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Zhang M, Liang Z, Tian L, Han Y, Jiang X, Li Y, Su Z, Liu T. Effects of Exercise Therapy in Axial Spondyloarthritis: A Systematic Review, Meta-analysis, and Meta-regression of Randomized Trials. Arch Phys Med Rehabil 2024:S0003-9993(24)01065-7. [PMID: 38942347 DOI: 10.1016/j.apmr.2024.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 03/04/2024] [Accepted: 06/12/2024] [Indexed: 06/30/2024]
Abstract
OBJECTIVE This study aimed to assess the effectiveness of exercise therapy for patients with axial spondyloarthritis (axSpA). DATA SOURCES We searched MEDLINE (via PubMed), Cochrane Library, Embase, Web of Science, Scopus, and SPORTDiscus for all relevant publications from database inception to March 2024, without language restriction. STUDY SELECTION We included randomized controlled trials (RCTs) of patients with axSpA in which ≥1 group received exercise therapy. DATA EXTRACTION Two independent reviewers assessed the quality of the literature using the Cochrane Collaboration Risk of Bias Tool 2.0. The outcomes were ankylosing spondylitis (AS) disease activity score (ASDAS), Bath AS disease activity index (BASDAI), Bath AS functional index (BASFI), Bath AS metrology index (BASMI), 6-minute walk test (6MWT), chest expansion capacity, peak oxygen consumption (VO2peak), pain, fatigue, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). DATA SYNTHESIS A total of 20 RCTs, including 1670 patients, were included in this study. Compared with the control group, exercise therapy improved BASFI (weighted mean difference [WMD], -0.49; 95% confidence interval [CI], -0.65 to -0.32; I2=3.4%; P=.414), BASMI (WMD, -0.49; 95% CI, -0.87 to -0.11; I2=71.9%; P=.679), BASDAI (WMD, -0.78; 95% CI, -1.08 to -0.47; I2=55.9%; P=.021), ASDAS (WMD, -0.44; 95% CI, -0.64 to -0.24; I2=0.0%; P=.424), VO2peak (WMD, 3.16; 95% CI, 1.37-4.94; I2=0.0%; P=.873), 6MWT (WMD, 27.64; 95% CI, 12.04-43.24; I2=0.0%, P=.922), pain (standardized mean difference [SMD], -0.47; 95% CI, -0.74 to -0.21; I2=66.0%, P=.046), and fatigue (SMD, -0.49; 95% CI, -0.71 to -0.27; I2=0.0%; P=.446). However, no significant benefit was found in chest expansion, CRP, and ESR outcomes. CONCLUSIONS Exercise therapy is an effective strategy for improving disease control and symptom relief in patients with axSpA.
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Affiliation(s)
- Meng Zhang
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China; School of Exercise and Health Sciences, Xi'an Physical Education University, Xi'an, China
| | - Zhide Liang
- School of Physical Education, Qingdao University, Qingdao, China
| | - Liang Tian
- School of Physical Education, Kashi University, Kashgar, China
| | - Yaqi Han
- Ningxia Police Vocational College, Ningxia, China
| | - Xu Jiang
- School of Exercise and Health Sciences, Xi'an Physical Education University, Xi'an, China
| | - Yali Li
- School of Exercise and Health Sciences, Xi'an Physical Education University, Xi'an, China
| | - Zhaoxi Su
- Zhangzhai Town Centre Primary School, Liaocheng, China
| | - Tao Liu
- School of Exercise and Health Sciences, Xi'an Physical Education University, Xi'an, China.
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Luo Y, Chen Y, Yan X, Zhang L, Shang Y, Seo JC. Effectiveness of exercise intervention in relieving symptoms of ankylosing spondylitis: A network meta-analysis. PLoS One 2024; 19:e0302965. [PMID: 38875227 PMCID: PMC11178210 DOI: 10.1371/journal.pone.0302965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 04/17/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND Ankylosing spondylitis(AS) is a chronic inflammatory rheumatic disease that leads to a reduced quality of life. Exercise appears to be one of the promising modes of intervention. The aim of this study was to review the available evidence and compare the effectiveness of different exercises in relieving symptoms of AS. METHODS We searched the Pubmed, WOS, EMbase, CNKI, Cochrane Library, and Scopus databases. The search has spanned from the creation of the database until September 15, 2023. We extracted the first author, year of article publication, sample information, intervention, duration of intervention, and outcome indicators from the literature that met the inclusion criteria. The Cochrane Risk Assessment Tool was used to assess the risk of bias for included studies. I² was used to judge the consistency of the included studies. Egger's test and Begg's test were used to judge whether there was significant publication bias. Forest plots were used to compare intervention effects and SUCRA was provided to rank the effects of the interventions. This study has been registered in PROSPERO(No. CRD42024518522). RESULTS After screening, 10 papers matched the inclusion criteria for this study, and the total sample size of the 10 papers was 623. Upon analysis, the papers included in this study did not have significant publication bias (Begg's Test P = 0.210) and had good consistency (P>0.05). The direct comparisons showed that Running, Pilates, Stretching, Yoga, and Tai Chi were more effective interventions than traditional therapies. The effect sizes, confidence intervals, and number of studies for each intervention are shown below: Running [MD -1.90 (95% CI -3.14,-0.66) n = 1], Pilates [MD -1.70 (95% CI -2.90,-0.51) n = 1], Stretching [MD -1.54 (95% CI -2.21,-0.88) n = 4], Yoga [MD -1.24 (95% CI -2.18,-0.30) n = 1], Tai Chi [MD -0.78 (95% CI -1.44,-0.12) n = 2], Exergame[MD -0.80 (95% CI -1.99,0.39) n = 1], Swiss balls[MD -1.07 (95% CI -2.58,0.44) n = 1]. The indirect comparisons showed that the range of effect sizes for each sport intervention intersected the null line. Based on cumulative probability, the order of effectiveness of different exercises in relieving AS symptoms is Running, Pilates, Stretching, Yoga, Tai Chi, Exergame, and Swiss ball. CONCLUSION Running, Pilates, Stretching, Yoga, and Tai Chi provided significant relief from AS symptoms. Exergame and Swiss ball were not statistically significant in relieving AS symptoms. There were no significant differences in the effectiveness of different exercise interventions in relieving AS symptoms. Running may have the most beneficial effect on alleviating AS symptoms.
