Clinical improvement and reduction in serum calprotectin levels after an intensive exercise programme for patients with ankylosing spondylitis and non-radiographic axial spondyloarthritis
Abstract:BackgroundThe efficacy of exercise therapy for ankylosing spondylitis (AS) is well-documented, but dearth of information is for non-radiographic axial spondyloarthritis (nr-axSpA).Biomarkers like serum calprotectin, interleukins IL-6, IL-17 and tumour necrosis factor (TNF)-α may reflect the disease activity of axial spondyloarthritis (axSpA). In this study, we investigated clinical and laboratory parameters of both axSpA subgroups in response to intensive physical exercise.MethodsAltogether, 46 patients with a… Show more
“…This concept of "energetic concurrency" between physical activity and immunity is postulated to account for the reductions in inflammation that occur with exercise. Of note, CP levels will decrease after a six-month physical exercise program in adults with rheumatological conditions [22]. To our knowledge, it is not known whether physical activity levels will inversely correlate with CP levels in otherwise healthy people, especially healthy children.…”
Background: Calprotectin (CP) is a protein complex involved in many inflammatory diseases. Obesity is characterized by low-grade inflammation and elevated circulating levels of calprotectin. However, associations between body mass index (BMI) and calprotectin levels have not been explored in otherwise healthy children. Methods: In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched PubMed and Cochrane Library database up to July 2019. Healthy children’s blood calprotectin values were extracted, and potential correlations were explored. Results: A total of six studies that included data on 593 healthy children were identified. Median calprotectin value was 900.0 (482.0; 1700) ng·mL−1. Multivariable analysis showed no significant associations with age, sample type (serum vs. plasma), or sex. In contrast, a significant effect of BMI z-score (p < 0.001) emerged. Indeed, a positive correlation between BMI z-score and CP, was detected in girls (R: 0.48; p < 0.001) and boys (R: 0.39; p < 0.001). Conclusion: Calprotectin blood levels correlate with the degree of adiposity in healthy children, but are not affected by age, sex, or sample type (serum or plasma).
“…This concept of "energetic concurrency" between physical activity and immunity is postulated to account for the reductions in inflammation that occur with exercise. Of note, CP levels will decrease after a six-month physical exercise program in adults with rheumatological conditions [22]. To our knowledge, it is not known whether physical activity levels will inversely correlate with CP levels in otherwise healthy people, especially healthy children.…”
Background: Calprotectin (CP) is a protein complex involved in many inflammatory diseases. Obesity is characterized by low-grade inflammation and elevated circulating levels of calprotectin. However, associations between body mass index (BMI) and calprotectin levels have not been explored in otherwise healthy children. Methods: In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched PubMed and Cochrane Library database up to July 2019. Healthy children’s blood calprotectin values were extracted, and potential correlations were explored. Results: A total of six studies that included data on 593 healthy children were identified. Median calprotectin value was 900.0 (482.0; 1700) ng·mL−1. Multivariable analysis showed no significant associations with age, sample type (serum vs. plasma), or sex. In contrast, a significant effect of BMI z-score (p < 0.001) emerged. Indeed, a positive correlation between BMI z-score and CP, was detected in girls (R: 0.48; p < 0.001) and boys (R: 0.39; p < 0.001). Conclusion: Calprotectin blood levels correlate with the degree of adiposity in healthy children, but are not affected by age, sex, or sample type (serum or plasma).
