Effect of Exercise on Disease Activity in Patients With Ankylosing Spondylitis by SIRI and SII

Ankylosing Spondylitis Clinical Trial

Official title:

Effect of Exercise on Disease Activity in Patients With Ankylosing Spondylitis by Systemic Inflammatory Response Index (SIRI) and Systemic Inflammation Index (SII)

Clinical Trial Details — Status: Not yet recruiting

Administrative data

• NCT number: NCT05703932
• Other study ID #: 1
• Status: Not yet recruiting
• Phase: N/A
• Start date: February 1, 2023
• Est. completion date: April 15, 2024

Study information

• Verified date: January 2023
• Source: Bakirkoy Dr. Sadi Konuk Research and Training Hospital
• Contact: Isil Ustun
• Phone: 905053117449
• Email: isil_altan[@]yahoo.com.tr
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The systemic inflammatory response index (SIRI) is defined as "neutrophil count × monocytes/lymphocyte counts". It has been reported that SIRI can predict survival in various types of cancer, including pancreatic cancer , gallbladder cancer , oral squamous cell carcinoma , and cervical cancer. Again, SIRI can demonstrate disease activity in patients with rheumatoid arthritis (RA), It has been reported that it can predict the development of RA-related interstitial lung disease and tumor development .

Ankylosing spondylitis management strategies should be aimed at controlling disease activity, improving spinal mobility and functional status . Treatment usually includes the use of anti-inflammatory drugs to reduce pain and stiffness, and the use of disease-modifying drugs to try to stop or prevent disease progression. Patients are also advised to exercise to maintain the mobility of the spine and peripheral joints . Studies on this subject reveal that exercise is as important as drug therapy in the treatment of AS . Again, the importance of exercise in AS was emphasized in the clinical guidelines for the treatment of AS by ASAS (The Assesment in Ankylosing Spondylitis : Working Group) and EULAR (European League Against Rheumatism) . In addition to the effects of exercise on muscle strength, joint limitations, physical performance, endurance capacity and quality of life, its anti-inflammatory effects are also known.

In this study, it was aimed to evaluate the effect of exercise therapy on disease activity in AS patients with systemic inflammatory response index (SIRI) and systemic inflammation index (SII). There is not enough evidence in the literature that systemic inflammatory response index (SIRI) and systemic inflammation index (SII) can be used in the evaluation of disease activity in AS.

Description:

Ankylosing spondylitis (AS) is an inflammatory disease of unknown etiology characterized by chronic inflammation of the sacroiliac joints, spine and paraspinal soft tissues. Extra-articular manifestations such as anterior uveitis, inflammatory bowel disease, aortic valve disease and osteoporosis may also occur. Joint fusion and dysfunction may also be seen in progressive disease states. Inflammatory low back pain and morning stiffness are common symptoms of AS. These symptoms lead to limitation of activity and exacerbation of pain in the active phase of the disease. Therefore, evaluation of disease activity in AS is very important in terms of better understanding the pathophysiology of AS, predicting prognosis, and treatment. Currently, two non-specific inflammatory biomarkers, C-reactive protein (CRP) level and erythrocyte sedimentation rate (ESH), are frequently used to monitor disease activity of rheumatic diseases; however, these biomarkers have low sensitivity and specificity . Therefore, it is necessary to identify new indicators that more accurately reflect disease activity.

Recently, complete blood cell count parameters have emerged as useful biomarkers of many inflammatory diseases due to their availability and affordability. Previous studies have shown that platelet (PLT), neutrophil, lymphocyte cell counts, red blood distribution width (RDW), neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLO) are important indicators of systemic inflammation. In addition, it was found that SII (Systemic Inflammation Index), calculated by the formula "platelet count × neutrophil count/lymphocyte count", increased in active-stage AS patients compared to both the healthy control group and other AS patients in remission, and showed a positive correlation with disease activity .The systemic inflammatory response index (SIRI) is defined as "neutrophil count × monocytes/lymphocyte counts". It has been reported that SIRI can predict survival in various types of cancer, including pancreatic cancer, gallbladder cancer , oral squamous cell carcinoma , and cervical cancer. Again, SIRI can demonstrate disease activity in patients with rheumatoid arthritis (RA), It has been reported that it can predict the development of RA-related interstitial lung disease and tumor development .

