Important Questions/Answers

Q.	How can I advice patients to fit exercise in to their busy life-styles?"
A.	Importance of regular exercising for patients with Ankylosing spondylitis (AS) conditions is a vital issue. Sundstrom et al (2002) evaluated that the main obstacle to exercise was lack of time and fatigue. Fitting exercise in to a busy life style can be tricky, but once fitted in it would easily become second nature. It is not necessary to exercises for long periods. You can do exercises by yourself fitting them in when it is convenient. Start by doing 5 minutes of lower trunk exercises before you get out of bed in the morning and before you go to sleep at night. You can try trunk (including neck) mobilising exercises whilst sitting in a chair, either at work or at home, and try stretches against the wall when you got a 2 minutes break. Fitting back exercises in to a routine is essential. You could introduce jogging for e.g. start by jogging on the spot for a minute and build up gradually. This would increase your general exercise tolerance and help to improve your cardio-vascular fitness. (See www.nass.co.uk for exercise examples) Reference... Sundstrom et al, (2002). "Exercise habits among patients with AS. A questionnaire based survey in Sweden". Scand-Journ-Rheumatol.vol. 31, no. 3, pp163-167
Q	Some patients describe that some days they feel better without exercising. Can they leave exercises on good days?
A	It is important tht AS patients do some exercise, everyday, regardless of good or bad days. On a good day it is important to stretch the spine (as your tolerance is better on good days) as maintaining and improving the range of movement is equally as important as preventing deformities with AS condition.
Q	How would you differentially diagnosis between AS and mechanical back pain?   See table below...
A.	Mechanical Back Pain AS (Inflammatory Back Pain) Onset Age of onset Effects of exercise Effects of rest Morning stiffness Pain radiation Sleep disturbance Tenderness/spasm Extraskeletal problems Acute, often after trauma Any age Generally aggravated by activity Better + Nerve root irritation, tension signs +/- Local None Gradual Usually < 40 Usually improves with activity Usually worse +++ Diffuse +++ Diffuse Possible iritis, enthesitis of tendo achilles or plantar fascia
Q	Once a patient has started anti TNF treatment, how do you decide whether they should remain on it?
A	Follow BSR Guidelines for prescribing TNFa Blockers in Adults with Ankylosing Spondylitis – July 2004. The guidelines can be downloaded from http://www.rheumatology.org.uk/guidelines/clinicalguidelines
Q	Page 11 Definition of Response to Treatment
A	Response to treatment is defined as: Reduction of BASDAI to 50% of the pre-treatment value or a fall of =/>2 units And reduction of the spinal pain VAS (last one week) by =/>2cm. Assessments of response should be carried out between 6 and 12 weeks after initiation of treatment. If the response criteria are not met a second assessment should be made at 12 weeks. Treatment should not be stopped because of ineffectiveness within 12 weeks. Response criteria should be reviewed 3 monthly Failure to maintain the original response leads to repeat assessment after 6 weeks; failure to maintain response on both occasions leads to cessation or change of treatment.

*******************************************************************