Spondyloarthritis on the Move: Biomechanical Benefits or Harm

Abstract

Purpose of review Physical activity is beneficial in several diseases including spondyloarthritis despite mechanical stress being suggested as a trigger of disease onset or activity. Moreover, there is no clear answer as to where physiological loading of the joints ends and pathological overloading begins.The aim of this review is to provide an overview of what is known about exercise and biomechanical loading in spondyloarthritis.Recent findings Recent studies focused on the impact of mechanical loading in healthy individuals and spondyloarthritis patients, demonstrating an overlap between the groups and pointing out possible beneficial and detrimental activities. The discovery that several animal models of inflammatory arthritis are dependent on mechanical stress helps unraveling the involved molecular pathways.Summary There is a knowledge gap between the beneficial effect of exercise reported in clinical trials and the harm seen in observational studies and animal models. Imaging studies provide a first step in joining these two opposites by highlighting a wide-ranging spectrum between healthy and diseased joints. Future research is warranted on specific interventions in well-defined patient populations and in animal models in order to understand the pathogenesis. Targeted exercise therapy and prevention should be considered specific goals.

Similarities and differences between axial spondyloarthritis and axial psoriatic arthritis

“…Compared to AS, axPsA patients can be asymptomatic, have asymmetrical sacroiliitis, present worse degree of peripheral arthritis, and may present with or without sacroiliitis. However, compared to axPsA, AS patients are more likely to be male, younger, and have more limitation of spinal mobility and back pain 6 …”

New Bone Formation in Axial Spondyloarthritis: A Review

“…Several other studies showed that axSpA patients working in physically demanding occupations had more loss of function and radiological damage than patients with more sedentary jobs 21 and that greater mechanical stress was associated with more severe lumbar myofascial stiffness in axSpA patients 22 23 . Microtrauma is therefore hypothesized to have a significant impact on entheses, triggering inflammation and osteoproliferation 24 . Furthermore, the relationship between post-inflammatory changes, like fat metaplasia as a precursor, and an increased risk of new bone formation in the spine 25 and SIJs 26 has also been investigated.…”

Inflammatory Foot Involvement in Spondyloarthritis: From Tarsitis to Ankylosing Tarsitis

“…Not surprisingly, mechanical stress has also been linked to inflammatory rheumatic diseases such as RA, PsA, and AS (136). Here, physical trauma has been associated with disease initiation and structural progression (137,138).…”