Ankylosing spondylitis management strategies should be aimed at controlling disease activity, improving spinal mobility and functional status . Treatment usually includes the use of anti-inflammatory drugs to reduce pain and stiffness, and the use of disease-modifying drugs to try to stop or prevent disease progression. Patients are also advised to exercise to maintain the mobility of the spine and peripheral joints . Studies on this subject reveal that exercise is as important as drug therapy in the treatment of AS . Again, the importance of exercise in AS was emphasized in the clinical guidelines for the treatment of AS by ASAS (The Assesment in Ankylosing Spondylitis : Working Group) and EULAR (European League Against Rheumatism) . In addition to the effects of exercise on muscle strength, joint limitations, physical performance, endurance capacity and quality of life, its anti-inflammatory effects are also known.

In this study, it was aimed to evaluate the effect of exercise therapy on disease activity in AS patients with systemic inflammatory response index (SIRI) and systemic inflammation index (SII). There is not enough evidence in the literature that systemic inflammatory response index (SIRI) and systemic inflammation index (SII) can be used in the evaluation of disease activity in AS.

Recruitment information / eligibility

• Status: Not yet recruiting
• Enrollment: 60
• Est. completion date: April 15, 2024
• Est. primary completion date: February 1, 2024
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 18 Years to 65 Years

Eligibility

Inclusion Criteria:

Being diagnosed with ankylosing spondylitis according to the modified New York criteria and/or ASAS criteria

Exclusion Criteria:

Presence of neurological disease (Epilepsy, stroke, Parkinson's, etc.) Severe cardiac disease (coronary artery disease, history of myocardial infarction and angina, heart failure) Pacemaker users Patients with COPD and advanced respiratory failure Hypertension and diabetes that cannot be controlled with medication malignancy Acute or chronic infections Organ/System dysfunction History of previous upper and lower extremity orthopedic surgery Patients with joint prosthesis Insufficient cooperation Pregnancy Cognitive dysfunction Dementia Presence of psychiatric illness

Related Conditions & MeSH terms

• Ankylosing Spondylitis
• Spondylarthritis
• Spondylitis
• Spondylitis, Ankylosing

Intervention

Other:
• home-based exercises
Joint range of motion and stretching exercises for cervical, thoracic and lumbar spine, stretching for erector spina, hamstring and shoulder muscles, chest expansion, abdominal and diaphragmatic breathing exercises will be applied. Exercises will be performed at submaximal level, paying attention to blood pressure, arterial (TA) and heart rate.For the patients in the exercise group, it was planned to perform the exercise program 5 days a week in 1 set with 10 repetitions, 40 minutes/day.

Locations

Country	Name	City	State
Turkey	Bakirkoy Dr Sadi Konuk Hospital	Istanbul	Bakirkoy

Sponsors (1)

Lead Sponsor	Collaborator
Bakirkoy Dr. Sadi Konuk Research and Training Hospital

Country where clinical trial is conducted

Turkey, 

References & Publications (21)

Chetrit M, Khan MA, Kapadia S. State of the Art Management of Aortic Valve Disease in Ankylosing Spondylitis. Curr Rheumatol Rep. 2020 May 14;22(6):23. doi: 10.1007/s11926-020-00898-4. — View Citation

Deng J, Xu S, Gao X, Xu S, Shuai Z, Pan F. Red Cell Distribution Width and Mean Platelet Volume in Patients With Ankylosing Spondylitis: A Systematic Review and Meta-analysis. J Clin Rheumatol. 2021 Oct 1;27(7):292-297. doi: 10.1097/RHU.0000000000001174. — View Citation

