Skip to main content

Advertisement

SpringerLink
Log in

Spondyloarthritis on the Move: Biomechanical Benefits or Harm

  • Spondyloarthritis (M Khan, Section Editor)
  • Published:
Current Rheumatology Reports Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Lee IM, Shiroma EJ, Lobelo F, Puska P, Blair SN, Katzmarzyk PT, et al. Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet. 2012;380(9838):219–29. https://doi.org/10.1016/S0140-6736(12)61031-9.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Gracey E, Burssens A, Cambre I, Schett G, Lories R, McInnes IB, et al. Tendon and ligament mechanical loading in the pathogenesis of inflammatory arthritis. Nat Rev Rheumatol. 2020;16(4):193–207. https://doi.org/10.1038/s41584-019-0364-x.

    Article  PubMed  Google Scholar 

  3. Schett G, Lories RJ, D'Agostino MA, Elewaut D, Kirkham B, Soriano ER, et al. Enthesitis: from pathophysiology to treatment. Nat Rev Rheumatol. 2017;13(12):731–41. https://doi.org/10.1038/nrrheum.2017.188.

    Article  CAS  PubMed  Google Scholar 

  4. Buckley WR, Raleigh RL. Psoriasis with acro-osteolysis. N Engl J Med. 1959;261:539–41. https://doi.org/10.1056/NEJM195909102611103.

    Article  CAS  PubMed  Google Scholar 

  5. Hart FD. Ankylosing spondylitis. Lancet. 1968;2(7582):1340–4. https://doi.org/10.1016/s0140-6736(68)91832-1.

    Article  CAS  PubMed  Google Scholar 

  6. van der Heijde D, Ramiro S, Landewe R, Baraliakos X, Van den Bosch F, Sepriano A, et al. 2016 update of the ASAS-EULAR management recommendations for axial spondyloarthritis. Ann Rheum Dis. 2017;76(6):978–91. https://doi.org/10.1136/annrheumdis-2016-210770.

    Article  PubMed  Google Scholar 

  7. Dagfinrud H, Kvien TK, Hagen KB. Physiotherapy interventions for ankylosing spondylitis. Cochrane Database Syst Rev. 2008;1:CD002822. https://doi.org/10.1002/14651858.CD002822.pub3.

    Article  Google Scholar 

  8. Regel A, Sepriano A, Baraliakos X, van der Heijde D, Braun J, Landewe R, et al. Efficacy and safety of non-pharmacological and non-biological pharmacological treatment: a systematic literature review informing the 2016 update of the ASAS/EULAR recommendations for the management of axial spondyloarthritis. RMD Open. 2017;3(1):e000397. https://doi.org/10.1136/rmdopen-2016-000397.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Ward MM, Deodhar A, Akl EA, Lui A, Ermann J, Gensler LS, et al. American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network 2015 recommendations for the treatment of Ankylosing spondylitis and nonradiographic axial spondyloarthritis. Arthritis Rheum. 2016;68(2):282–98. https://doi.org/10.1002/art.39298.

    Article  Google Scholar 

  10. Ward MM, Deodhar A, Gensler LS, Dubreuil M, Yu D, Khan MA, et al. 2019 update of the American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network recommendations for the treatment of ankylosing spondylitis and nonradiographic axial spondyloarthritis. Arthritis Rheum. 2019;71(10):1599–613. https://doi.org/10.1002/art.41042.

    Article  Google Scholar 

  11. Singh JA, Guyatt G, Ogdie A, Gladman DD, Deal C, Deodhar A, et al. Special article: 2018 American College of Rheumatology/National Psoriasis Foundation guideline for the treatment of psoriatic arthritis. Arthritis Care Res. 2019;71(1):2–29. https://doi.org/10.1002/acr.23789.

    Article  Google Scholar 

  12. Rausch Osthoff AK, Niedermann K, Braun J, Adams J, Brodin N, Dagfinrud H, et al. 2018 EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis. Ann Rheum Dis. 2018;77(9):1251–60. https://doi.org/10.1136/annrheumdis-2018-213585.

    Article  PubMed  Google Scholar 

  13. Coulter EH, McDonald MT, Cameron S, Siebert S, Paul L. Physical activity and sedentary behaviour and their associations with clinical measures in axial spondyloarthritis. Rheumatol Int. 2020;40(3):375–81. https://doi.org/10.1007/s00296-019-04494-3.

    Article  PubMed  Google Scholar 

  14. Pecourneau V, Degboe Y, Barnetche T, Cantagrel A, Constantin A, Ruyssen-Witrand A. Effectiveness of exercise programs in ankylosing spondylitis: a meta-analysis of randomized controlled trials. Arch Phys Med Rehabil. 2018;99(2):383–9 e1. https://doi.org/10.1016/j.apmr.2017.07.015.