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Affiliation(s)
- Yekui Luo
- Department of Marine Sports, Pukyong National University, Busan, South Korea
| | - Yonghuan Chen
- Department of Marine Sports, Pukyong National University, Busan, South Korea
| | - Xiangning Yan
- Physical Education, Shaanxi College of Communications Technology, Xi’an, China
| | - Lan Zhang
- Department of Marine Sports, Pukyong National University, Busan, South Korea
| | - Yuan Shang
- Department of Marine Sports, Pukyong National University, Busan, South Korea
| | - Jae Chul Seo
- Department of Marine Sports, Pukyong National University, Busan, South Korea
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Boudjani R, Challal S, Semerano L, Sigaux J. Impact of different types of exercise programs on ankylosing spondylitis: a systematic review and meta-analysis. Disabil Rehabil 2023; 45:3989-4000. [PMID: 36369692 DOI: 10.1080/09638288.2022.2140842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 10/23/2022] [Indexed: 11/15/2022]
Abstract
PURPOSE This systematic review and meta-analysis of controlled studies aimed to assess the efficacy of different types of exercise programs (EP) on ankylosing spondylitis (AS) activity, function and mobility. METHODS We searched PubMed/Medline, Cochrane Library and Embase databases for reports of controlled trials of patients with AS published up to May 2022. The studies were classified by intervention into categories defined by the 4 exercise domains established by the American College of Sports Medicine and then adopted by the European League Against Rheumatism: aerobic, muscle strength, flexibility, neuromotor performance. RESULTS We found a moderate effect of EP as a whole on BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) (-0.60, 95% CI -0.95, -0.25, p < 0.001), BASFI (Functional) (-0.63, 95% CI -0.84, -0.42, p < 0.0001) and BASMI (Metrology) (-0.52, 95% CI -0.88, -0.15, p < 0.01). The effect of "flexibility + muscle strength" EP was large for BASMI, moderate for BASDAI and BASFI. The effect of "flexibility + muscle strength + aerobic" EP was large for BASFI, moderate for BASDAI. CONCLUSIONS EP, regardless of the specific type of exercise, have a moderate effect on AS activity, function and mobility. EP including flexibility and muscle strength exercises may have a large effect, especially for mobility. Programs including aerobic exercise showed significant efficacy for function.IMPLICATIONS FOR REHABILITATIONIn ankylosing spondylitis (AS), any exercise program (EP), regardless of the type of exercises involved, showed a moderate effect on disease activity, function and spinal mobility.In AS, EP combining flexibility and strength exercises showed the largest effect on spinal mobility and should be encouraged.In AS, EP combining flexibility, muscle strength and aerobic exercises may be particularly effective on patient function.
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Affiliation(s)
| | | | - Luca Semerano
- Rheumatology Department, Hospital Avicenne, Bobigny, France
- INSERM UMR 1125 Sorbonne Paris Nord, Bobigny, France
| | - Johanna Sigaux
- Rheumatology Department, Hospital Avicenne, Bobigny, France
- INSERM UMR 1125 Sorbonne Paris Nord, Bobigny, France
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Benavent D, Jochems A, Pascual-Salcedo D, Jochems G, Plasencia-Rodríguez C, Ramiro S, Arends S, Spoorenberg A, Balsa A, Navarro-Compán V. Translation and cross-cultural adaptation of the mSQUASH into Spanish. REUMATOLOGIA CLINICA 2023; 19:436-441. [PMID: 37805257 DOI: 10.1016/j.reumae.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 07/22/2022] [Indexed: 10/09/2023]
Abstract
BACKGROUND There is a lack of outcome measures for the assessment of physical activity in patients with axial spondyloarthritis (axSpA). For this matter, the modified Short QUestionnaire to Assess Health (mSQUASH) was developed and validated, originally in Dutch. OBJECTIVE To translate and cross-culturally adapt the mSQUASH into Spanish and to evaluate the equivalence of the translated version in patients with axSpA. METHODS The mSQUASH was translated following forward-backward procedure according to the protocol of Beaton. Two bi-lingual translators produced independent forward translations of the mSQUASH into Spanish, and the versions were harmonized in a consensual version. Another translator back translated the synthesized version into Dutch. A scientific committee reached consensus on discrepancies and developed a pre-final version of the questionnaire. The field test with cognitive debriefing involved 10 patients with axSpA with different gender, age, disease duration, educational level and working status. RESULTS The translation process of the mSQUASH was completed without major issues. The first translation needed several iterations due to small discrepancies in the wording. Back-translation was performed without difficulties, and the scientific committee agreed upon a final version of the questionnaire. Cognitive debriefing showed the Spanish questionnaire to be clear, relevant, understandable and comprehensive. The preliminary version was accepted with minor modifications. CONCLUSIONS The resulting Spanish version of the mSQUASH showed good linguistic and face validity according to the field test, revealing potential for use in clinical practice and research. In order to conclude the cross-cultural adaptation of the mSQUASH into Spanish, the next step is the assessment of psychometric properties of the Spanish version.
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Affiliation(s)
- Diego Benavent
- Department of Rheumatology, Hospital Universitario La Paz, Madrid, Spain.
| | - Andrea Jochems
- Immuno-Rheumatology Group, Hospital Universitario La Paz, Madrid, Spain
| | | | | | | | - Sofia Ramiro
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands; Department of Rheumatology, Zuyderland Medical Center, Heerlen, the Netherlands
| | - Suzanne Arends
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Anneke Spoorenberg
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Alejandro Balsa
- Department of Rheumatology, Hospital Universitario La Paz, Madrid, Spain
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Fedkov D, Berghofen A, Weiss C, Peine C, Lang F, Knitza J, Kuhn S, Krämer BK, Leipe J. Efficacy and safety of a mobile app intervention in patients with inflammatory arthritis: a prospective pilot study. Rheumatol Int 2022; 42:2177-2190. [PMID: 36112186 PMCID: PMC9483251 DOI: 10.1007/s00296-022-05175-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/20/2022] [Indexed: 11/30/2022]
Abstract
AbstractEULAR highlighted the essential role of digital health in increasing self-management and improving clinical outcomes in patients with arthritis. The objective of this study was to evaluate the efficacy and safety of the digital health application (DHA) in patients with inflammatory arthritis. We assessed demographic parameters, treatment regimen, disease activity, and other patient-reported outcomes at baseline and after 4 weeks of DHA use added to standard care treatment. Of 17 patients, who completed the study, 7 (41.2%) patients were male, ranging from 19 to 63 (40.5 ± 12.2) years. No significant change in antirheumatic treatment was observed during the study. Statistically significant improvements (p < 0.05) were noted for health-related quality of life (increase in Physical Component Summary of Short Form-36 (SF-36) by 23.6%) and disease activity (decrease of Clinical Disease Activity Index and Simple Disease Activity Index by 38.4% and 39.9%, respectively). Clinically significant improvement was demonstrated for SF-36 Total Score (+ 14.4%), disease activity (Rheumatoid Arthritis Disease Activity Index− 5 to 15.9%), and depression (Patient Health Questionnaire− 9 to 13.5%). None of the efficacy parameters showed negative trends. No adverse events were reported throughout the study. The usability level was high i.e., the mean mHealth Application Usability Questionnaire Score of 5.96 (max.: 7.0) demonstrated a high level of application usability. This suggests that using a personalized disease management program based on DHA significantly improves several measures of patient-reported outcomes and disease activity in patients with inflammatory arthritis in a timely manner. These findings highlight the potential of complementary digital therapy in patients with inflammatory arthritis.
