Search

Modern treatment of patients with ankylosing spondylitis consists of therapies according to the ASAS criteria. Rehabilitation is a necessary process for enabling persons with disabilities caused by inflammatory destructions. The goal is to reach optimal physical, sensory, psychiatric and social health to reach higher levels of independence. It includes a wide range of measures and activities for changing the behaviour and increases activity, participation, strength, stability and coordination.

To measure the disease activity of spondyloarthritides (SpA), quality of life is assessed in addition to inflammation and functional impairment. To measure quality of life in ankylosing spondylitis (AS), the generic measurement instruments SF-36, SF-12 and EQ-5D are available in German, whereby the SF-36 is the instrument primarily used in clinical investigations. Compared to the normal population, AS patients experience a reduced quality of life. In woman and patients with a poor educational background, quality of life was particularly reduced.Measuring quality of life is also a generally recognised part of evaluating psoriasis arthritis (PsA), for which only SF-36 and EQ-5D are available in German-speaking countries. The instrument most frequently used in clinical studies is SF-36. The quality of life in PsA patients, in terms of both physical and mental components, was found to be significantly lower than in the normal population. Although PsA patients shared a similar reduction in quality of life to AS patients, they nevertheless enjoyed a better quality of life than rheumatoid arthritis patients.

Background: For effective self-management of chronic pain changes of cognitive and behavioral attitudes are required. The readiness to change can be described within the framework of the transtheoretical model (TTM) and is facilitated through motivational interviewing. This prospective study evaluated the effectiveness of brief motivational interviewing by telephone for the variables self-efficacy, cognitive and behavioral coping and psychological strain through chronic pain over a period of 9 months., Methods: Different questionnaires, the self-efficacy expectations (ASES-D), cognitive, behavioral coping and psychological strain through chronic pain (FESV) and the German version of the pain stages of change questionnaires (PSOCQ), the FF-STABS were distributed to 147 patients at a rehabilitation clinic (indications: fibromyalgia syndrome, rheumatoid arthritis, ankylosing spondylitis). The intervention group participants received 3 telephone calls at intervals of 2 months with a follow-up time of 9 months after first study admission. At the end of the study 91 patients were enrolled for analysis (drop out rate 38%). To evaluate the effects of treatment nonparametric-analysis for longitudinal data was used., Results and Conclusion: The analysis showed significant positive effects in the intervention group for cognitive coping (U-value -2.423; p=0.015 group x time-effect) and for coping with emotional strains of chronic pain (subscale anxiety: U-value -2.3618; p=0.018; subscale anger: U-value 2.8638; p=0.004; group x time-effect). No significant effects were shown for self-efficacy expectations and behavioral coping with pain. Further explorative analysis of subgroups revealed slightly better treatment effects for patients with rheumatoid arthritis and ankylosing spondylitis than for those with fibromyalgia syndrome.

Objectives: To obtain information on the profile of patients with ankylosing spondylitis (AS), disease activity, previous and current treatments, and the proportion and profile of patients treated with conventional medications but considered eligible for anti-tumour necrosis factor (TNF) therapy., Methods: Participants were rheumatologists from seven Central and Eastern European countries who were considered experts in the treatment of AS and were to include 3-5 patients who had never received anti-TNF therapy. Rheumatologists were asked to decide whether they considered their patients candidates for anti-TNF therapy., Results: A total of 1506 patients were analysed. Overall, 61% of AS patients who had never received anti-TNF therapy until the time of the survey were considered candidates for anti-TNF therapy based on the clinical judgement of their rheumatologists. This proportion ranged from 40% in Slovakia to 84% in Romania. Candidates had higher levels of disease activity and functional impairment, and they were more likely to report a lower quality of life. Only 38% of candidates fulfilled the Assessment in Ankylosing Spondylitis (ASAS) recommendations with respect to a Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) of at least 4 combined with previous use of at least two non-steroidal anti-inflammatory drugs, ranging from 18% in Poland to 57% in Hungary., Conclusion: More than half of AS patients currently treated with other medications may be eligible for anti-TNF therapy. Also, rheumatologists regarded disease activity as the determining factor for starting anti-TNF drugs, but their decision did not always fully comply with the ASAS recommendations, confirming the need for continued exchange among the medical community to increase awareness of the ASAS recommendations.

Patients with early spondyloarthritis often suffer from uncertainty regarding to their disease and the future development, sometimes fear of the future is to the fore. Patients with rheumatic diseases need a comprehensive and interdisciplinary treatment. In this connection patient education takes the part to lead patients to a better self-management. The goals of patient education are: to increase knowledge and interoception, to influence attitudes and self-efficacy and in addition to improve the disease or health behaviour. The study group "patient education" of the German Society of Rheumatology (DGRh) developed several education programmes, which methods and topics are based on behavioural science. The program for patients with spondyloarthritis is topic entered and close to patients needs. It is an interdisciplinary course, carried out by a qualified education team. The course contains 6 modules each lasting 90 minutes. The efficacy has been proved in different levels as well as return to work, economic advantages have been shown. Particularly patients with early spondyloarthritis and noticeable scores in the self-assessments (BASDAI, FFbH-R, AHI) profited from the education course.

