Rehabilitation in ankylosing spondylitis

Purpose of review Medical therapy of ankylosing spondylitis has improved dramatically with the advent of anti-tumor necrosis factor therapy, but nonpharmacologic therapies have long been employed to treat the condition. The purpose of this review is to summarize the most recent data to assess the role of exercise and nonpharmacologic therapies in ankylosing spondylitis. Recent findings We review six articles published since 2005. The most common outcome measures (validated scores from Bath group) were only formally utilized in two studies. Four of the six studies were randomized controlled trials. One study using balneotherapy did not reveal any significant improvement in the medium term. One study used a multimodal exercise program, which revealed some benefit. Two studies assessed short and long-term efficacy of an experimental exercise protocol and suggested a prolonged benefit. Two small studies looking at biologic markers suggested that exercise may impact cytokine production. Summary All studies we reviewed had small numbers of participants without a standardized control group and each study used different outcome measures. This review demonstrates the importance of continued emphasis on exercise therapy, the need for a standardized approach to exercise therapy, and a potential biologic effect. Exercise therapy should remain a mainstay of ankylosing spondylitis treatment complementing medical therapy.