“…In this study, that included a large cohort of patients with axSpA, we disclosed significantly lower CPT serum concentrations in our patients when compared to controls. In this regard, a recent study revealed that CPT levels decrease after the end of a 6-month intensive exercise programme in AS and nr-axSpA patients, accompanied by clinical improvement 45 . This may be particularly relevant, given that regular exercise and physical therapy is recommended to complement medical therapy in axSpA, aimed to ameliorate physical disability as well as cardiorespiratory complications of the disease 46 .…”
Calprotectin (CPT) is released during inflammation, also in the context of atherosclerosis. The link between CPT and the atherosclerotic process was evaluated in several diseases. However, studies in axial spondyloarthritis (axSpA), associated with a high incidence of subclinical atherosclerosis, are scarce. Therefore, we assessed the association of CPT with subclinical atherosclerosis and metabolic risk factors in axSpA. CPT serum levels were measured by enzyme-linked immunosorbent assay in 163 axSpA patients and 63 controls. Subclinical atherosclerosis was determined in patients by carotid ultrasonography (assessing the presence/absence of carotid plaques and carotid intima-media thickness [cIMT]). Data on inflammation, disease activity, lipid profile and treatment were collected to evaluate its relationship with CPT. axSpA patients evidenced lower CPT levels than controls. CPT showed no association with plaques or cIMT in axSpA. CPT and HDL-cholesterol negatively correlated, while a positive association of CPT with the atherogenic index was disclosed. Additionally, axSpA patients with C-reactive protein values at diagnosis higher than 3 mg/L displayed higher CPT levels. Our study shows no relationship between CPT and markers of subclinical atherosclerosis in axSpA. Nevertheless, it demonstrates an association of CPT with adverse lipid profiles and inflammatory biomarkers, which could further influence on the development of atherosclerosis.
“…With supervised group exercise (SGE), greater improvements in quality of life, spinal mobility, and patient global assessment were achieved as compared to unsupervised, individual exercise programs . SGE appears similarly effective for patients with radiographic axial SpA (also known as ankylosing spondylitis) and those with nonradiographic axial SpA . Recently, results of a systematic review on the effectiveness of exercise either on land or in water in patients with radiographic axial SpA demonstrated the added value of hydrotherapy and education within SGE (including 35 trials) .Recent scientific insight on supervised group exercise (SGE) for patients with axial spondyloarthritis (SpA) recommend appropriately dosed strengthening and cardiorespiratory exercise (in addition to mobility exercise), monitoring of intensity of cardiorespiratory exercise, periodic reassessments, patient education, and guidance by therapists who specialize in axial SpA, yet these aspects may currently be missing in practice.The majority of patients with axial SpA who participated in weekly SGE were satisfied with its current contents and mode of delivery.The majority of patients with axial SpA would agree with the introduction of program enhancements; however, given the high current satisfaction, a planned and tailored implementation strategy (including education) is warranted.…”
Objective. Supervised group exercise (SGE) has been proven effective in patients with axial spondyloarthritis (SpA), but its contents and dosage do not always comply with current scientific insight. This aim of this study was to describe axial SpA patients' satisfaction with current SGE and perspective on potential evidence-based SGE enhancements.Methods. Patients with axial SpA who participated in SGE in 4 regions in The Netherlands (n = 118) completed a cross-sectional survey on their satisfaction with features of their current SGE (8 questions scored on a 3-point Likert scale; 1 overall grade, scored according to an 11-point scale) and their perspective on the introduction of appropriately dosed cardiorespiratory and strengthening exercise, monitoring of exercise intensity, periodic reassessments, patient education, and supervision by physical therapists with specific expertise (4 dichotomous questions and one 5-point Likert scale).Results. Most patients were satisfied with the current total intensity (84 of 112 patients [75%]), duration (93 of 111 patients [84%]), and load (89 of 117 patients [76%]) of the program and the proportion of mobility (102 of 114 patients [90%]), strengthening (90 of 115 patients [78%]), and cardiorespiratory exercise (82 of 114 patients [72%]). The median overall grade of the program was a 7 (interquartile range 7-8). Most patients agreed with the implementation of more frequent (home) exercise (73 of 117 patients [62%]), heart-rate monitoring (97 of 117 patients [83%]), and annual reassessments (97 of 118 patients [82%]), whereas 50% agreed with the introduction of patient education (37 of 74 patients). The majority found supervision by therapists specializing in axial SpA to be of high importance (105 of 118 patients [89%]).Conclusion. The majority of SGE participants with axial SpA were satisfied with current SGE but also agreed with enhancements in line with scientific evidence. Current satisfaction levels indicate that a planned implementation strategy, including education and addressing potential barriers and facilitators for the uptake of enhancements, is warranted.
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