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Effects of a Combination Treatment of an Intensive Rehabilitation Program and Etanercept in Patients
with Ankylosing Spondylitis: A Pilot Study
ENNIO LUBRANO, SALVATORE D'ANGELO, WENDY J. PARSONS, FRANCA SERINO, ANGELO TOMMASO TANZILLO, IGNAZIO OLIVIERI, and NICOLA PAPPONE ABSTRACT. Objective. To determine the effects of a combination treatment including rehabilitation and etanercept versus rehabilitation only, on function, disability, and quality of life in a group of patients with active ankylosing spondylitis (AS). Methods. Nineteen patients with AS consecutively admitted to a rehabilitation inpatient clinic were enrolled. Patients first participated in an intensive rehabilitation program and after a 6-month interval started etanercept therapy. After 3 weeks, they started a combination of rehabilitation and etanercept. The primary outcome measure was an improvement of the Bath Ankylosing Spondylitis Functional Index (BASFI) defined as the difference (Δ) between the 2 measurements (beginning and end). The difference between the 2 measurements for the first rehabilitation program was expressed as Δ1 and for the second as Δ2; the comparison between Δ1 and Δ2 for each outcome measure was taken into account. Secondary outcome measures included an improvement in the Revised Leeds Disability Questionnaire (LDQ), anthropometric measures, EuroQol (EQ-5Dvas), and the 6 minute walking test (6-MWT). Results. A statistically significant improvement was observed both for BASFI (Δ1 = –0.71 ± 0.23; Δ2 = –1.19 ± 0.36, p < 0.001) and for LDQ (Δ1 = –0.28 ± 0.08; Δ2 = –0.46 ± 0.17, p = 0.001). All anthropometric measures as well as 6-MWT were statistically improved. Finally, EQ5Dvas showed a statistically significant difference (Δ1 = 6.63 ± 2.81; Δ2 = 20.26 ± 4.89, p < 0.001). No adverse effects were seen during treatment with etanercept. Conclusion. This combination treatment seems to improve function, disability, and quality of life in patients with active AS. (J Rheumatol 2006;33:2029-34) Key Indexing Terms:
ANKYLOSING SPONDYLITIS From the Rheumatology and Rehabilitation Unit, Maugeri Foundation IRCCS; Research Institute for Rehabilitative Medicine, Telese Terme; and the Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Materna, Potenza, Italy. E. Lubrano, MD, PhD, Research Institute for Rehabilitative Medicine; S. D'Angelo, MD, Rheumatology Department of Lucania, San Carlo Hospital; W.J. Parsons, BSc, MPH; F. Serino, Physiotherapist; A.T. Tanzillo, Physiotherapist, Research Institute for Rehabilitative Medicine; I. Olivieri, MD, Rheumatology Department of Lucania, San Carlo Hospital; N. Pappone, MD, Research Institute for Rehabilitative Medicine. Address reprint requests to Dr. E. Lubrano, Istituto Scientifico di Telese Terme, Via Bagni Vecchi 1, Telese Terme (BN) 82037, Italy. E-mail: enniolubrano@hotmail.com Accepted for publication May 23, 2006.
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