    Article  PubMed  Google Scholar 

  15. Verhoeven F, Guillot X, Prati C, Mougin F, Tordi N, Demougeot C, et al. Aerobic exercise for axial spondyloarthritis - its effects on disease activity and function as compared to standard physiotherapy: a systematic review and meta-analysis. Int J Rheum Dis. 2019;22(2):234–41. https://doi.org/10.1111/1756-185X.13385.

    Article  CAS  PubMed  Google Scholar 

  16. Sveaas SH, Bilberg A, Berg IJ, Provan SA, Rollefstad S, Semb AG, et al. High intensity exercise for 3 months reduces disease activity in axial spondyloarthritis (axSpA): a multicentre randomised trial of 100 patients. Br J Sports Med. 2020;54(5):292–7. https://doi.org/10.1136/bjsports-2018-099943.

    Article  PubMed  Google Scholar 

  17. Sveaas SH, Dagfinrud H, Johansen MW, Pedersen E, Wold OM, Bilberg A. Beneficial long-term effect on leisure time physical activity level in individuals with axial spondyloarthritis: secondary analysis of a randomized controlled trial. J Rheumatol. 2019:jrheum.190317. https://doi.org/10.3899/jrheum.190317.

  18. Sundstrom B, Ljung L, Wallberg-Jonsson S. Exercise habits and C-reactive protein may predict development of spinal immobility in patients with ankylosing spondylitis. Clin Rheumatol. 2018;37(10):2881–5. https://doi.org/10.1007/s10067-018-4195-y.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Zhang G, Li J, Xia Z, Xu W. The gait deviations of ankylosing spondylitis with hip involvement. Clin Rheumatol. 2019;38(4):1163–75. https://doi.org/10.1007/s10067-018-4401-y.

    Article  PubMed  Google Scholar 

  20. Lin H, Seerden S, Zhang X, Fu W, Vanwanseele B. Inter-segmental coordination of the spine is altered during lifting in patients with ankylosing spondylitis: a cross-sectional study. Medicine (Baltimore). 2020;99(5):e18941. https://doi.org/10.1097/MD.0000000000018941.

    Article  Google Scholar 

  21. Basakci Calik B, Gur Kabul E, Taskin H, Telli Atalay O, Bas Aslan U, Tasci M, et al. The efficiency of inspiratory muscle training in patients with ankylosing spondylitis. Rheumatol Int. 2018;38(9):1713–20. https://doi.org/10.1007/s00296-018-4093-2.

    Article  PubMed  Google Scholar 

  22. Thomsen RS, Nilsen TIL, Haugeberg G, Bye A, Kavanaugh A, Hoff M. Impact of high-intensity interval training on disease activity and disease in patients with psoriatic arthritis: a randomized controlled trial. Arthritis Care Res. 2019;71(4):530–7. https://doi.org/10.1002/acr.23614.

    Article  Google Scholar 

  23. Roger-Silva D, Natour J, Moreira E, Jennings F. A resistance exercise program improves functional capacity of patients with psoriatic arthritis: a randomized controlled trial. Clin Rheumatol. 2018;37(2):389–95. https://doi.org/10.1007/s10067-017-3917-x.

    Article  PubMed  Google Scholar 

  24. Thomsen RS, Nilsen TI, Haugeberg G, Gulati AM, Kavanaugh A, Hoff M. Adiposity and physical activity as risk factors for developing psoriatic arthritis. Longitudinal data from the HUNT study. Arthritis Care Res. 2019. https://doi.org/10.1002/acr.24121.

  25. •• Zhou W, Chandran V, Cook R, Gladman DD, Eder L. The association between occupational-related mechanical stress and radiographic damage in psoriatic arthritis. Semin Arthritis Rheum. 2019;48(4):638–43. https://doi.org/10.1016/j.semarthrit.2018.06.001. This prospective longitudinal cohort study is the first to identify occupation-related mechanical exposures associated with radiographic damage in the peripheral joints in psoriatic arthritis patients.

    Article  PubMed  Google Scholar 

  26. Ward MM, Reveille JD, Learch TJ, Davis JC Jr, Weisman MH. Occupational physical activities and long-term functional and radiographic outcomes in patients with ankylosing spondylitis. Arthritis Rheum. 2008;59(6):822–32. https://doi.org/10.1002/art.23704.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Ursin K, Lydersen S, Skomsvoll JF, Wallenius M. Psoriatic arthritis disease activity during and after pregnancy: a prospective multicenter study. Arthritis Care Res. 2019;71(8):1092–100. https://doi.org/10.1002/acr.23747.

