The 16th Annual SPARTAN meeting featured presentations in both clinical and basic science Spondyloarthritis research and care. The meeting also held its first "Unmet Needs" breakout sessions. Below highlights two of the scientific sessions from the meeting:

 

Rik Lories from the Clinical division of Rheumatology , KU Leuven, Belgium spoke on basic science research using mouse models for spondyloarthritis. Enthesitis is very common in rodent models for spondyloarthritis. Enthesitis develops in mice with TNF overexpression. Paw unloading was found to prevent arthritis in TNF-dARE mice models. Anti IL-17 and IL-23 have be effective in treatment and prevention of structural damage in HLA-B27 transgenic rats.   New bone formation is likely steered indirectly by inflammation from growth factor casades such as BMPs, Wnts and Hedgehogs as inhibition of inflammation tends to inhibit ankylosis. Animal models suggest that biomechanical factors/stress may trigger enthesis or arthritis. Also rodent models suggest anti-cytokine strategies may be effective on enthesis and structural damage in spondyloarthritis.

 

Angelo Papachristos, an advanced practice Physiotherapist from St. Michael's Hospital, Toronto reviewed the current role of physical therapy in the Biologic Era. He reviewed current evidence in patients with spondyloarthritis and recommendations for physical therapy from the American College of Sports medicine (ACSM). Physical therapy is included in the ACR/SPARTAN 2015 treatment recommendation for Ankylosing Spondylitis/nr-Axial Spondyloarthritis with land-based therapy preferred over aquatic based physical thearpy. The ASCM recommends moderate-intensity of cardiovascular exercise for at least 30 minutes per day or 150 minutes per week; resistance training, neuromotor exercise and flexibility training at least twice a week. JR Millner, et al (2016) made 10 recommendations including anti-TNF therapy and exercise in a 2016 review in Sem In Arthritis & Rheumatism. Review of 12 clinical trials in spondyloarthritis with a total of 826 AS patients evaluated, which included cardiovascular exercise, only one trial met ACSM recommendations for intensity, frequency and length of exercise period with the greatest improvement in aerobic capacity (effect size=2.19). Overall the clinical trials showed small improvements in spinal mobility (ES=0.02-0.67). Although five trials included muscle strengthening, none measured physiologic responses not meeting the muscle strength improvement recommendation. A study of 120 Dutch outpatients with Ankylosing spondylitis underwent three weeks of spa exercise therapy with follow-up weekly group therapy which was found to be more effective and cost effective.(van tubergen et al 2002 Arthritis Rheum).

As the evidence is not strong for physical therapy as there are no specific protocols for physical therapies being used in studies, Mr. Papachristos concluded that with diagnosis patients should be educated about their disease, medication therapy and a baseline fitness assessment should be made. In the first 6-9 months, the patient would be introduced to basic exercises for range of motion and flexibility with gradual increase of exercise efforts. At 12 months, patient would start core cervical and lumbar strengthening followed by cardiovascular and sport recreation.    

 

- Elizabeth Chang, MD