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PRACA PRZEGLĄDOWA
Ambiguities in the effect of physical activity on bone remodelling in spondyloarthritis
1
Department of Rheumatology, Immunology and Internal Medicine, University Hospital, Krakow, Poland
2
Department of Rheumatology and Immunology, Jagiellonian University Medical College, Krakow, Poland
Data nadesłania: 10-04-2025
Data ostatniej rewizji: 07-08-2025
Data akceptacji: 22-10-2025
Data publikacji: 10-06-2026
Autor do korespondencji
Agnieszka Alicja Kowalczyk
Department of Rheumatology, Immunology and Internal Medicine, University Hospital, Macieja Jakubowskiego 2, 30-688 Cracow, Poland.
Department of Rheumatology, Immunology and Internal Medicine, University Hospital, Macieja Jakubowskiego 2, 30-688 Cracow, Poland.
Reumatologia 2026;64(3):218-229
SŁOWA KLUCZOWE
DZIEDZINY
STRESZCZENIE
Spondyloarthritis (SpA) is characterized by inflammation of joints and entheses, leading to structural damage and loss of bone mineral density. The goal of this narrative review was to analyse the impact of physical activity on bone remodelling in patients with SpA.
Two investigators searched the PubMed, Scopus, Directory of Open Access Journals, and Web of Science bibliographic databases (May 20, 2024; October 4, 2024; and May 19, 2025), then screened the articles for compliance with the inclusion criteria.
Six related articles were included. No studies directly assessed the impact of physical activity on bone density in SpA. Prior research showed that short-term exercise does not affect ultrasound or magnetic resonance imaging findings, while repeated activities, such as certain job types, may worsen structural damage.
Data regarding the effect of physical activity on bone remodelling are scarce, and results are divergent. More research regarding biomechanical stress and bone remodelling is needed.
REFERENCJE (66)
1.
Allado E, Moussu A, Bigna JJ, et al. Global prevalence of spondyloarthritis in low-income and middle-income countries: a systematic review and meta-analysis protocol. BMJ Open 2020; 10: e041180, DOI: 10.1136/bmjopen-2020-041180.
2.
Zimba O, Kocyigit BF, Korkosz M. Diagnosis, monitoring, and management of axial spondyloarthritis. Rheumatol Int 2024; 44: 1395–1407, DOI: 10.1007/s00296-024-05615-3.
3.
Ogdie A, Weiss P. The epidemiology of psoriatic arthritis. Rheum Dis Clin North Am 2015; 41: 545–568, DOI: 10.1016/ j.rdc.2015.07.001.
4.
Aouad K, Ziade N, Baraliakos X. Structural progression in axial spondyloarthritis. Joint Bone Spine 2020; 87: 131–136, DOI: 10.1016/j.jbspin.2019.04.006.
5.
Jacques P, Lambrecht S, Verheugen E, et al. Proof of concept: enthesitis and new bone formation in spondyloarthritis are driven by mechanical strain and stromal cells. Ann Rheum Dis 2014; 73: 437–445, DOI: 10.1136/annrheumdis-2013-203643. .
6.
Briot K, Roux C. Inflammation, bone loss and fracture risk in spondyloarthritis. RMD Open 2015; 1: e000052, DOI: 10.1136/rmdopen-2015-000052.
7.
Van der Weijden MAC, van Denderen JC, Lems WF, et al. Low bone mineral density is related to male gender and decreased functional capacity in early spondylarthropathies. Clin Rheumatol 2011; 30: 497–503, DOI: 10.1007/s10067-010-1538-8.
8.
Ognjenovic M, Raymond WD, Inderjeeth CA, et al. The Risk and consequences of vertebral fracture in patients with ankylosing spondylitis: a population-based data linkage study. J Rheumatol 2020; 47: 1629–1636, DOI: 10.3899/jrheum.190675.
9.
Angelopoulos A, Kouverianos I, Daoussis D. The paradox of osteoporosis in spondyloarthropathies. Mediterr J Rheumatol 2024; 35 (Suppl 3): 528–533, DOI: 10.31138/mjr.270924.poa.
10.
Ramiro S, Nikiphorou E, Sepriano A, et al. ASAS-EULAR recommendations for the management of axial spondyloarthritis: 2022 update. Ann Rheum Dis 2023; 82: 19–34, DOI: 10.1136/ard-2022-223296.
11.
Jones A, Ciurtin C, Ismajli M, et al. Biologics for treating axial spondyloarthritis. Expert Opin Biol Ther 2018; 18: 641–652, DOI: 10.1080/14712598.2018.1468884.
12.
Braun J, Zochling J, Baraliakos X, et al. Efficacy of sulfasalazine in patients with inflammatory back pain due to undifferentiated spondyloarthritis and early ankylosing spondylitis: a multicentre randomised controlled trial. Ann Rheum Dis 2006; 65: 1147–1153, DOI: 10.1136/ard.2006.052878.
13.
Ahmed S, Yesudian R, Ubaide H, Coates LC. Rationale and concerns for using JAK inhibitors in axial spondyloarthritis. Rheumatol Adv Pract 2024; 8: rkae141, DOI: 10.1093/rap/rkae141.