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Affiliation(s)
- Dmytro Fedkov
- Department of Internal Medicine #3, Bogomolets National Medical University, Kiev, Ukraine
| | - Andrea Berghofen
- Medical Clinic, Medical Faculty Mannheim of the University Heidelberg, Mannheim, Germany
| | - Christel Weiss
- Department of Medical Statistics and Biomathematics, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer, Mannheim, Germany
| | | | | | - Johannes Knitza
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg, Erlangen, Germany
- Deutsches Zentrum Für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Université Grenoble Alpes, AGEIS, Grenoble, France
| | - Sebastian Kuhn
- Department of Digital Medicine, Bielefeld University—Medical Faculty OWL, Bielefeld, Germany
- Department of Orthopaedic and Trauma Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Bernhard K. Krämer
- Department of Medicine (Nephrology, Rheumatology, Pneumology), University Hospital Mannheim, University of Heidelberg, HypertensiologyMannheim, Endocrinology Germany
| | - Jan Leipe
- Medical Clinic, Medical Faculty Mannheim of the University Heidelberg, Mannheim, Germany
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Soulard J, Carlin T, Knitza J, Vuillerme N. Wearables for Measuring the Physical Activity and Sedentary Behavior of Patients With Axial Spondyloarthritis: Systematic Review. JMIR Mhealth Uhealth 2022; 10:e34734. [PMID: 35994315 PMCID: PMC9446133 DOI: 10.2196/34734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 02/02/2022] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Axial spondyloarthritis (axSpA) is an inflammatory rheumatic disease associated with chronic back pain and restricted mobility and physical function. Increasing physical activity is a viable strategy for improving the health and quality of life of patients with axSpA. Thus, quantifying physical activity and sedentary behavior in this population is relevant to clinical outcomes and disease management. However, to the best of our knowledge, no systematic review to date has identified and synthesized the available evidence on the use of wearable devices to objectively measure the physical activity or sedentary behavior of patients with axSpA. OBJECTIVE This study aimed to review the literature on the use of wearable activity trackers as outcome measures for physical activity and sedentary behavior in patients with axSpA. METHODS PubMed, PEDro, and Cochrane electronic databases were searched in July 2021 for relevant original articles, with no limits on publication dates. Studies were included if they were original articles, targeted adults with a diagnosis of axSpA, and reported wearable device-measured physical activity or sedentary behavior among patients with axSpA. Data regarding the study's characteristics, the sample description, the methods used for measuring physical activity and sedentary behavior (eg, wearable devices, assessment methods, and outcomes), and the main results of the physical activity and sedentary behavior assessments were extracted. RESULTS A total of 31 studies were initially identified; 13 (13/31, 42%) met the inclusion criteria, including 819 patients with axSpA. All the studies used accelerometer-based wearable devices to assess physical activity. Of the 13 studies, 4 (4/31, 31%) studies also reported outcomes related to sedentary behavior. Wearable devices were secured on the wrists (3/13 studies, 23%), lower back (3/13, 23%), right hip (3/13, 23%), waist (2/13, 15%), anterior thigh (1/13, 8%), or right arm (1/13, 8%). The methods for reporting physical activity and sedentary behavior were heterogeneous. Approximately 77% (10/13) of studies had a monitoring period of 1 week, including weekend days. CONCLUSIONS To date, few studies have used wearable devices to quantify the physical activity and sedentary behavior of patients with axSpA. The methodologies and results were heterogeneous, and none of these studies assessed the psychometric properties of these wearables in this specific population. Further investigation in this direction is needed before using wearable device-measured physical activity and sedentary behavior as outcome measures in intervention studies in patients with axSpA. TRIAL REGISTRATION PROSPERO CRD42020182398; https://tinyurl.com/ec22jzkt. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/23359.
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Affiliation(s)
- Julie Soulard
- Université Grenoble Alpes, AGEIS, La Tronche, France
- LabCom Telecom4Health, Orange Labs & Université Grenoble Alpes, CNRS, Inria, Grenoble INP-UGA, Grenoble, France
- Grenoble Alpes University Hospital, Grenoble, France
| | - Thomas Carlin
- Université Grenoble Alpes, AGEIS, La Tronche, France
- LabCom Telecom4Health, Orange Labs & Université Grenoble Alpes, CNRS, Inria, Grenoble INP-UGA, Grenoble, France
| | - Johannes Knitza
- Université Grenoble Alpes, AGEIS, La Tronche, France
- LabCom Telecom4Health, Orange Labs & Université Grenoble Alpes, CNRS, Inria, Grenoble INP-UGA, Grenoble, France
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander University, Erlangen-Nürnberg, and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Nicolas Vuillerme
- Université Grenoble Alpes, AGEIS, La Tronche, France
- LabCom Telecom4Health, Orange Labs & Université Grenoble Alpes, CNRS, Inria, Grenoble INP-UGA, Grenoble, France
- Institut Universitaire de France, Paris, France
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Kim MY, Hong YS, Park SH, Kang KY. Physical activity is associated with physical and global function in patients with axial spondyloarthritis, independent of disease activity. Semin Arthritis Rheum 2022; 56:152067. [PMID: 35849891 DOI: 10.1016/j.semarthrit.2022.152067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 06/23/2022] [Accepted: 07/07/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To investigate whether physical activity is independently associated with physical and global function in patients with axial spondyloarthritis (axSpA), and to analyse the relationship between subtypes of physical activity (work, transport, and recreation) and functional impairment. METHODS One-hundred-and-eighty-five patients were included. Physical function was assessed using BASFI, and global function was assessed using the ASAS health index (HI). Physical activity was measured using the Global Physical Activity Questionnaire. Levels of physical activity were categorised as low, moderate or high. The associations between levels of physical activity and the BASFI and ASAS HI scores were analysed using multivariate regression analysis. RESULTS Of the 185 patients, 46, 63 and 76 reported low, moderate and high levels of physical activity, respectively. There was a negative correlation between the BASFI and total physical activity. Multivariate linear regression analysis revealed that a high level of physical activity was independently associated with BASFI after adjusting for age, ASDAS. sacroiliitis and syndesmophyte number (ß (95% CI) =-0.88 (-1.49--0.26); p=0.006). One-hundred-and-forty-six had good global functioning (ASAS HI≤5). Multivariate logistic regression analysis revealed that moderate physical activity was independently associated with good global functioning (OR (95% CI) = 2.82 (1.02-7.86); p = 0.047). Recreational activity, but not work- and transport-related activity, showed a significant relationship with ASAS HI scores (ß (95% CI) =-0.55 (-1.02-0.08); p = 0.023). CONCLUSIONS Physical activity in those with axSpA is associated independently with physical and global functioning. Among the subtypes of physical activity, recreational activity is related to global functioning.
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Affiliation(s)
- Moon-Young Kim
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul; Division of Rheumatology, Department of Internal Medicine, Incheon Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, South Korea
| | - Yeon Sik Hong
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul; Division of Rheumatology, Department of Internal Medicine, Incheon Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, South Korea
| | - Sung-Hwan Park
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul
| | - Kwi Young Kang
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul; Division of Rheumatology, Department of Internal Medicine, Incheon Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, South Korea.
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Harpham C, Harpham QK, Barker AR. The effect of exercise training programs with aerobic components on C-reactive protein, erythrocyte sedimentation rate and self-assessed disease activity in people with ankylosing spondylitis: A systematic review and meta-analysis. Int J Rheum Dis 2022; 25:635-649. [PMID: 35274458 DOI: 10.1111/1756-185x.14315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 02/08/2022] [Accepted: 03/01/2022] [Indexed: 12/17/2022]
Abstract
AIM To examine the effect of exercise training programs with aerobic components on C-reactive protein, erythrocyte sedimentation rate and self-assessed disease activity in people with ankylosing spondylitis compared to non-aerobic rehabilitation. METHODS A systematic review was undertaken of PubMED, Cochrane Library, Embase and Web of Science databases. Articles evaluating the effect of exercise training programs with aerobic components on C-reactive protein, erythrocyte sedimentation rate or Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) in adults (>17 years) with ankylosing spondylitis were included. Control groups were defined as non-aerobic rehabilitation, including usual care or physiotherapy. RESULTS Thirteen articles met inclusion criteria for qualitative and meta-analysis, involving 366 participants undertaking exercise and 361 controls. Exercise programs included modalities such as running, aerobic walking and swimming, and were between 3 weeks and 3 months in duration. Exercise programs significantly reduced C-reactive protein (weighted mean difference [WMD]: -1.09; 95% CI: -2.08 to -0.10; P = .03; n = 5) and BASDAI (WMD: -0.78; 95% CI: -0.98 to -0.58; P < .001; n = 13) compared to non-aerobic rehabilitation. BASDAI subgroup analysis revealed greater improvements compared to usual care than structured physiotherapy. Exercise programs did not reduce erythrocyte sedimentation rate (WMD: 0.16; 95% CI: -2.15 to 2.47; P = .89; n = 4). CONCLUSION Exercise training programs with aerobic components reduced C-reactive protein and improved self-assessed disease activity in people with ankylosing spondylitis. Further research is required to investigate the effects of differing aerobic exercise modes, intensities and durations.
