Combination Treatment with Etanercept and an Intensive SPA Rehabilitation Program in Active Ankylosing Spondylitis

Abstract

The aim of this study is to determine the effects of a combination treatment with etanercept and spa rehabilitation versus etanercept alone on function, disability and quality of life in a group of patients with active ankylosing spondylitis (AS). Sixty patients with AS underwent etanercept as suggested by ASAS/EULAR recommendations. As the clinical and laboratory conditions improved, 30 patients accepted the proposal of coupling the medical therapy with a 7-day rehabilitation program in a thermal baths centre; the remaining 30 subjects continued to take the biologic agent alone. The comparisons between the 2 groups were made after 3 and 6 months. The primary outcome was an improvement in BASFI. The secondary outcome was an improvement in the visual analogic scale of EuroQol (EQ-5Dvas). After 6 months a statistically significant improvement in BASFI (p < 0.05) and EQ-5DVAS (p < 0.05) scores was observed in both groups. The mean change in EQ-5DVAS value showed a statistically significant difference in favour of the combination therapy group versus the monotherapy group (22 vs 32, p < 0.05). A therapeutic regimen combining etanercept with an intensive rehabilitation program contributes to disability reduction and ameliorates quality of life for AS patients.

Short term in-patient rehabilitation in axial spondyloarthritis - the results of a 2-week program performed in daily clinical practice

“…In our study, the intervention period was 5 days a week for 2 weeks, whereas, e.g. in the study by Colina et al, [6] the intervention period was one week and in the study by Ince et al, the period was three months [10]. In our study, the daily program consisted of water exercises (30 minutes), basic exercises for movement, muscle strength and stability, balance and coordination (45 minutes), and exercises for endurance (40 minutes).…”

“…This includes different exercise programs [9,10,12], spa rehabilitation and exercise programs [6,7], combined intensive group exercise with an educational-behavioural program [8], and rehabilitation and exercise programs tested in different climates [11]. In a Cochrane review of the literature, it was concluded that supervised group therapy was better than home exercises, and combined in-patient spa-exercise therapy followed by group physiotherapy was better than group physiotherapy alone [14].…”

“…In the study by Colina et al, an intensive rehabilitation program in AS patients treated with the TNF-inhibitor etanercept was shown to contribute to reducing disability and to ameliorating quality of life [6]. These points highlight that exercise programs should be part of the treatment strategy, even in patients who have responded favourably to anti-TNF treatment.…”

Physiotherapy for ankylosing spondylitis: evidence and application

“…Significant improvement in function and quality of life was found in the study presented by Colina et al [25], suggesting that physiotherapy and exercise will continue to play an important management role in an era of biologic intervention. Further study into the combined effects of biologics and physiotherapy is warranted.…”

“…This physiotherapy modality has been traditionally used in the treatment of AS, with evidence to support its use in the improvement of spinal mobility, pain and disease activity [23,24]. This review revealed one study [25] examining the effects of combination treatment with etanercept and spa rehabilitation versus etanercept alone. This study compared 30 AS patients who combined etanercept therapy with 7 days of spa rehabilitation in a thermal bath center with 30 AS patients who took etanercept therapy alone.…”