    Article  Google Scholar 

  28. Ursin K, Lydersen S, Skomsvoll JF, Wallenius M. Disease activity during and after pregnancy in women with axial spondyloarthritis: a prospective multicentre study. Rheumatology (Oxford). 2018;57(6):1064–71. https://doi.org/10.1093/rheumatology/key047.

    Article  Google Scholar 

  29. Kiapour A, Joukar A, Elgafy H, Erbulut DU, Agarwal AK, Goel VK. Biomechanics of the sacroiliac joint: anatomy, function, biomechanics, sexual dimorphism, and causes of pain. Int J Spine Surg. 2020;14(Suppl 1):3–13. https://doi.org/10.14444/6077.

    Article  PubMed  Google Scholar 

  30. • Thorarensen SM, Lu N, Ogdie A, Gelfand JM, Choi HK, Love TJ. Physical trauma recorded in primary care is associated with the onset of psoriatic arthritis among patients with psoriasis. Ann Rheum Dis. 2017;76(3):521–5. https://doi.org/10.1136/annrheumdis-2016-209334. A matched cohort study analyzing data of 425 120 person-years demonstrating an increased risk of psoriatic arthritis in psoriasis patients after exposure to bone or joint trauma.

    Article  PubMed  Google Scholar 

  31. Wervers K, Herrings I, Luime JJ, Tchetverikov I, Gerards AH, Hazes JMW, et al. Association of Physical Activity and Medication with Enthesitis on ultrasound in psoriatic arthritis. J Rheumatol. 2019;46(10):1290–4. https://doi.org/10.3899/jrheum.180782.

    Article  PubMed  Google Scholar 

  32. Husakova M, Siebuhr AS, Pavelka K, Spiritovic M, Bay-Jensen AC, Levitova A. Changes of patient-reported outcomes and protein fingerprint biomarkers after exercise therapy for axial spondyloarthritis. Clin Rheumatol. 2019;38(1):173–9. https://doi.org/10.1007/s10067-017-3802-7.

    Article  PubMed  Google Scholar 

  33. El Jamal A, Briolay A, Mebarek S, Le Goff B, Blanchard F, Magne D, et al. Cytokine-induced and stretch-induced Sphingosine 1-phosphate production by enthesis cells could favor abnormal ossification in Spondyloarthritis. J Bone Miner Res. 2019;34(12):2264–76. https://doi.org/10.1002/jbmr.3844.

    Article  CAS  PubMed  Google Scholar 

  34. Deodhar A. Sacroiliac joint magnetic resonance imaging in the diagnosis of axial spondyloarthritis: "a tiny bit of white on two consecutive slices" may be objective, but not specific. Arthritis Rheum. 2016;68(4):775–8. https://doi.org/10.1002/art.39549.

    Article  Google Scholar 

  35. Ritchlin C. Editorial: magnetic resonance imaging signals in the sacroiliac joints of healthy athletes: refining disease thresholds and treatment strategies in axial spondyloarthritis. Arthritis Rheum. 2018;70(5):629–32. https://doi.org/10.1002/art.40426.

    Article  Google Scholar 

  36. Agten CA, Zubler V, Zanetti M, Binkert CA, Kolokythas O, Prentl E, et al. Postpartum bone marrow edema at the sacroiliac joints may mimic sacroiliitis of axial spondyloarthritis on MRI. AJR Am J Roentgenol. 2018;211(6):1306–12. https://doi.org/10.2214/AJR.17.19404.

    Article  PubMed  Google Scholar 

  37. Weber U, Jurik AG, Zejden A, Larsen E, Jorgensen SH, Rufibach K, et al. Frequency and anatomic distribution of magnetic resonance imaging features in the sacroiliac joints of young athletes: exploring "background noise" toward a data-driven definition of sacroiliitis in early spondyloarthritis. Arthritis Rheum. 2018;70(5):736–45. https://doi.org/10.1002/art.40429.

    Article  Google Scholar 

  38. • Weber U, Jurik AG, Zejden A, Larsen E, Jorgensen SH, Rufibach K, et al. MRI of the sacroiliac joints in athletes: recognition of non-specific bone marrow oedema by semi-axial added to standard semi-coronal scans. Rheumatology (Oxford). 2019. https://doi.org/10.1093/rheumatology/kez458. A study identifying and facilitating the recognition of non-specific bone marrow edema on MRI of the sacroiliac joints by combining semi-axial with standard semi-coronal scans.