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Affiliation(s)
- Conrad Harpham
- College of Life and Environmental Science, University of Exeter, Exeter, UK
| | | | - Alan R Barker
- College of Life and Environmental Science, University of Exeter, Exeter, UK
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Chimenti MS, Alten R, D'Agostino MA, Gremese E, Kiltz U, Lubrano E, Moreno M, Pham T, Ramonda R, Spinelli FR, Perella C, Andreoli L. Sex-associated and gender-associated differences in the diagnosis and management of axial spondyloarthritis: addressing the unmet needs of female patients. RMD Open 2021; 7:rmdopen-2021-001681. [PMID: 34876490 PMCID: PMC8655606 DOI: 10.1136/rmdopen-2021-001681] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 11/11/2021] [Indexed: 11/03/2022] Open
Abstract
Emerging evidence suggests that axial spondyloarthritis (axSpA) should not be seen as a predominantly male disease, as the non-radiographic form occurs with roughly equal frequency in women and men. However, men and women experience this disease differently. The purpose of this review is to highlight sex-associated and gender-associated differences in the patient's journey through the diagnosis and management of axSpA, in order to increase the awareness about the unmet needs of female axSpA patients.Female patients experience a longer diagnostic delay compared with men, possibly due to the different pattern of clinical presentations across genders. Therefore, it is crucial to sensitise physicians to pay attention and identify the red flags of axSpA in women and promote early referral to a rheumatologist. Women with a diagnosis of axSpA experience greater limitations in physical function, although they have less structural spinal damage compared with men. Women tend to have less adherence and a lower response to treatment, so more gender-oriented data are needed about drugs used for axSpA, especially biological disease-modifying antirheumatic drugs.Lifestyle factors have a strong impact on the disease course. Interventions regarding physical activity, smoking cessation and diet should be communicated to the patients, with particular attention to the gender-related cultural background.Patients of childbearing age living with axSpA should be engaged in a discussion about reproductive health, in terms of preservation of fertility, management of pregnancy and delivery and use of biologic drugs during pregnancy and breastfeeding.
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Affiliation(s)
- Maria-Sole Chimenti
- Rheumatology, Allergology and Clinical Immunology, University of Rome Tor Vergata, Rome, Italy
| | - Rieke Alten
- Internal Medicine II, Rheumatology, Schlosspark-Klinik, University Medicine Berlin, Berlin, Germany
| | - Maria-Antonieta D'Agostino
- Rheumatology Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCSS, Università Cattolica del Sacro Cuore, Rome, Italy.,Inserm U1173, Infection et inflammation, Laboratory of Excellence Inflamex, Université Versailles-Paris-Saclay, Montigny-le-Bretonneux, France
| | - Elisa Gremese
- Rheumatology Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCSS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Uta Kiltz
- Internal Medicine and Rheumatology, Rheumazentrum Ruhrgebiet, Herne, Germany.,Rheumatology Department, Ruhr University Bochum, Bochum, Germany
| | - Ennio Lubrano
- Academic Rheumatology Unit, Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio", Università degli Studi del Molise, Campobasso, Italy
| | - Mireia Moreno
- Rheumatology Department, Hospital Universitario Parc Taulí, Barcelona, Spain
| | - Thao Pham
- Rheumatology, Aix-Marseille-University, Marseille, France.,Rheumatology Department, Assistance Publique-Hôpitaux de Marseille (APHM), Marseille, France
| | - Roberta Ramonda
- Rheumatology Unit, Department of Medicine-DIMED, University Hospital of Padova, Padova, Italy
| | - Francesca-Romana Spinelli
- Rheumatology Unit, Department of Internistic, Anaesthesiologic and Cardiovascular Sciences, Sapienza Universita Editrice, Roma, Lazio, Italy
| | - Chiara Perella
- Immunology, Hepatology and Dermatology, Novartis AG, Basel, Basel-Stadt, Switzerland
| | - Laura Andreoli
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy .,Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili di Brescia, Brescia, Italy
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10
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Soulard J, Vaillant J, Vuillerme N. Gait in patients with axial spondyloarthritis: A systematic review of the literature. Curr Rheumatol Rev 2021; 18:117-123. [PMID: 34548003 DOI: 10.2174/1573397117666210921114949] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 06/11/2021] [Accepted: 06/28/2021] [Indexed: 11/22/2022]
Abstract
Axial spondyloarthritis (axSpA) is a chronic inflammatory disease predominantly affecting the axial skeleton. axSpA includes radiographic (i.e., ankylosing spondylitis (AS)) and non-radiographic forms (nr-axSpA). Although recent studies have reported that patients with AS have impaired gait, axSpA's consequences on gait remain unknown. The present review's objectives were to identify: 1) how gait is assessed in patients with axSpA, and 2) what the gait characteristics are of patients with axSpA. This systematic review's protocol was registered in the Prospero database (CRD42020128509). Three databases were systematically searched using keywords related to axSpA and gait. Two independent reviewers selected the articles and extracted the data. The search revealed two hundred titles and abstracts, and two articles were finally included in this review, comprising a total of 132 patients with axSpA. One of the included studies used the 6 m maximum gait velocity test (axSpA: 2.2 ± 0.5 m/s), and the other used the six-minute walk test (axSpA: 414 ± 106 m). Neither study involved a control group to compare gait. Only two published studies assessed the gait performance of patients with axSpA using clinical tests. Furthermore, neither of them compared gait performance to healthy controls or differentiated gait between the AS and nr-axSpA forms of axSPA. The present literature review highlights the need for future research to learn more about how gait is impaired in different types of patients with axSpA.
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Affiliation(s)
- Julie Soulard
- Univ. Grenoble Alpes, AGEIS, Grenoble, France; bGrenoble Alpes University Hospital, Grenoble. France
| | - Jacques Vaillant
- Univ. Grenoble Alpes, AGEIS, Grenoble, France; bGrenoble Alpes University Hospital, Grenoble. France
| | - Nicolas Vuillerme
- Univ. Grenoble Alpes, AGEIS, Grenoble, France; bGrenoble Alpes University Hospital, Grenoble. France
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11
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Braun J, Baraliakos X, Kiltz U. Treat-to-target in axial spondyloarthritis - what about physical function and activity? Nat Rev Rheumatol 2021; 17:565-576. [PMID: 34312518 DOI: 10.1038/s41584-021-00656-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2021] [Indexed: 02/07/2023]
Abstract
In patients with axial spondyloarthritis (axSpA), pain, functional and structural impairments, reduced mobility and potential deformity of the axial skeleton are the most prominent health concerns. Limitations in physical function and spinal mobility are caused by both inflammation and structural damage, and therefore restrictions to physical function must be monitored throughout a patient's life. Consequently, the assessment of physical function is recommended as a key domain in the Assessment of Spondyloarthritis International Society-OMERACT Core Outcome Set. However, in comparison with disease activity, physical function seems to be a relatively neglected target of intervention in patients with axSpA, even though physical function is a major contributor to costs and disability in this disease. This Review aims to reacquaint rheumatologists with the targets for physical function, physical activity and performance by giving guidance on determinants of physical function and how physical function can be examined in patients with axSpA.