Dominguez CJ, Ugalde PF, Vilchez DR, Carretero-Dios H, Estevez EC. Positive and negative affective states and disease activity in ankylosing spondylitis. Rheumatol Int. 2015 Mar;35(3):519-24. doi: 10.1007/s00296-014-3107-y. Epub 2014 Aug 15. — View Citation

Dougados M, van der Heijde D. Ankylosing spondylitis: how should the disease be assessed? Best Pract Res Clin Rheumatol. 2002 Sep;16(4):605-18. doi: 10.1053/berh.2002.0252. — View Citation

Gokmen F, Akbal A, Resorlu H, Gokmen E, Guven M, Aras AB, Erbag G, Komurcu E, Akbal E, Cosar M. Neutrophil-Lymphocyte Ratio Connected to Treatment Options and Inflammation Markers of Ankylosing Spondylitis. J Clin Lab Anal. 2015 Jul;29(4):294-8. doi: 10.1002/jcla.21768. Epub 2014 May 21. — View Citation

Heikkila S, Viitanen JV, Kautiainen H, Kauppi M. Sensitivity to change of mobility tests; effect of short term intensive physiotherapy and exercise on spinal, hip, and shoulder measurements in spondyloarthropathy. J Rheumatol. 2000 May;27(5):1251-6. — View Citation

Hidding A, van der Linden S, Boers M, Gielen X, de Witte L, Kester A, Dijkmans B, Moolenburgh D. Is group physical therapy superior to individualized therapy in ankylosing spondylitis? A randomized controlled trial. Arthritis Care Res. 1993 Sep;6(3):117-25. doi: 10.1002/art.1790060303. — View Citation

Lee JH, Choi M, Rim THT, Lee SC, Lee CS. Clinical Characteristics and Prognostic Factors in Ankylosing Spondylitis Associated Uveitis. Ocul Immunol Inflamm. 2019;27(1):64-69. doi: 10.1080/09273948.2017.1359630. Epub 2017 Oct 11. — View Citation

Lin J, Chen L, Chen Q, Zhuang Z, Bao X, Qian J, Hong Y, Yan L, Lin L, Shi B, Qiu Y, Pan L, Wei L, Zheng X, Wang J, Liu F, He B, Chen F. Prognostic value of preoperative systemic inflammation response index in patients with oral squamous cell carcinoma: Propensity score-based analysis. Head Neck. 2020 Nov;42(11):3263-3274. doi: 10.1002/hed.26375. Epub 2020 Jul 18. — View Citation

Machado PM, Landewe R, Heijde DV; Assessment of SpondyloArthritis international Society (ASAS). Ankylosing Spondylitis Disease Activity Score (ASDAS): 2018 update of the nomenclature for disease activity states. Ann Rheum Dis. 2018 Oct;77(10):1539-1540. doi: 10.1136/annrheumdis-2018-213184. Epub 2018 Feb 16. No abstract available. — View Citation

Magrey MN, Lewis S, Asim Khan M. Utility of DXA scanning and risk factors for osteoporosis in ankylosing spondylitis-A prospective study. Semin Arthritis Rheum. 2016 Aug;46(1):88-94. doi: 10.1016/j.semarthrit.2016.03.003. Epub 2016 Mar 9. — View Citation

Nolte K, van Rensburg DCJ, Fletcher L. Effects of a 6-month exercise programme on disease activity, physical and functional parameters in patients with ankylosing spondylitis: Randomised controlled trial. S Afr J Physiother. 2021 Jun 29;77(1):1546. doi: 10.4102/sajp.v77i1.1546. eCollection 2021. — View Citation

Ozdemir O. Quality of life in patients with ankylosing spondylitis: relationships with spinal mobility, disease activity and functional status. Rheumatol Int. 2011 May;31(5):605-10. doi: 10.1007/s00296-009-1328-2. Epub 2010 Jan 5. — View Citation

