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Changes of patient-reported outcomes and protein fingerprint biomarkers after exercise therapy for axial spondyloarthritis

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Abstract

The objective of this study was to investigate the patient-reported outcomes (PROs) and matrix metalloproteinase (MMP) derived extracellular matrix (ECM) biomarkers in non-radiographic (nr)-axial spondyloarthritis (axSpA) and radiographic (r)-axSpA after exercise intervention. Forty-six axSpA patients with stable disease and treatment underwent 24 weeks long exercise intervention. The clinical and laboratory assessments were performed at baseline and at follow-up. The PROs included evaluation of patient’s global disease activity (PGDA), disease activity (DA7), pain (PAIN7) and fatigue during last week and quality of life questionnaires. ELISAs for MMP-degraded collagen type II, C-reactive protein (CRPM) and citrullinated vimentin were used. The data of 23 r-axSpA and 19 nr-axSpA were analysed. The PDGA was similar for nr-axSpA (35.2 ± 18.9) and r-axSpA (33.4 ± 22.3) at baseline, improved significantly after intervention (p < 0.01) and the change of PDGA was almost identical for nr-axSpA (− 10.0 ± 15.4) and r-axSpA (− 9.8 ± 11.9). Evaluations of DA7 and PAIN7 were significantly improved only in nr-axSpA (3.5 ± 2.3 and 34.7 ± 25.6 at baseline vs. 2.1 ± 1.9 and 21.0 ± 20.5, respectively, p < 0.01). The decline of DA7 and PAIN7 was more profound, but not significantly in nr-axSpA than in r-axSpA (− 1.4 ± 1.6 and − 13.7 ± 17.4 vs. − 0.5 ± 3.1 and − 3.7 ± 3.3, respectively). The quality of life was not changed. At baseline, increased levels of CRPM were found in r-axSpA (14.85 ± 4.10) compared to nr-axSpA (11.83 ± 3.20), p < 0.05, but all three biomarkers were not influenced by exercise therapy. We found that exercise therapy mainly in the nr-axSpA improves PROs, but not ECM turnover biomarkers. This indicates that exercise therapy is important for patients’ health but does not affect ECM turnover.

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Acknowledgements

The authors would like to thank Mrs. Jitka Smékalová for technical assistance during the laboratory analyses and Dr. Petr Fučík for statistical analysis and consultation.

Funding

This study has been supported by the Project for Conceptual Development for the institution of the Ministry of Health Czech Republic—Institute of Rheumatology (number 023728), by Specific University Research (SVV for FTVS 2017—number 260466), Grant Agency of the Charles University (GAUK number 214615) and Programme of the institutional support for the development of science at Charles University Progress, number Q41 Biological Aspects of the Investigation of Human Movement.

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Author notes

  1. Marketa Husakova and Anne Sofie Siebuhr contributed equally to this work.

Authors and Affiliations

  1. Institute of Rheumatology and Department of Rheumatology, First Faculty of Medicine, Charles University, Na Slupi 4, 128 50, Prague 2, Czech Republic

    Marketa Husakova, Karel Pavelka & Maja Spiritovic

  2. Nordic Bioscience, Biomarkers and Research, Herlev, Denmark

    Anne Sofie Siebuhr & Anne-Christine Bay-Jensen

  3. Faculty of Physical Education and Sports, Department of Physiotherapy, Charles University, Prague, Czech Republic

    Maja Spiritovic

  4. Faculty of Physical Education and Sports, Department of Adapted Physical Education and Sport Medicine, Charles University, Prague, Czech Republic

    Andrea Levitova

Authors
  1. Marketa Husakova
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  2. Anne Sofie Siebuhr
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  3. Karel Pavelka
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  4. Maja Spiritovic
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  5. Anne-Christine Bay-Jensen
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  6. Andrea Levitova
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Contributions

All of the authors participated in drafting the article or critically revising it for important intellectual content, and all of the authors approved the final version to be published. Study design: AL, MH and ASS. Clinical assessments: AL, MS, KP and MH. Exercise therapy: AL and MS. Laboratory analysis: ASS. Analysis and interpretation of the data: AL, KP, MH and ASS.

Corresponding author

Correspondence to Marketa Husakova.

Ethics declarations

All patients signed informed consent (approved by the Ethics Committee of the Institute of Rheumatology) and have all data and biomarkers analysed after study conclusion. Principles of Good Clinical Practice and the Declaration of Helsinki were reflected in this study.

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Husakova, M., Siebuhr, A.S., Pavelka, K. et al. Changes of patient-reported outcomes and protein fingerprint biomarkers after exercise therapy for axial spondyloarthritis. Clin Rheumatol 38, 173–179 (2019). https://doi.org/10.1007/s10067-017-3802-7

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