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Affiliation(s)
- Jürgen Braun
- Rheumazentrum Ruhrgebiet, Herne, Ruhr Universität Bochum, Bochum, Germany.
| | - Xenofon Baraliakos
- Rheumazentrum Ruhrgebiet, Herne, Ruhr Universität Bochum, Bochum, Germany
| | - Uta Kiltz
- Rheumazentrum Ruhrgebiet, Herne, Ruhr Universität Bochum, Bochum, Germany
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12
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Carbo MJ, Paap D, Maas F, Baron AJ, van Overbeeke LC, Siderius M, Bootsma H, Wink F, Arends S, Spoorenberg A. The mSQUASH; a valid, reliable and responsive questionnaire for daily physical activity in patients with axial spondyloarthritis. Semin Arthritis Rheum 2021; 51:719-727. [PMID: 34144381 DOI: 10.1016/j.semarthrit.2021.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/14/2021] [Accepted: 05/10/2021] [Indexed: 01/02/2023]
Abstract
AIM Adaptation of the Short QUestionnaire to Assess Health-enhancing physical activity (SQUASH) in order to improve measurement properties in axSpA patients. METHODS The original SQUASH was adapted using a qualitative stepwise approach with in-depth interviews including healthcare professionals and patients. Content validity was explored by comparing modified-SQUASH (mSQUASH) and original SQUASH. Next, mSQUASH was validated according to the OMERACT filter. International Physical Activity Questionnaire (IPAQ) was used as comparator and tri-axial accelerometer as gold standard for criterion validity and classification accuracy of intensity. Construct validity was assessed using Spearman correlations with clinical outcome assessments. For test-retest reliability, intra-class correlation coefficients (ICCs) were calculated. Responsiveness was assessed using standardized response mean (SRM), stratified by Anchor method. RESULTS The mSQUASH measured a systematically higher activity count and had less missing values (8% vs. 16%) then SQUASH. mSQUASH correlated better with accelerometer compared to IPAQ (ρ = 0.60 vs. ρ = 0.34). Accelerometer measured most activity in light intensity, whereas mSQUASH and IPAQ predominately measured moderate intensity. Correlations with ASDAS, BASDAI, BASFI and ASQoL were better for mSQUASH then IPAQ. Test-retest reliability was good in both questionnaires. In contrast to IPAQ, responsiveness was in correspondence with self-reported changes in physical activity for mSQUASH (SRM -0.84 for improvement and 0.88 for decrease). The average completion time of the mSQUASH was 7 minutes. CONCLUSIONS The development of the mSQUASH resulted in an easy applicable, valid, reliable and responsive questionnaire for the assessment of daily physical activity in axSpA patients, which can be used in research and daily clinical practice.
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Affiliation(s)
- Marlies Jg Carbo
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, the Netherlands.
| | - Davy Paap
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, the Netherlands; Department of Rehabilitation Medicine, University of Medical Center Groningen, University of Groningen, the Netherlands
| | - Fiona Maas
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, the Netherlands; Rheumatology, Medical Center Leeuwarden, the Netherlands; Department of Rehabilitation Medicine, University of Medical Center Groningen, University of Groningen, the Netherlands
| | - Anna Jetske Baron
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Laura C van Overbeeke
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Mark Siderius
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Hendrika Bootsma
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Freke Wink
- Rheumatology, Medical Center Leeuwarden, the Netherlands
| | - Suzanne Arends
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, the Netherlands; Rheumatology, Medical Center Leeuwarden, the Netherlands
| | - Anneke Spoorenberg
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, the Netherlands; Rheumatology, Medical Center Leeuwarden, the Netherlands
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13
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Physical therapy in axial spondyloarthritis: guidelines, evidence and clinical practice. Curr Opin Rheumatol 2021; 32:365-370. [PMID: 32453037 DOI: 10.1097/bor.0000000000000714] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW Physical therapy is recommended for the management of axial spondyloarthritis (axSpA) with the focus of promoting physical activity and prescribing exercise within four domains, outlined recently by the European League against Rheumatism (EULAR): aerobic, resistance, flexibility and neuro-motor exercise. There is an increasing evidence base to support physical therapy interventions in axSpA. RECENT FINDINGS We present evidence supporting the use of exercise as treatment for patients with axSpA, recent updates among different exercise modalities, and make clear its critical place in the management of this condition. Recent large, multicentre data have shown that high-intensity exercise can improve disease activity and also positively impact cardiovascular risk factors in these patients. Although international treatment guidelines advocate the inclusion of physical activity and exercise for the optimal management of axSpA, specific guidance about the amount of exercise required to produce a beneficial effect is lacking. SUMMARY Exercise must be used in the management of axSpA, and whilst hydrotherapy and flexibility exercises are traditionally the main focus, other applications, such as strength training, may be underutilized domains. Further studies are needed to determine the dose-response relationship between exercise and axSpA patient subsets.
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14
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Dantas LO, Carvalho C, Prando BC, McAlindon TE, da Silva Serrão PRM. Mobile health technologies for the management of rheumatic diseases: a systematic review of online stores in Brazil. Clin Rheumatol 2021; 40:2601-2609. [PMID: 33389312 DOI: 10.1007/s10067-020-05561-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 11/29/2020] [Accepted: 12/21/2020] [Indexed: 01/17/2023]
Abstract
Rheumatic diseases are serious conditions with a low uptake of conservative treatments. Mobile health (mHealth) applications (apps) offer potential to assist the self-management of rheumatic diseases. Our goal was to perform a systematic review of available mHealth apps for rheumatic diseases in Brazil. We focused on the most prevalent rheumatic diseases: osteoarthritis, rheumatoid arthritis, fibromyalgia, systemic lupus erythematosus, osteoporosis, and axial spondylarthritis. Google Play Store and AppStore in Brazil were queried by two independent reviewers on September 2020, and the quality of eligible mHealth apps was assessed using the Mobile App Rating Scale (MARS). Of the 3173 mHealth apps found, five were eligible for inclusion. Two for fibromyalgia and two for axial spondylarthritis offered exercise, educational content, and tools to track patient-reported symptoms; and one for osteoporosis offered educational content and tracking tools only. The included apps scored moderately on the MARS quality scale, with a mean score (SD) of 3.1 (0.7) on a 0-5 scale. Most apps scored poorly based on credibility, user interface and experience, and engagement. There is growing interest in the development of mHealth technologies to support rheumatic diseases patients. Although the majority of the included apps came from non-profit organizations, they are still of poor quality and limited functionality. This study is a call for to the development of new user-centered mHealth apps that can empower rheumatic diseases patients in Brazil, especially in the area of osteoarthritis, rheumatoid arthritis, and lupus, since no apps were found.
