Exercise, including physical therapy, improves function and decreases pain. Dr. Khan recommended swimming as the best exercise for SpA patients. The exercise should not be short-term but rather the beginning of a lifelong exercise program, which is necessary in the management of a chronic condition.
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Explore This IssueFebruary 2012
Also By This Author
ASAS recommendations on managing SpA suggest using anti-TNF agents in patients with SpA, but only after:
- A regimen of NSAIDs (at least two different drugs tried for one month or more total);
- An adequate therapeutic trial of a disease-modifying antirheumatic drug (DMARD), preferably sulfasalazine, for patients with peripheral symptoms; and
- An efficacy evaluation of the above steps after 12 weeks.6
Note that patients with axial spondylarthritis do not need to take a DMARD before or concomitant with an anti-TNF agent.
All TNF inhibitors are remarkably effective as monotherapy for treating SpA, and the response is even better in early disease. TNF inhibitors have long-term efficacy and an acceptable safety profile, but there is a need for adequate intake of vitamin D and calcium and for ongoing screening for concomitant osteopenia and osteoporosis.
Ann Kepler is a medical journalist based in Chicago.
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- Sieper J, Rudwaleit M, Baraliakos X, et al. The Assessment of SpondyloArthritis international Society (ASAS) handbook: A guide to assess spondyloarthritis. Ann Rheum Dis. 2009;68(Suppl II):ii1–ii44.