Spondyloarthritiden und Lebensstil (Lifestyle)

Zusammenfassung

Die Spondyloarthritiden (SpA) sind entzündlich rheumatische Erkrankungen, die durch Entzündungen im Bereich der Wirbelsäule gekennzeichnet sind. Das im Vordergrund stehende typische Symptom bei der axialen SpA (axSpA) ist der entzündliche Rückenschmerz. Dieser kann neben der Morgensteifigkeit von Müdigkeit und Abgeschlagenheit (Fatigue) begleitet sein. Die axSpA führt durch Entzündung und Knochenneubildung zu funktionellen Einschränkungen nicht nur der Beweglichkeit, sondern auch der Lebensqualität insgesamt. Positive Effekte von regelmäßigen Übungen und körperlicher Aktivität konnten in Studien belegt werden. Dabei müssen die ideale Art und das ideale Ausmaß der körperlichen Aktivität in der Regel individuell festgelegt werden. Das Interesse von Patienten für einen gesunden Lifestyle wie Raucherentwöhnung oder das Management der Gewichtskontrolle hat in den vergangenen Jahren zugenommen. Die schädliche Wirkung des Rauchens bei Patienten mit axSpA ist zweifelsfrei nachgewiesen worden. Der Zusammenhang zwischen Darmentzündungen und SpA ist von zunehmendem wissenschaftlichen Interesse; besondere Aufmerksamkeit wird in der letzten Zeit dem intestinalen Mikrobiom gewidmet.

Summary

Spondyloarthritides (SpA) are chronic rheumatic diseases characterized by spine inflammation. Back pain, often accompanied by morning stiffness and fatigue, represent the most specific symptoms of the axial spondyloarthritis (axSpA). Due to inflammation and new bone formation, the functional impairments altering patient’s movement abilities largely affect also the wellbeing and the life quality of the patient. Several studies indicate that regular physical activity improves the disease outcome. However, the extent and type of exercise imprinting beneficial effects require careful evaluation for each patient in order to achieve maximal therapeutic effects. The interest of patients for a healthy lifestyle, including smoking cessation and controlling of body weight, to efficiently manage spondyloarthritis has been newly reported. The deleterious effects of smoking in axSpA patients have been unambiguously unveiled. The association between gut inflammation and occurrence of axSpA fosters scientific interest, in particular studies focusing on the intestinal microbiome.