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Affiliation(s)
- Lucas Ogura Dantas
- Physical Therapy Department, Federal University of São Carlos, São Carlos, 13565-905, Brazil
| | - Cristiano Carvalho
- Physical Therapy Department, Federal University of São Carlos, São Carlos, 13565-905, Brazil
| | - Beatriz Cardinal Prando
- Physical Therapy Department, Federal University of São Carlos, São Carlos, 13565-905, Brazil
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15
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Cetin SY, Calik BB, Ayan A, Kabul EG. The effectiveness of 10-Tai Chi movements in patients with ankylosing spondylitis receiving anti-tumor necrosis factor α therapy: A randomized controlled trial. Eur J Integr Med 2020. [DOI: 10.1016/j.eujim.2020.101208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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16
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17
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Basakci Calik B, Pekesen Kurtca M, Gur Kabul E, Telli Atalay O, Taskin H, Yigit M, Tasci M, Cobankara V. Investigation of the effectiveness of aerobic exercise training in individuals with ankylosing spondylitis: Randomized controlled study. Mod Rheumatol 2020; 31:442-450. [PMID: 32202181 DOI: 10.1080/14397595.2020.1745409] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To investigate the effect of the addition of aerobic training to spinal mobility exercises on disease-specific outcomes and functional exercise capacity, aerobic capacity and respiratory muscle strength of ankylosing spondylitis (AS) patients. METHODS The study included 31 volunteers (mean age: 44.90 ± 11.52 years) diagnosed with AS. The demographic characteristics and disease-related data of all subjects were recorded, then, the Bath AS Disease Activity Index (BASDAI), Bath AS Metrology Index (BASMI) and Bath AS Disease Function Index (BASFI), the 6-minute walk test, the Bruce Treadmill Test and spirometry were used, respectively. The intervention group attended a 12-week program of aerobic exercise sessions, plus supervised spinal mobility exercises, 3 days a week. The control group performed the supervised spinal mobility exercises only, 3 times a week, for 12 weeks. RESULTS There was a significant improvement in BASDAI (p = .002), BASMI (p = .021), 6 DYT (p = .036), VO2 max (p = .000), MIP (p = .005) and MEP (p = .022) results in the intervention group after 12 weeks of training. In the comparisons of the pre-treatment and post-treatment differences, BASDAI (p = .032) decreased and VO2 (p = .001) max increased, showing significant improvements in the intervention group and these values were maintained. CONCLUSION It is striking that improvements in all parameters except BASFI were achieved in the aerobic training group. These results demonstrate that an aerobic exercise program should be included in an individual exercise prescription for the management of AS.
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Affiliation(s)
- Bilge Basakci Calik
- School of Physical Therapy and Rehabilitation, Pamukkale University, Denizli, Turkey
| | | | - Elif Gur Kabul
- School of Physical Therapy and Rehabilitation, Pamukkale University, Denizli, Turkey
| | - Orcin Telli Atalay
- School of Physical Therapy and Rehabilitation, Pamukkale University, Denizli, Turkey
| | - Harun Taskin
- School of Physical Therapy and Rehabilitation, Pamukkale University, Denizli, Turkey
| | - Murat Yigit
- Department of Rheumatology, Medical School, Pamukkale University, Denizli, Turkey
| | - Murat Tasci
- Department of Rheumatology, Medical School, Pamukkale University, Denizli, Turkey
| | - Veli Cobankara
- Department of Rheumatology, Medical School, Pamukkale University, Denizli, Turkey
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18
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Metsios GS, Fenton SA, Moe HR, van der Esch M, van Zanten JV, Koutedakis Y, Vitalis P, Kennedy N, Brodin NC, Tzika A, Boström C, Swinnen TW, Jester R, Schneider KN, Nikiphorou E, Fragoulis GE, Vlieland TPMV, Van den Ende C, Kitas GD. Implementation of Physical Activity into routine Clinical pracTice in Rheumatic Musculoskeletal Disease: The IMPACT-RMD study protocol and rationale. Mediterr J Rheumatol 2020; 30:231-236. [PMID: 32467876 PMCID: PMC7241658 DOI: 10.31138/mjr.30.4.231] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 12/10/2019] [Indexed: 11/25/2022] Open
Abstract
Background: Physical activity is an important intervention for improving disease-related symptoms and systemic manifestations in rheumatic and musculoskeletal disease (RMDs). However, studies suggest that RMD patients report that the lack of individualized and consistent information about physical activity from managing doctors and healthcare professionals, acts as a barrier for engagement. On the other hand, managing doctors and healthcare professionals report lack of knowledge in this area and thus lack of confidence to educate and advise RMD patients about the beneficial effects of physical activity. The aim of the present study therefore, is to develop two e-Learning courses for RMD doctors and health professionals: a) the first one to provide consistent information about the collective benefits of physical activity in RMDs and b) the second on how to implement physical activity advice in routine clinical practice. Methods: An international collaboration of seven countries, consisting of one academic institution and one patient organization from each country, will co-develop the two e-Learning courses. The final e-Learning courses will primarily target to improve – through physical activity advice – RMD symptoms which are important for patients. Discussion: The main result of this study will be to co-develop two e-Learning courses that can be used by managing RMD doctors and healthcare professionals to be made aware of the overall benefits of physical activity in RMDs as well as how to implement physical activity advise within their practice.
