19). Five trials included muscular strength training, but none measured the physiologic responses nor met the recommendations for improving muscular strength. Eleven trials included flexibility training, but the programs were poorly described overall. Small improvements in spinal mobility (ES range 0.02-0.67) were reported in all trials. Finally, 4 trials reported on participants' adherence to the exercise programs, but only 1 provided sufficient information to evaluate the possible influence of the adherence. CONCLUSION: The quality of interventions in exercise trials for patients with AS can be improved. Future trials should also focus on measuring and reporting physiologic responses and adherence to exercise interventions.