Article
Effects and tolerability of low to moderate biomechanical stress during leisure sport activity in patients with Psoriasis and Psoriatic Arthritis
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Authors
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Axel Hueber
- Friedrich Alexander University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Department of Internal Medicine 3 – Rheumatology and Immunology, Erlangen; Klinikum Nürnberg, Paracelsus Medical University, Division of Rheumatology, Nürnberg
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Filippo Fagni
- Friedrich Alexander University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Department of Internal Medicine 3 – Rheumatology and Immunology, Erlangen; Deutsches Zentrum für Immuntherapie (DZI), Friedrich Alexander University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen
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David Simon
- Friedrich Alexander University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Department of Internal Medicine 3 – Rheumatology and Immunology, Erlangen; Deutsches Zentrum für Immuntherapie (DZI), Friedrich Alexander University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen
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Melek Yalcin Mutlu
- Friedrich Alexander University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Department of Internal Medicine 3 – Rheumatology and Immunology, Erlangen; Deutsches Zentrum für Immuntherapie (DZI), Friedrich Alexander University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen
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Ioanna Minopoulou
- Friedrich Alexander University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Department of Internal Medicine 3 – Rheumatology and Immunology, Erlangen; Deutsches Zentrum für Immuntherapie (DZI), Friedrich Alexander University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen
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Manuel Krieter
- Klinikum Nürnberg, Paracelsus Medical University, Department of Dermatology, Nürnberg
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Georg Schett
- Friedrich Alexander University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Department of Internal Medicine 3 – Rheumatology and Immunology, Erlangen; Deutsches Zentrum für Immuntherapie (DZI), Friedrich Alexander University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen
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Arnd Kleyer
- Friedrich Alexander University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Department of Internal Medicine 3 – Rheumatology and Immunology, Erlangen; Deutsches Zentrum für Immuntherapie (DZI), Friedrich Alexander University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen
| Published: | August 30, 2023 |
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Outline
Text
Introduction: The concept of mechano-inflammation is an accepted pathogenic model to explain the development of enthesitis in PsA [1]. However, the lack of systematic observations in PsA patients does not allow to provide evidence-based proof of this concept in humans. Thus, we aimed to assess the effects of mechanical strain on the entheses of patients with psoriasis and PsA exposed to the sport of badminton, which exerts relevant level mechanical stress on upper and lower extremities.
Methods: Patients with fulfilling CASPAR criteria for PsA and with a dermatologist-confirmed diagnosis of psoriasis were recruited. Participants underwent a physical examination (US assessor independent) of 29 entheses and ultrasound of the entheses at lateral humeral epicondyle, inferior patellar pole, and of the Achilles tendon before and after a 60-minutes training session of amateur badminton through two separate rheumatologists. One week later participants were interviewed for adverse events and pain. Images were scored by two blinded independent readers for entheseal pathologies [2]. The study was approved by the ethics committee (#226_18B).
Results: Seven PsA patients and 9 psoriasis patients were included. Baseline characteristics and disease activity measures are reported in Table 1 [Tab. 1]. At baseline, VAS pain (cm) (median, (IQR)) was 0,5 (0–2,25), the number of painful entheses was 12/464. After training, no significant change in pain (0 (0–2)) nor tender entheses (13/464) emerged. At ultrasound, 3 patients (2 PsA, 1 Psoriasis) developed a grade-1 power-doppler signal at 5 entheses, which remained clinically silent (Table 2 [Tab. 2]). After a week, pain remained stable (0,5 (0–3)). One PsA participant with active disease at baseline experienced an increase in disease activity with onset of arthritis in 3 joints. A single adverse event (disc protrusion) was reported.
Conclusion: Our study shows that low-to-moderate mechanical strain on entheses by amateur-level badminton as leisure activity is well tolerated by patients with psoriasis and PsA and does not lead to an increase in disease activity.
Disclosure: This study was supported by a conditional grant by Novartis and supported by Samsung providing HS50.
References
- 1.
- Schett G, Lories RJ, D'Agostino MA, Elewaut D, Kirkham B, Soriano ER, McGonagle D. Enthesitis: from pathophysiology to treatment. Nat Rev Rheumatol. 2017 Nov 21;13(12):731-41. DOI: 10.1038/nrrheum.2017.188
- 2.
- Simon D, Kleyer A, Bayat S, Knitza J, Valor-Mendez L, Schweiger M, Schett G, Tascilar K, Hueber AJ. Biomechanical stress in the context of competitive sports training triggers enthesitis. Arthritis Res Ther. 2021 Jun 21;23(1):172. DOI: 10.1186/s13075-021-02530-x