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Affiliation(s)
- George S Metsios
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, United Kingdom.,Department of Rheumatology, Russells Hall Hospital, Dudley Group NHS Foundation Trust, Dudley, United Kingdom.,School of Physical Education and Sport Science, University of Thessaly, Greece
| | - Sally Am Fenton
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Helene Rikke Moe
- National Resource Centre for Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Martin van der Esch
- ACHIEVE - Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences. Reade, Center for Rehabilitation and Rheumatology/Amsterdam Rehabilitation Research Center, Amsterdam, The Netherlands
| | - Jet Veldhuijzen van Zanten
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Yannis Koutedakis
- School of Physical Education and Sport Science, University of Thessaly, Greece
| | - Panagiotis Vitalis
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, United Kingdom
| | - Norelee Kennedy
- School of Allied Health, Faculty of Education and Health Sciences and Health Research Institute, University of Limerick, Limerick, Ireland
| | - Nina C Brodin
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
| | - Aikaterini Tzika
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, United Kingdom
| | - Carina Boström
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
| | | | - Rebecca Jester
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, United Kingdom
| | - Karin Niedermann Schneider
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, United Kingdom.,Department of Rheumatology, Russells Hall Hospital, Dudley Group NHS Foundation Trust, Dudley, United Kingdom.,School of Physical Education and Sport Science, University of Thessaly, Greece.,School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom.,National Resource Centre for Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,ACHIEVE - Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences. Reade, Center for Rehabilitation and Rheumatology/Amsterdam Rehabilitation Research Center, Amsterdam, The Netherlands.,School of Allied Health, Faculty of Education and Health Sciences and Health Research Institute, University of Limerick, Limerick, Ireland.,Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden.,Division of Rheumatology, University Hospitals Leuven, Leuven, Belgium.,School of Health Professions, Institute of Physiotherapy, Zurich University of Applied Sciences, Winterthur, Switzerland.,School of Immunology and Microbial Sciences, King's College, London, UK.,Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK.,Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, the Netherlands.,Department of Rheumatology, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Elena Nikiphorou
- School of Immunology and Microbial Sciences, King's College, London, UK
| | - George E Fragoulis
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Thea P M Vliet Vlieland
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, the Netherlands
| | | | - George D Kitas
- Department of Rheumatology, Russells Hall Hospital, Dudley Group NHS Foundation Trust, Dudley, United Kingdom.,ACHIEVE - Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences. Reade, Center for Rehabilitation and Rheumatology/Amsterdam Rehabilitation Research Center, Amsterdam, The Netherlands
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19
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Deodhar A, Gensler LS, Magrey M, Walsh JA, Winseck A, Grant D, Mease PJ. Assessing Physical Activity and Sleep in Axial Spondyloarthritis: Measuring the Gap. Rheumatol Ther 2019; 6:487-501. [PMID: 31673975 PMCID: PMC6858410 DOI: 10.1007/s40744-019-00176-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Indexed: 01/17/2023] Open
Abstract
Patients with axial spondyloarthritis (axSpA) frequently report pain, stiffness, fatigue, and sleep problems, which may lead to impaired physical activity. The majority of reported-on measures evaluating physical activity and sleep disturbance in axSpA are self-reported questionnaires, which can be impacted by patient recall (reporting bias). One objective measure, polysomnography, has been employed to evaluate sleep in patients with axSpA; however, it is an intrusive measure and cannot be used over the long term. More convenient objective measures are therefore needed to allow for the long-term assessment of both sleep and physical activity in patients' daily lives. Wearable technology that utilizes actigraphy is increasingly being used for the objective measurement of physical activity and sleep in various therapy areas, as it is unintrusive and suitable for continuous tracking to allow longitudinal assessment. Actigraphy characterizes sleep disruption as restless movement while sleeping, which is particularly useful when studying conditions such as axSpA in which chronic pain and discomfort due to stiffness may be evident. Studies have also shown that actigraphy can effectively assess the impact of disease on physical activity. More research is needed to establish the usefulness of objective monitoring of sleep and physical activity specifically in axSpA patients over time. This review summarizes the current perspectives on physical activity and sleep quality in patients with axSpA, and the possible role of actigraphy in the future to more accurately evaluate the impact of treatment interventions on sleep and physical activity in axSpA.Funding: Novartis Pharmaceuticals Corporation.Plain Language Summary: Plain language summary available for this article.
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Affiliation(s)
- Atul Deodhar
- Oregon Health & Science University, Portland, OR, USA.
| | | | - Marina Magrey
- Case Western Reserve University, MetroHealth System, Cleveland, OH, USA
| | - Jessica A Walsh
- University of Utah and Salt Lake City Veterans Affairs Medical Center, Salt Lake City, UT, USA
| | - Adam Winseck
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Daniel Grant
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Philip J Mease
- Swedish Medical Center and University of Washington, Seattle, WA, USA
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20
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Gait as predictor of physical function in axial spondyloarthritis: the prospective longitudinal FOLOMI (Function, Locomotion, Measurement, Inflammation) study protocol. Rheumatol Int 2019; 39:1681-1688. [PMID: 31392500 DOI: 10.1007/s00296-019-04396-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 07/26/2019] [Indexed: 12/23/2022]
Abstract
Axial spondyloarthritis (axSpA) is a chronic inflammatory rheumatic disease affecting predominantly sacroiliac joints and axial skeleton. axSpA progression being irregular and hardly predictable, identifying functional decline is particularly important in patient with axSpA to allow delivery of timely and targeted interventions. Pain, reduced range of motion or altered posture can have adverse consequences on gait. Although gait has previously been used as a sensitive measure of physical outcomes in elderly and pathological populations, to the best of our knowledge, no study has used gait as a predictor of physical function in patients with axSpA. The objective of our study is hence to determine if gait parameters measured in patients with axSpA could predict the evaluation at 18 months of physical function as assessed by the Bath Ankylosing Spondylitis Functional Index (BASFI). This is a prospective and longitudinal study. Sixty patients with axSpA and 30 healthy age- and sex-matched controls will be included. Patients should be aged 18-65 years at time of their first evaluation, followed at Grenoble Alpes University Hospital for axSpA or ankylosing spondylitis, able to walk 180 m without technical help and with stable treatment for at least 12 months. Clinical characteristics, BASFI, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), clinical and laboratory measurements of gait will be assessed during four visits (at baseline and at months 6, 12, and 18). Similar assessments will be performed once for the healthy control group. A linear mixed model at 6, 12 and 18 months will be constructed to answer to the first objective, with the BASFI as dependent variable and gait parameters as explanatory variables. The data collection started in August 2018 and will be completed with the inclusion and follow-up of all the participants. We believe that the combination of clinical and laboratory measurements of gait in patients with axSpA could strengthen the capacity to monitor disease's evolution and to predict changes in patients' physical function. Results of the present study could ultimately allow delivering targeted, timely, personalized interventions and treatment in patients with axSpA.Trial registration: The study was approved by local ethic committee (CPP Ile De France 1, RCB: 2017-A03468-45, date of agreement: July 17th, last version: V4.0, 2018, March 5th, 2019) and is retrospectively registered in Clinical trials (NCT03761212).
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21
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Soulard J, Vuillerme N, Vaillant J. Gait Characteristics in Patients With Ankylosing Spondylitis: Protocol for a Systematic Review. JMIR Res Protoc 2019; 8:e12470. [PMID: 31042158 PMCID: PMC6658243 DOI: 10.2196/12470] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 01/30/2019] [Accepted: 01/30/2019] [Indexed: 11/20/2022] Open
Abstract