  39. Varkas G, de Hooge M, Renson T, De Mits S, Carron P, Jacques P, et al. Effect of mechanical stress on magnetic resonance imaging of the sacroiliac joints: assessment of military recruits by magnetic resonance imaging study. Rheumatology (Oxford). 2018;57(3):588. https://doi.org/10.1093/rheumatology/kex534.

    Article  Google Scholar 

  40. de Winter J, de Hooge M, van de Sande M, de Jong H, van Hoeven L, de Koning A, et al. Magnetic resonance imaging of the sacroiliac joints indicating Sacroiliitis according to the assessment of spondyloarthritis international society definition in healthy individuals, runners, and women with postpartum Back pain. Arthritis Rheum. 2018;70(7):1042–8. https://doi.org/10.1002/art.40475.

    Article  Google Scholar 

  41. Arnbak B, Jensen TS, Schiottz-Christensen B, Pedersen SJ, Ostergaard M, Weber U, et al. What level of inflammation leads to structural damage in the sacroiliac joints? A four-year magnetic resonance imaging follow-up study of low Back pain patients. Arthritis Rheum. 2019;71(12):2027–33. https://doi.org/10.1002/art.41040.

    Article  Google Scholar 

  42. Braem K, Carter S, Lories RJ. Spontaneous arthritis and ankylosis in male DBA/1 mice: further evidence for a role of behavioral factors in "stress-induced arthritis". Biol Proced Online. 2012;14(1):10. https://doi.org/10.1186/1480-9222-14-10.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Jacques P, Lambrecht S, Verheugen E, Pauwels E, Kollias G, Armaka M, et al. Proof of concept: enthesitis and new bone formation in spondyloarthritis are driven by mechanical strain and stromal cells. Ann Rheum Dis. 2014;73(2):437–45. https://doi.org/10.1136/annrheumdis-2013-203643.

    Article  PubMed  Google Scholar 

  44. •• Cambre I, Gaublomme D, Burssens A, Jacques P, Schryvers N, De Muynck A, et al. Mechanical strain determines the site-specific localization of inflammation and tissue damage in arthritis. Nat Commun. 2018;9(1):4613. https://doi.org/10.1038/s41467-018-06933-4. In this paper the authors demonstrate the key role of biomechanical loading in animal models of inflammatory arthritis and identify this as a potential common principle for site specific localization of joint disease.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Cambre I, Gaublomme D, Schryvers N, Lambrecht S, Lories R, Venken K, et al. Running promotes chronicity of arthritis by local modulation of complement activators and impairing T regulatory feedback loops. Ann Rheum Dis. 2019;78(6):787–95. https://doi.org/10.1136/annrheumdis-2018-214627.

    Article  CAS  PubMed  Google Scholar 

  46. Mazor M, Best TM, Cesaro A, Lespessailles E, Toumi H. Osteoarthritis biomarker responses and cartilage adaptation to exercise: a review of animal and human models. Scand J Med Sci Sports. 2019;29(8):1072–82. https://doi.org/10.1111/sms.13435.

    Article  PubMed  Google Scholar 

  47. Debusschere K, Cambre I, Gracey E, Elewaut D. Born to run: the paradox of biomechanical force in spondyloarthritis from an evolutionary perspective. Best Pract Res Clin Rheumatol. 2017;31(6):887–94. https://doi.org/10.1016/j.berh.2018.07.011.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Laboratory of Tissue Homeostasis and Disease, Skeletal Biology and Engineering Research Center, Department of Development and Regeneration, KU Leuven, Leuven, Belgium

    Margot Van Mechelen & Rik Lories

  2. Division of Rheumatology, UZ Leuven, Herestraat 49, 3000, Leuven, Belgium

    Margot Van Mechelen & Rik Lories

Authors
  1. Margot Van Mechelen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rik Lories
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Margot Van Mechelen.

Ethics declarations

Conflict of Interest

Margot Van Mechelen is the recipient of an Aspirant fellowship of the Flanders Research Foundation (FWO-Vlaanderen) and a GRAPPA pilot research grant. Research on the topic of the review is supported by FWO Grants G094614 and G095916N. Leuven Research and Development, the technology transfer office of KU Leuven, has received consultancy and speaker fees and research grants on behalf of Rik Lories from Abbvie, Boehringer-Ingelheim, Celgene, Eli-Lilly, Galapagos, Janssen, MSD, Novartis, Pfizer, Samumed, and UCB.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Spondyloarthritis

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Van Mechelen, M., Lories, R. Spondyloarthritis on the Move: Biomechanical Benefits or Harm. Curr Rheumatol Rep 22, 35 (2020). https://doi.org/10.1007/s11926-020-00913-8

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11926-020-00913-8

Keywords

Search

Navigation