EFFECTS AND TOLERABILITY OF LOW TO MODERATE BIOMECHANICAL STRESS DURING LEISURE SPORT ACTIVITY IN PATIENTS WITH PSORIASIS AND PSORIATIC ARTHRITIS
Authors: Fagni F et al.
Excessive physical exercise might theoretically aggravate PsA as this has been implicated in the pathogenesis of enthesitis (so called “Deep Koebner phenomenon”). This rises the question of how intense and what kind of physical activity should be recommended to PsA patients. A prospective trial was conducted at the University of Erlangen and Nürnberg including 7 PsA and 9 PsO patients who underwent physical examination of 29 entheses and US scans of the entheses of the lateral humeral epicondyle, inferior patellar pole and Achilles tendon bilaterally before and after a 60 minutes Badminton session. No significant change in median VAS pain or in tender entheses emerged. Baseline US showed structural and inflammatory changes in 15/96 and 17/96 entheses. After training, 4 patients developed a grade-1 power doppler signal at 6 entheses that were not tender and median VAS over the following week was stable. Only one untreated PsA patient with active disease at baseline developed new onset of arthritis in three joints.
The scientific question behind that (small) prospective study is interesting as mechanical stress has been implicated in the pathogenesis of enthesitis. The data suggests that low to moderate mechanical stress on enthesitis (Badminton for 60min) does not worsen disease activity. As assessed clinically and by ultrasound. The only patient with new arthritis after sports was not on DMARD therapy suggesting that immunomodulatory therapy might offer some protection against mechanical challenges.