Background Ankylosing spondylitis is a subtype of inflammatory rheumatic disease, affecting predominantly the axial skeleton and sacroiliac joints. The main clinical manifestations are spinal stiffness and inflammatory back pain, which can potentially affect gait ability of patients with ankylosing spondylitis. However, published studies show discrepancies regarding gait characteristics in ankylosing spondylitis and heterogeneity in terms of task requirement, types of equipment, data collection, and analysis techniques used to assess gait ability of patients with ankylosing spondylitis. Objective This review aimed to determine (1) the consequences of ankylosing spondylitis on gait and (2) how gait is assessed in patients with ankylosing spondylitis. Methods Three electronic databases—PubMed, Physiotherapy Evidence Database (PEDro), and Cochrane—were searched systematically with no limit on the publication date in order to identify studies satisfying the search criteria. The research focused on original research, using Boolean operators “AND” and “OR” in the combination of the Medical Subject Headings descriptors found in titles or abstracts: (Gait OR Walk OR Walking OR locomotor OR locomotion) AND (ankylosing spondylitis OR spondyloarthritis). Only English-language original articles were included. Results As of September 2018, the search was completed, and 168 records were obtained. After screening titles and abstracts, 19 full texts were reviewed. Of those, 17 were included in the review. We are currently in the process of data extraction and synthesis. Conclusions The systematic review will provide a synthesis and comprehensive evaluation of published studies on gait characteristics in patients with ankylosing spondylitis. This work is also intended to help identify the likely relevant directions for future research. Trial Registration PROSPERO CRD42018102540; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=102540 International Registered Report Identifier (IRRID) DERR1-10.2196/12470
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Affiliation(s)
- Julie Soulard
- AGEIS, Université Grenoble Alpes, Grenoble, France.,Grenoble Alpes University Hospital, Grenoble, France
| | - Nicolas Vuillerme
- AGEIS, Université Grenoble Alpes, Grenoble, France.,Institut Universitaire de France, Paris, France
| | - Jacques Vaillant
- AGEIS, Université Grenoble Alpes, Grenoble, France.,Grenoble Alpes University Hospital, Grenoble, France
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22
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Miyamoto ST, Valim V, Carletti L, Ng WF, Perez AJ, Lendrem DW, Trennel M, Giovelli RA, Dias LH, Serrano ÉV, Subtil AM, Abreu VC, Natour J. Supervised walking improves cardiorespiratory fitness, exercise tolerance, and fatigue in women with primary Sjögren's syndrome: a randomized-controlled trial. Rheumatol Int 2019; 39:227-238. [PMID: 30604204 DOI: 10.1007/s00296-018-4213-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 11/24/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the safety and effectiveness of a supervised walking program in women with primary Sjögren's syndrome (pSS). METHODS Forty-five sedentary women fulfilling the American European Consensus Criteria for pSS were randomized to a training group (TG, n = 23) or control group (CG, n = 22). Patients in the TG were submitted to supervise walking three times a week for 16 weeks. The patients of the CG were instructed to not perform any kind of regular physical exercise. Physical fitness [maximum oxygen uptake (VO2max) and distance], EULAR Sjögren's Syndrome Disease Activity Index (ESSDAI), hematological tests, and Medical Outcomes Study 36 (SF-36) were assessed at baseline and week 16. In addition, EULAR Sjögren's Syndrome Patient Reported Index (ESSPRI), Functional Assessment of Chronic Illness Therapy Fatigue Subscale (FACIT-fatigue), and Beck Depression Inventory (BDI) were measured prior to intervention, after 8 and 16 weeks. Patient global assessment of response to therapy was completed at the final assessment. An intent-to-treat analysis was performed. RESULTS After 16 weeks, the mean change of VO2max (ml/kg/min), distance, and FACIT-fatigue were higher in the TG than in the CG (p = 0.016, p = 0.043 and p = 0.030, respectively). Improved cardiorespiratory fitness was associated with improvements in fatigue scores and physical components of quality of life (SF-36). Furthermore, improved fatigue scores were associated with reduced depression and improvements in the physical and mental components of SF-36. Overall, 95.4% of patients in the TG rated themselves as clinically improved versus 62% of the patients in the CG (p = 0.049). There was no flare in disease activity and no serious adverse events with exercise. CONCLUSIONS This supervised walking program was demonstrated to be feasible and safe with improvements in cardiorespiratory fitness, exercise tolerance, fatigue, and patient perception of improvement in pSS patients. TRIAL REGISTRATION Clinical Trials.gov ID, number NCT02370225.
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Affiliation(s)
- Samira Tatiyama Miyamoto
- Department of Integrated Education in Health, Universidade Federal do Espírito Santo, Av. Maruípe, 1468, Vitoria, ES, 29040-090, Brazil
- Department of Rheumatology, Universidade Federal de São Paulo-Escola Paulista de Medicina, Rua Botucatu, 740, São Paulo, SP, 04023-900, Brazil
| | - Valéria Valim
- Rheumatology Outpatient Clinic-Hospital Universitário Cassiano Antônio de Moares (HUCAM), Universidade Federal do Espírito Santo, Av. Marechal Campos, 1355, 29043-260, Vitoria, ES, Brazil
- Department of Medical Clinic, Universidade Federal do Espírito Santo, Av. Marechal Campos, 1468, Vitoria, ES, 29040-090, Brazil
| | - Luciana Carletti
- Exercise Physiology Laboratory (LAFEX), Universidade Federal do Espírito Santo, Av. Fernando Ferrari, 514, Vitoria, ES, 29075-810, Brazil
| | - Wan-Fai Ng
- Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - Anselmo José Perez
- Exercise Physiology Laboratory (LAFEX), Universidade Federal do Espírito Santo, Av. Fernando Ferrari, 514, Vitoria, ES, 29075-810, Brazil
| | - Dennis William Lendrem
- Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - Michael Trennel
- MoveLab, Physical Activity and Exercise Research, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - Raquel Altoé Giovelli
- Rheumatology Outpatient Clinic-Hospital Universitário Cassiano Antônio de Moares (HUCAM), Universidade Federal do Espírito Santo, Av. Marechal Campos, 1355, 29043-260, Vitoria, ES, Brazil
| | - Laiza Hombre Dias
- Rheumatology Outpatient Clinic-Hospital Universitário Cassiano Antônio de Moares (HUCAM), Universidade Federal do Espírito Santo, Av. Marechal Campos, 1355, 29043-260, Vitoria, ES, Brazil
| | - Érica Vieira Serrano
- Rheumatology Outpatient Clinic-Hospital Universitário Cassiano Antônio de Moares (HUCAM), Universidade Federal do Espírito Santo, Av. Marechal Campos, 1355, 29043-260, Vitoria, ES, Brazil
| | - Alice Mendonça Subtil
- Exercise Physiology Laboratory (LAFEX), Universidade Federal do Espírito Santo, Av. Fernando Ferrari, 514, Vitoria, ES, 29075-810, Brazil
| | - Vanessa Cândido Abreu
- Exercise Physiology Laboratory (LAFEX), Universidade Federal do Espírito Santo, Av. Fernando Ferrari, 514, Vitoria, ES, 29075-810, Brazil
| | - Jamil Natour
- Department of Rheumatology, Universidade Federal de São Paulo-Escola Paulista de Medicina, Rua Botucatu, 740, São Paulo, SP, 04023-900, Brazil.
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23
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Mistry RR, Patro P, Agarwal V, Misra DP. Enthesitis-related arthritis: current perspectives. Open Access Rheumatol 2019; 11:19-31. [PMID: 30774484 PMCID: PMC6354696 DOI: 10.2147/oarrr.s163677] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
In this narrative review, we overview the recent literature on enthesitis-related arthritis (ERA). For the purpose of our review, we searched Scopus for recent articles on this subject from 2013 onward, including some classic older articles for perspective. ERA is a juvenile idiopathic arthritis (JIA) subtype more common in males, associated in a majority with human leucocyte antigen B27. Such children generally present with asymmetric oligoarthritis or polyarthritis, predominantly of lower limb joints, associated with enthesitis or sacroiliitis. While diagnosis remains clinical, ultrasound is being increasingly used to detect subclinical enthesitis and for guiding entheseal site injections. Spine MRI can help detect sacroiliitis, inflammatory spinal changes, and pelvic sites of enthesitis in such patients. The recent juvenile spondyloarthropathy disease activity index recognizes the key clinical features of ERA, viz enthesitis and inflammatory back pain, which other disease activity indices used in JIA did not include. Management includes NSAIDs with physical therapy. Conventional disease-modifying agents like sulfasalazine and methotrexate may be used to minimize duration of NSAID use and in those with high inflammatory burden. In patients refractory to these drugs, biologics such as antitumor necrosis factor alpha agents have proven useful, based on evidences from randomized controlled trials and retrospective registry analyses. Factors predicting a poorer outcome in such children include hip or ankle involvement or restricted spinal mobility. Considering that children with ERA have overall poorer long-term outcomes than other subtypes of JIA, there is a need to further optimize therapeutic strategies for such patients.
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Affiliation(s)
- Rutviz Rajendra Mistry
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India,
| | - Pallavi Patro
- Department of Pharmacology, Sriram Chandra Bhanja (SCB) Medical College, Cuttack, India
| | - Vikas Agarwal
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India,
| | - Durga Prasanna Misra
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India,
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