Background: Quality of life as a part of the WHO definition of health is an important assessment tool for measuring the success in the treatment of chronic diseases. The short form 36 questionnaire (SF-36), which is measuring health related quality of life, was used in a multicentre placebo controlled study in patients with ankylosing spondylitis (AS) treated with the anti-TNF-alpha antibody infliximab. As previously reported, substantial changes of almost all outcome parameters were observed in this study because of the substantial clinical improvement that is known to occur in most patients treated with anti-TNF agents. The short form 12 questionnaire (SF-12) is shorter and quicker to complete as the SF-36. The summary scales of both questionnaires were compared in this study to answer the question whether the SF-12 can also be used in AS patient populations without too much loss of information. Using the shorter from could be an advantage for further studies in patients with AS, for example, the inception cohort for spondyloarthritides within the German Network of competence in rheumatology. Furthermore the data can be compared to the German standard population., Methods: In this multicentre placebo controlled study 70 patients with active disease were enrolled: 35 AS patients received placebo, 35 were treated with infliximab, 5 mg/kg at week 0/2/6. Thereafter all patients were treated in an open study with infliximab at 5 mg/kg every 6 weeks. The disease activity (BASDAI), function (BASFI), mobility (BASMI), pain (NRS) and CRP as well as SF-36 were assessed. Data to calculate the SF-12 were extracted from the SF-36 questions and compared concerning agreement of individual levels, correlation with each other and with the BASFI, sensitivity to change and missing values., Results: All outcome parameters for disease activity as well as all subscales of health related quality of life improved in patients with active AS treated with infliximab. The comparability of the sum components for SF-12 and SF-36 were high (physical health r=0.912 and mental health r=0.957)., Conclusion: These data suggest that the shorter version of the SF-36, the SF-12, is capable to measure quality of life in clinical studies with AS patients.

Objectives: To investigate the relevance of somatic, psychic and psychosocial factors on the health-related quality of life at the one year follow-up of patients with lower back pain., Methods: Prospective cohort study of 109 patients recruited consecutively. At baseline and at one year follow-up self-report instruments were administered to evaluate health-related quality of life (SF-36), psychic or psychological distress (SF-36), and coping strategies (FKV-LIS)., Results: In regards to the physical and mental dimensions of the quality of life at follow-up, psychosocial factors evaluated at baseline were far more relevant. Using a multiple regression analysis we were able to account for 38 % of the variance in the physical dimension of the quality of life and 45 % of the variance in the mental dimension. In these two dimensions the factors "psychic distress" (GSI, SCL-90-R) and "sick leave" were significant predictors, in the mental dimension additionally "doctor shopping". Beyond that, impaired health-related quality of life at baseline as well as at follow-up was related to depressive coping (FKV-LIS)., Conclusions: The study shows the high impact of psychic and psychosocial factors on health-related quality of life in patients with chronic lower back pain.

Background: Patients with chronic rheumatic disease often seek relief in unconventional treatments, but many of them do not share this information with their physician., Objective: To explore which conventional and unconventional interventions are used by patients with ankylosing spondylitis. Which of these do they continue to use and which do they give up?, Patients: One-hundred fifty patients (36 female, 114 male) with ankylosing spondylitis, who presented for radon thermal treatment at the Gasteiner Heilstollen Hospital (mean age 50 +/- 11 years; disease duration 24 +/- 11 years)., Method: A previous investigation identified 75 interventions used by patients with AS to influence their disease. In a face-to-face, structured interview all these interventions (terms used by the patients) were now presented to 150 other patients with AS. They were asked to state whether they had already used (and given up) the respective intervention or whether they intend to continue using it and intend to use it in future., Results: A summary of all interventions previously and still used by patients showed conventional interventions (67%) to out-number unconventional (33%) interventions. Of the 150 patients, 20 stated that they use or have used more than 15 different unconventional interventions. In addition to health resort medicine (interview at a health resort!), massage therapy, physiotherapy and physical exercise were the most commonly used of the conventional interventions. Of the unconventional interventions warm climate, sea bathing, self-applied psychotherapy, vitamin pills, repression, showering with alternating cold and warm water, and self-help groups were named most frequently., Conclusion: Some patients with ankylosing spondylitis use many different (33% unconventional) interventions. In the patient's view, even rather general interventions such as warm climate or sea bathing are regarded as relevant to the disease. An open doctor-patient discussion of unconventional interventions used by the patient appears reasonable. The results confirm that most patients suffering from chronic and incurable disease seek relief in unconventional therapies.