Poddubnyy D, Rudwaleit M, Haibel H, Listing J, Marker-Hermann E, Zeidler H, Braun J, Sieper J. Rates and predictors of radiographic sacroiliitis progression over 2 years in patients with axial spondyloarthritis. Ann Rheum Dis. 2011 Aug;70(8):1369-74. doi: 10.1136/ard.2010.145995. Epub 2011 May 27. — View Citation

Sezgin M, Tecer D, Kanik A, Kekik FS, Yesildal E, Akaslan E, Yildirim G, Sahin G. Serum RDW and MPV in Ankylosing Spondylitis: Can they show the disease activity? Clin Hemorheol Microcirc. 2017;65(1):1-10. doi: 10.3233/CH-162067. — View Citation

Stolwijk C, Essers I, van Tubergen A, Boonen A, Bazelier MT, De Bruin ML, de Vries F. The epidemiology of extra-articular manifestations in ankylosing spondylitis: a population-based matched cohort study. Ann Rheum Dis. 2015 Jul;74(7):1373-8. doi: 10.1136/annrheumdis-2014-205253. Epub 2014 Mar 21. — View Citation

Sun L, Hu W, Liu M, Chen Y, Jin B, Xu H, Du S, Xu Y, Zhao H, Lu X, Sang X, Zhong S, Yang H, Mao Y. High Systemic Inflammation Response Index (SIRI) Indicates Poor Outcome in Gallbladder Cancer Patients with Surgical Resection: A Single Institution Experience in China. Cancer Res Treat. 2020 Oct;52(4):1199-1210. doi: 10.4143/crt.2020.303. Epub 2020 Jul 21. — View Citation

Topkan E, Mertsoylu H, Kucuk A, Besen AA, Sezer A, Sezen D, Bolukbasi Y, Selek U, Pehlivan B. Low Systemic Inflammation Response Index Predicts Good Prognosis in Locally Advanced Pancreatic Carcinoma Patients Treated with Concurrent Chemoradiotherapy. Gastroenterol Res Pract. 2020 Jul 30;2020:5701949. doi: 10.1155/2020/5701949. eCollection 2020. — View Citation

Wu J, Yan L, Chai K. Systemic immune-inflammation index is associated with disease activity in patients with ankylosing spondylitis. J Clin Lab Anal. 2021 Sep;35(9):e23964. doi: 10.1002/jcla.23964. Epub 2021 Aug 21. — View Citation

Xu Y, He H, Zang Y, Yu Z, Hu H, Cui J, Wang W, Gao Y, Wei H, Wang Z. Systemic inflammation response index (SIRI) as a novel biomarker in patients with rheumatoid arthritis: a multi-center retrospective study. Clin Rheumatol. 2022 Jul;41(7):1989-2000. doi: 10.1007/s10067-022-06122-1. Epub 2022 Mar 9. — View Citation

Zochling J, van der Heijde D, Burgos-Vargas R, Collantes E, Davis JC Jr, Dijkmans B, Dougados M, Geher P, Inman RD, Khan MA, Kvien TK, Leirisalo-Repo M, Olivieri I, Pavelka K, Sieper J, Stucki G, Sturrock RD, van der Linden S, Wendling D, Bohm H, van Royen BJ, Braun J; 'ASsessment in AS' international working group; European League Against Rheumatism. ASAS/EULAR recommendations for the management of ankylosing spondylitis. Ann Rheum Dis. 2006 Apr;65(4):442-52. doi: 10.1136/ard.2005.041137. Epub 2005 Aug 26. — View Citation