Schlüsselwörter

Spondyloarthritis - körperliche Aktivität - Adipositas - Rauchen

Keywords

Spondyloarthritis - physical exercise - obesity - smoking

• Literatur

• 1 Braun J, Sieper J. Ankylosing Spondylitis. Lancet 2007; 369: 1379-1390
• 2 Rudwaleit M, van der Heijde D, Landewé R. et al. The development of assessment of spondyloarthritis international society classification criteria for axial spondyloarthritis. Ann Rheum Dis 2009; 68 (06) 777-783
• 3 Braun J, Bollow M, Remlinger G. et al. Prevalence of Spondyloarthropathies in HLA B27positive und negative blood donors. Arthritis Rheum 1998; 41 (01) 58-67
• 4 Rudwaleit M, Metter A, Listing J. et al. Inflammatory back pain in ankylosing spondylitis:a reassessment of the clinical hystory für application as classification and diagnostic criteria. Arthritis rheuma 2006; 54 (02) 569-578
• 5 Dagfinrud H, Kjeken I, Mowinckel P. et al. Impact of functional impairment in ankylosing spondylitis: impairment, activity limitation, and participation restrictions. J Rheumatol 2005; 32: 516-523
• 6 Braun J, van den Berg R, Baraliakos X. et al. 2010 Update of the ASAS/EULAR recommendations for the management of ankylosing spondylitis. Ann Rheum Dis 2011; 70: 896-904
• 7 Reimold A M, Chandran V. Best Practice & Research Clinical Rheumatology. 2014; 28: 779-792
• 8 Mathieu S, Gossec L, Dougados M. et al. Cardiovascular profile in ankylosing spondylitis: a systematic review and meta-analysis. Arthritis Care Res 2011; 63 (04) 557-563
• 9 Van Doornum S, Bohensky M, Racey MA. et al. Increased 30-day and 1-year mortality rates and lower coronary revascularisation rates following acute myocardial Infarction in patients with auto-immune disease. Arthritis Res Ther 2015; 17: 38
• 10 World Health Organization Global recommendations on physical activity for health. 2010 http://apps.who.int/iris/bitstr eam/10665/44399/1/9789241599979_eng.pdf. Accessed 15 June 2015
• 11 Neville CE, Murray LJ, Boreham CA. et al. Relationship between physical activity and bone mineral status in young adults: The Northern Ireland young hearts project. Bone 2002; 30: 792-798
• 12 Dagfinrud H, Kvien TK, Hagen KB. Physiotherapy interventions for ankylosing spondylitis. Cochrane Database Syst Rev 2008; 1: CD002822.
• 13 Fongen C, Halvorsen S, Dagfinrud H. Barriers and facilitators for being physically active in patients with ankylosing spondylitis: a cross-sectional comparative study. Musculo- skeletal Care 2015; 13: 76-83
• 14 Haglund E, Bergman S. et al. Differences in physical activity patterns in patients with spondylarthritis. Arthritis Care & Research 2012; 64: 1886-1894
• 15 Fongen C, Halvorsen S, Dagfinrud H. High disease activity is related to low levels of physical activity in patients with ankylosing spondylitis. Clin Rheumatol 2013; 32: 1719-1725
• 16 Craig CL, Marshall AL, Sjostrom M. et al. International physical activity questionnaire: 12 -country reliability and validity. Med Sci Sports Exerc 2003; 35: 1381-1395
• 17 Fabre Set al. Physical activity in patients with axial spondyloarthritis: a cross-sectional study of 203 patients. Rheumatol Int 2016; 36: 1711-1718
• 18 Sechrist KR, Walker SN, Pender NJ. et al Development and psychometric evaluation of the exercise benefits/barriers scale. Res Nurs Health 1987; 10: 357-365
• 19 Ramiro S, Landewé R, van Tubergen A. et al. Lifestyle factors may modify the effect of disease activity on radiographic progression in patients with ankylosing spondylitis: a longitudinal analysis. RMD Open 2015; 1: e000153. doi:10.1136
• 20 Ramiro S, van der Heijde D, van Tubergen A. et al. Higher disease activity leads to more structural damage in the spine in ankylosing spondylitis: 12-year longitudinal data from the OASIS cohort. Ann Rheum Dis 2014; 73: 1455-1461
• 21 Poddubnyy D, Haibel H, Listing J. et al. Baseline radiographic damage, elevated acute-phase reactant levels, and cigarette smoking status predict spinal radiographic progression in early axial spondylarthritis. Arthritis Rheum 2012; 64: 1388-1398
• 22 World Health Organization Global recommendations on physical activity for health. 2010 http://apps.who.int/iris/bitstr eam/10665/44399/1/9789241599979_eng.pdf. Accessed 15 June 2015
• 23 Braun J, Sieper J, Zink A. The risks of smoking in patients with spondyloarthritides. Ann Rheum Dis 2012; 71 (06) 791-792 [Epub 2012 Feb 13].
• 24 Ward M, Weisman M, Davis J. et al. Risk factors for functional limitations in patients with long-standing ankylosing spondylitis. Arthritis Rheum 2005; 53 (05) 710-717
• 25 Ward MM, Reveille J, Learch T. et al. Occupational physical activities and long-term functional and radiographic outcomes in patients with ankylosing spondylitis. Arthritis Rheum 2008; 59 (06) 822-832
• 26 O'Dwyer T, O'Shea F, Wilson F. Decreased physical activity and cardiorespiratory fitness in adults with ankylosing spondylitis: a cross-sectional controlled study. Rheumatol Int 2015; 35: 1863-1872
• 27 Doran MF, Brophy S, MacKay K. et al. Predictors of longterm outcome in ankylosing spondylitis. J Rheumatol 2003; 30 (02) 316-320
• 28 Poddubnyy D, Rudwaleit Haibel. H. et al. Rates and predictors of radiographic sacroiliitis progression over 2 years in patients with axial spondyloarthritis. Ann Rheum Dis 2011; 70 (08) 1369-1374
• 29 Ward MM. Predictors of the progression of functional disability in patients with ankylosing spondylitis. Rheumatol 2002; 29 (07) 1420-1425
• 30 Chung HY, Machado P, van der Heijde D. et al. Smokers in early axial spondyloarthritis have earlier disease onset, kore disease activity, inflammation and damage, and poorer function and health-related quality of life: results from the DESIR cohort. Ann Rheum Dis 2012; 71 (06) 809-816
• 31 Poddubnyy D, Haibel H, Listing J. et al. Cigarette smoking has a dose-dependent impact on progression of structural damage in the spine in patients with axial spondyloarthritis: results from the GErman SPondyloarthritis Inception Cohort (GESPIC). Ann Rheum Dis 2013 72. 08 Letters
• 32 Ciurea A, Scherer A, Weber U. et al. Impaired response to treatment with tumour necrosis factor alpha inhibitors in smokers with axial spondyloarthritis. Ann Rheum Dis 2016; 75 (03) 532-539
• 33 Glintgorg B, Højgaard P, Lung Hetland M. et al. Impact of tobacco smoking on response to tumour necrosis-alpha inhibitor treatment in patients with ankylosing spondylitis: results from the Danish nationwide DANBIO registry. Rheumatology (Oxford) 2016; 55 (04) 659-668
• 34 Zhang S, Li Y, Xu X. et al. Effect of cigarette smoking and alcohol consumption on disease activity and physical functioning in ankylosing spondylitis: a cross sectional study. Int J Exp Med 2015; 8 (08) 13919-13927
• 35 World Health Organisation. Obesity and over-weight.. Internet. Accessed October 28 2015 Available from www.who.int/mediacentre/factsheets/fs311/en/
• 36 Maas F, Arends S, van der Veer E. et al. Obesity is common in axial spondyloarthritis and is associated with poor clinical outcome. The Journal of Rheumatology 2016; 43: 210 3899/jrheum.150648
• 37 Rosas J, Llinares-Tello F, Senabre-Gallego JM. et al. Obesity decreases clinical efficacy and levels of adalimumab in patients with ankylosing spondylitis. Clin Exp rheumatol 2017; 35: 145-148
• 38 Ottaviani S, Allanore Y, Tubach F al. Body mass index influences the response to infliximab in anky-losing spondylitis. Arthritis Res Ther 2014; 14 (03) R 115.
• 39 Micheroli R, Hebeisen M, Wildi LM. et al. Impact of obesity on the response to tumor necrosis factor inhibitors in axial spondyloarthritis. Athritis Research & Therapie 2017; 19: 164-172
• 40 American College of Cardiology/American Heart Association Task. Force on Practice Guidelines OEP Executive summary: Guidelines 02013 for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Obesity. Obesity 2014 22. (Suppl 2) S5-S39