Symptoms, Effects on Quality of Life, Judgement and Expectations of Treatment in Active Ankylosing Spondylitis: The Patient's View.In ankylosing spondylitis uncertainty prevails among rheumatologists on how to define and measure activity. In the present study the patient's view of activity was evaluated. What does active ankylosing spondylitis mean for the patient? In a standardized interview the patient was asked to describe, from his own experience, what active ankylosing spondylitis means, what bothers him most, what helps most, and what he expects from therapy. For the patient, active ankylosing spondylitis means pain (99 responses), mobility restriction (19), muscle tension (10), inability to stay supine (6), restriction in chest mobility (5) and dyspnea (5). Fatigue was mentioned by two patients. In active states patients are mainly bothered by pain (77), mobility restriction (55), consequences for social life (20) and work (18), disturbed sleep (17) and difficult breathing (16). Drugs (84) and physical activity (42) were judged the best treatments during active ankylosing spondylitis. It was no surprise that pain and mobility restriction were cited most often by the patients. Breathing difficulties were cited rather often, whereas fatigue seems not to play an important role for most patients. The results suggest that modern rheumatology may have underestimated the relevance of difficult breathing and paid too much attention to fatigue.

Regular physical exercise is a major positive influence for the course of ankylosing spondylitis. By means of a standardized questionnaire, a total of 118 patients (78 male, 40 female) with ankylosing spondylitis were asked about their regular physical activity. The patients' mean age was 47 years, and they have been suffering from the symptoms of the disease for (a mean) 17 years. Twenty-nine percent of the patients practice disease-specific exercises daily. Thirty-nine percent have not received any instructions about the optimal exercises in the previous 5 years. Most information had been given by the physiotherapist at home or at the health resort. Non-specific physical exercises are practiced by half of the patients. Lack of time and lack of motivation are the major factors preventing the patients from greater activity. Deficient mobility was claimed by 37 of the 118 patients to prevent them from practicing sports. Better information, and hence motivation, of the patients are suggested by our findings as the most useful way to foster wider use of physical exercise.

Ankylosing spondylitis - (AS-)patients are reported being characterized by marked ego strength and a stable personality. The aim of the present study was to investigate if they can be differentiated into subgroups which suggest different indications for training psychological skills to cope with their disease. Constructs which were thought to be relevant for psychological pain treatment were: disease activity, irrationality, positive and negative self-communication, stress-reactions, and disease impacts. For each construct factorial values were calculated from indicator variables to classify the patients. Subjects were 197 patients with a long-standing diagnosis of AS, who were treated in a specialized theumatological treatment unit in the Karl-Aschoff-Klinic, Bad Kreuznach, Germany. A hierarchical-agglomerative cluster-analyses suggested five subgroups with a reclassification rate of 91%. 10.2% of the patients were marked by elevations on all negative scales (including disease activity) and low values on the positive self-communication scales. Further 28% showed low disease activity but high disease impacts (affective pain, general health condition). For both groups different indications for learning to cope with disease impacts were suggested. 60.8% of the patients demonstrated themselves to be good copers. Of special interest were 11.8% of all patients who reported high disease activity but low disease impacts and low positive self-communication. Two other subgroups differed only in the level of the variables-profile.

The spectrum of rheumatic diseases includes syndromes characterized solely by musculoskeletal pain and discomfort. Indeed, muskuloskeletal pain and dysfunction are experienced by almost everyone in the course of a lifetime. The rheumatic syndromes are diverse and often of unclear etiology. For many years, psychosomatic theories have been advanced as an attempt at explanation, especially in the case of chronic polyarthritis. This article discusses the meaning of risk factors viewed as relevant to the course of back pain syndromes in particular. Therapeutic and rehabilitative-psychological interventions for comprehensive treatment of chronic rheumatic pain-patients are presented, and the necessity for a well-coordinated psychosomatic-interdisciplinary approach is emphasized.

This paper discusses the importance of cognitive representation and individual patterns of behavior for coping with chronic disease. Chronically ill patients differ very much in their psychic situation. Biographical and situational factors and the future perspective contribute to these interindividual differences. Diagnostic and therapeutical tools are discussed from a psychological perspective.

Based on the literature we describe the prognosis and natural history of ankylosing spondylitis. The data on mortality are controversial and it seems that only a small group of patient show a decreased survival. It is a chronic disease with most prominent features of pain and increasing stiffness during the first decade. After a course of 40 years 90% of patients have none or only mild disability. Generally quality of life is slightly reduced. Most patients remain engaged in full-time employment, but job adaptations are often unavoidable and vocational counseling seems to be worthwhile.

