The edition · Rheumatology
Exercise helps axial spondyloarthritis, but no single type wins; yoga trims disease activity in rheumatoid arthritis
A network meta-analysis of 59 trials finds exercise improves disease activity, function and pain in axial spondyloarthritis, a pooled review puts late-onset disease near 13% with lower HLA-B27 positivity, and yoga shows a modest effect on DAS28 in eight trials.
The edition in brief
A network meta-analysis of 59 randomised trials (3,404 participants) found exercise improved disease activity, function and pain in axial spondyloarthritis compared with usual care. Pilates showed the largest effects on BASDAI (mean difference -1.72), BASFI (-1.65) and pain, and Qigong was the only modality linked to lower ESR and CRP, but no modality was definitively superior and certainty was low to moderate. A meta-analysis of 42 studies estimated that about 13.4% of axial spondyloarthritis cases begin after age 45, with lower HLA-B27 positivity in later-onset disease (OR 0.47) but very low certainty on prevalence. A retrospective cohort of 70 patients with lupus-associated warm autoimmune haemolytic anaemia found similar six-month response with B-cell-targeted therapy and conventional therapy (89.7% versus 85.7%). A meta-analysis of eight trials (651 participants) found yoga lowered DAS28 in rheumatoid arthritis (SMD -0.44) and IL-6 but not HAQ-DI or TNF-alpha.
Exercise in axial spondyloarthritis: all modalities help, none clearly best
Advise regular supervised or structured exercise for all patients with axial spondyloarthritis, and choose the type by what the patient will sustain, since no modality was shown to be best.
Late-onset axial spondyloarthritis: about 13% of cases, with less HLA-B27 positivity
Keep axial spondyloarthritis on the list for inflammatory back pain starting after 45, and do not rely on a negative HLA-B27 to exclude it.
B-cell-targeted therapy for lupus-associated autoimmune haemolytic anaemia: similar response to conventional treatment
Consider early B-cell-targeted therapy to spare steroids in lupus-associated haemolytic anaemia, recognising this retrospective study found no significant difference in response.
Ask about morning stiffness duration and night pain in every back pain consultation
Ask about morning stiffness and night pain in every chronic back pain consultation.
Yoga as an adjunct in rheumatoid arthritis: a modest fall in DAS28 and IL-6
Consider suggesting supervised yoga as an adjunct for rheumatoid arthritis patients interested in it, alongside their disease-modifying treatment.
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