* Note: There are 21 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Changed BASDAI score >2 in home-based exercise group measured by BASDAI-Bath Ankylosing Spondylitis Disease Activity Index at 10 week	The BASDAI index consists of 6 questions about disease activity. Patients are required to answer the questions considering their last week's situation and mark an appropriate point on the 10 cm horizontal line. At the beginning and end of the 10 cm horizontal line, there are the words "not at all - very severe". The average of the 2 questions about morning stiffness will be taken, added to the total of the first 4 questions, and a combined score will be obtained by dividing by 5.A higher score indicates higher disease activity.	10 week
Secondary	SII-systemic inflammation index	systemic inflammation index (SII) is defined as "platelet count × neutrophil count/lymphocyte count"	10 week
Secondary	SIRI-systemic inflammatory response index	The systemic inflammatory response index (SIRI) is defined as "neutrophil count × monocytes/lymphocyte counts".	10 week
Secondary	BASMI-Bath Ankylosing Spondylitis Metrology Index	BASMI consists of five clinical measurements: cervical rotation, tragus wall distance, lumbar flexion, trunk lateral flexion and intermalleolar distance.10 is highest score and indicates worst situtation.BASMI both groups before the treatment, after 6 weeks exercise program and when the treatment ends (4 weeks after) will be compared	10 week
Secondary	ASDAS-CRP-Ankylosing Spondylitis Disease Activity Score-CRP	The ASDAS evaluation consists of four questions to be answered by the patients and the results of the acute phase reactants CRP mg/L or ESH mm/sec . Three of the questions are some questions used in BASDAI(question 2,3,6)Patients are asked to answer these questions using a VAS on a 10 cm or 100 mm long horizontal or vertical lineThe point that patients show on the VAS is calculated in cm/mm. ASDAS-CRP/ESH will be calculated together with the CRP or ESH results in the formula.; Mild disease activity <1.3 Moderate disease activity 1.3-2.1 High disease activity 2.1-3.5 Very high disease activity is evaluated as >3.5	10 week
Secondary	BASFI-Bath Ankylosing Spondylitis Functional Index	BASFI includes 8 items related to daily activities and 2 items related to the patient's daily life skills. Each item is evaluated on a 10 cm visual analog scale. At the beginning and end of the scale, the words "I can do it easily - I can't" are located. The patients are asked to mark on the line, considering how difficult they have been while doing the tasks during the past week. The average of 10 scales gives the total BASFI score. The total score is between 0-10. A high score indicates poor function.	10 week
Secondary	ASDAS-ESR-Ankylosing Spondylitis Disease Activity Score-ESR	The ASDAS evaluation consists of four questions to be answered by the patients and the results of the acute phase reactants CRP mg/L or ESH mm/sec . Three of the questions are some questions used in BASDAI(question 2,3,6)Patients are asked to answer these questions using a VAS on a 10 cm or 100 mm long horizontal or vertical lineThe point that patients show on the VAS is calculated in cm/mm. ASDAS-CRP/ESH will be calculated together with the CRP or ESH results in the formula.; Mild disease activity <1.3 Moderate disease activity 1.3-2.1 High disease activity 2.1-3.5 Very high disease activity is evaluated as >3.5	10 week
Secondary	ASQoL-Ankylosing Spondylitis Quality of Life Index	The scale consists of 18 sentences questioning whether the patients have limitations in activities of daily living, pain, fatigue and morning stiffness, concerns about their illness, and depressed mood. The patient will be asked to answer each question as yes or no, taking into account the latest situation. Yes 1 point, no 0 points will be recorded and the total score will be calculated.	10 week
Secondary	VAS-Visual Analog Scale	Pain is measured by visual analog scale (VAS). The score is determined by measuring the distance (mm) on the 10-cm line between the "no pain" anchor and the patient's mark, providing a range of scores from 0-100. A higher score indicates greater pain intensity. Pain intensity as none, mild, moderate, or severe, the following cut points on the pain VAS have been recommended: no pain (0-4 mm), mild pain (5-44 mm), moderate pain (45-74 mm), and severe pain (75- 100 mm).	10 week
Secondary	HAD Scale-Hospital Anxiety-Depression Scale	Considering the last few days, each question is scored between 0-3 for the answers of the patients who are asked to give the answer that best expresses how they feel. Questions 1, 3, 5, 7, 9, 11, 13 give anxiety scores; Questions 2, 4, 6, 8, 10, 12, 14 give depression scores. The total score is obtained by summing the scores for each question. 0-7 points will be considered normal, 8-10 points will be considered borderline, while 11 points and above will be considered abnormal.	10 week