Based upon a multicomponent process model of pain, ways of patients control of pain as well as their pain-related subjective stresses are to be analyzed. In a questionnaire study with 322 patients suffering from persistent pain of degenerative or inflammatory origin, two domains of pain-control (cognitive and concrete modes) and of pain-related stress (emotional and behavioral facets) are identified. The cognitive domain consists of (a) process-related knowledge, (b) planning skills, and (c) cognitive restructuring. Concrete modes are (a) distraction of attention, (b) relaxation, and (c) counter-activities. Within the domain of pain-related stress (a) depression and anxiety, (b) anger and (c) pain behavior prove to be significant. Analyses of interrelations show only small effects for exogenous and illness-related variables. As expected, pain-experience contributes positively to the extent of pain-control and pain-related stress. Negative relations are found between pain-control and pain-related stress. For concrete modes of pain-control conditional effects are identified: Only if cognitive modes are sufficiently high, concrete modes are efficient in reducing pain-related stress. First results from a replication study and from an experimental intervention study indicate, that the model of pain postulated can be supported.

This study focuses on the significance of psychological correlates of membership in self-help groups for rheumatic diseases. 138 patients suffering from rheumatic arthritis, ankylosing spondylitis and arthrosis participated in the study. Self-help group members show specific control beliefs which differ from the non-self-help group members. They view the disease as more controllable by themselves (internal locus of control) and as less dependent on health professionals (powerful others health locus of control) and on fate or chance (chance locus of control). Further, self-help group members show more compliance and engagement in their treatment than non-self-help group members. In addition, they search for more information, for more sources of information and show better knowledge about the disease and about treatment which may also be a result of higher frequencies of conversations about the disease and about treatment reported by members of self-help groups. Self-help group members do not only speak more frequently about these topics, but such conversations are also more important in their estimation. Results further suggest a relation between self-help group membership and emotional variables.

Following earlier psychoanalytical articles on polyarthritic diseases without rheumatism factor, this investigation reports on patients with morbus Bechterew. The psychoanalytically expanded anamneses showed a distinct predominance of hysterical and depressive structures. With their friendly, open nature these patients appear cooperative and tension-free. They have problems when aggressive confrontations occur, especially with good acquaintances, from whom they expect recognition and friendly or loving attention. They try to earn these through a strong readiness to help, which often reaches a point of exhaustion. The causing situations appear especially characteristic: Before the disease started, most patients were able to sow their wild oats in all directions for a pretty long time. The disease breaks out when this lax style of living is given up, for the partner's sake, in a marriage or other firm kind of relationship. In their new life situation the patients cannot fully live their aggressive as well as their sexual needs in the accustomed way. A heightened muscular tension, as the physical correlate of this affective restraint, is postulated, which, as one of the factors, plays a role in the origin of morbus Bechterew.

Three aspects of locus of control (internality; powerful others external control orientations; chance control orientation) were studied in a sample of 76 patients with ankylosing spondylitis. The accumulation of the scores in the three scales shows that these patients are more internally than externally orientated. This is discussed with reference to the evaluation of effective coping-strategies in patients with ankylosing spondylitis.

80 female patients were tested for personality differences by the Freiburg Personality Inventory and the Giessen Test Self Image. They were divided into four groups with 20 patients each, suffering from rheumatoid arthritis, ankylosing spondylitis, spondylosis and coxarthrosis. While RA patients did not significantly differ from AS patients, nor spondylosis patients from coxarthrosis patients, certain personality differences were detected between the patients with inflammatory and those with degenerative rheumatic diseases. These results, however, do not allow us to draw the conclusion that a "degenerative or inflammatory rheumatic personality" exists. Besides the Giessen Test Self Image the Giessen Test Self Ideal was also administered to all of the patients. In all four groups the desire for a better basic mood and less depression was prevailing. RA patients also wanted more "social resonance" and "predominance". AS patients wanted significantly less "control" and more "responsiveness". These components should be given special consideration in the psychological care of rheumatic patients.

As an adjunctive treatment, a cognitive-behavioral program for pain management was administered to 25 patients with spondylitis ankylosans organized in self-help groups of the German Rheumatism-League. Another 20 patients with the same disorder served as a waiting-for-treatment control-group. The program consisted of training in progressive muscle relaxation, of cognitive and hypnotic procedures for the control of pain, as well as of information and group discussions, and it was conducted in a group setting with 12 sessions of about 90 min each. A pain diary and questionnaires on trait anxiety, depression, and psychophysiological complaints were used to evaluate the outcome. In a six-month follow-up, significant reductions in pain intensity, in impairments due to pain, in anxiety, and in sleep disorders could be confirmed by analyses of variance. Besides in improvement in pain control, our results indicate a long-term effect on wellbeing as a consequence of our program.