14.
Rausch Osthoff AK, Niedermann K, Braun J, et al. 2018 EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis. Ann Rheum Dis 2018; 77: 1251–1260, DOI: 10.1136/annrheumdis-2018-213585.
15.
Sveaas SH, Bilberg A, Berg IJ, et al. High intensity exercise for 3 months reduces disease activity in axial spondyloarthritis (axSpA): a multicentre randomised trial of 100 patients. Br J Sports Med 2020; 54: 292–297, DOI: 10.1136/bjsports-2018-099943. .
16.
Dundar U, Solak O, Toktas H, et al. Effect of aquatic exercise on ankylosing spondylitis: a randomized controlled trial. Rheumatol Int 2014; 34: 1505–1511, DOI: 10.1007/s00296-014-2980-8.
17.
Zaggelidou E, Theodoridou A, Michou V, et al. The effects of Pilates exercise training combined with walking on cardiorespiratory fitness, functional capacity, and disease activity in patients with non-radiologically confirmed axial spondyloarthritis. J Funct Morphol Kinesiol 2023; 8: 140, DOI: 10.3390/jfmk8040140.
18.
Kang KY, Park SY, Chung TH. Long-term association between physical activity and global functioning in patients with axial spondyloarthritis: results of a two-year prospective study. Scand J Rheumatol 2025; 54: 8–15, DOI: 10.1080/03009742.2024.2376810.
19.
Ward MM, Reveille JD, Learch TJ, et al. Occupational physical activities and long-term functional and radiographic outcomes in patients with ankylosing spondylitis. Arthritis Care Res 2008; 59: 822–832, DOI: 10.1002/art.23704.
20.
Zhou W, Chandran V, Cook R, et al. The association between occupational-related mechanical stress and radiographic damage in psoriatic arthritis. Semin Arthritis Rheum 2019; 48: 638–643, DOI: 10.1016/j.semarthrit.2018.06.001.
21.
Ramiro S, Landewé R, Van Tubergen A, et al. Lifestyle factors may modify the effect of disease activity on radiographic progression in patients with ankylosing spondylitis: a longitudinal analysis. RMD Open 2015; 1: e000153, DOI: 10.1136/rmdopen-2015-000153.
22.
McGonagle D, Stockwin L, Isaacs J, et al. An enthesitis based model for the pathogenesis of spondyloarthropathy: additive effects of microbial adjuvant and biomechanical factors at disease sites. J Rheumatol 2001; 28: 2155–2159.
23.
Sveaas SH, Berg IJ, Provan SA, et al. Efficacy of high intensity exercise on disease activity and cardiovascular risk in active axial spondyloarthritis: a randomized controlled pilot study. PLoS One 2014; 9: e108688, DOI: 10.1371/journal.pone.0108688.
24.
Millner JR, Barron JS, Beinke KM, et al. Exercise for ankylosing spondylitis: an evidence-based consensus statement. Semin Arthritis Rheum 2016; 45: 411–427, DOI: 10.1016/j.semarthrit. 2015.08.003.
25.
McGonagle D, Wakefield RJ, Tan AL, et al. Distinct topography of erosion and new bone formation in Achilles tendon enthesitis: implications for understanding the link between inflammation and bone formation in spondyloarthritis. Arthritis Rheum 2008; 58: 2694–2699, DOI: 10.1002/art.23755.
26.
Tan S, Dasgupta A, Flynn JA, et al. Aortic-vertebral interaction in ankylosing spondylitis: syndesmophyte development at the juxta-aortic vertebral rim. Ann Rheum Dis 2019; 78: 922–928, DOI: 10.1136/annrheumdis-2018-214675.
27.
Seven S, Østergaard M, Morsel-Carlsen L, et al. Anatomic distribution of sacroiliac joint lesions on magnetic resonance imaging in patients with axial spondyloarthritis and control subjects: a prospective cross-sectional study, including postpartum women, patients with disc herniation, cleaning staff, runners, and healthy individuals. Arthritis Care Res 2021; 73: 742–754, DOI: 10.1002/acr.24473.
28.
De Winter J, De Hooge M, Van De Sande M, et al. Magnetic resonance imaging of the sacroiliac joints indicating sacroiliitis according to the Assessment of SpondyloArthritis International Society definition in healthy individuals, runners, and women with postpartum back pain. Arthritis Rheumatol 2018; 70: 1042–1048, DOI: 10.1002/art.40475.
29.
Varkas G, De Hooge M, Renson T, et al. Effect of mechanical stress on magnetic resonance imaging of the sacroiliac joints: assessment of military recruits by magnetic resonance imaging study. Rheumatology 2018; 57: 508–513, DOI: 10.1093/rheumatology/kex491.
30.
Shevchuk S, Pavliuk O, Shevchuk O. Levels of osteocalcin and N-terminal telopeptide of type I collagen in men with ankylosing spondylitis: associations with disease course and structural-functional status of bone tissue. Reumatologia 2025; 63: 144–151, DOI: 10.5114/reum/201175.
31.
Shevchuk S, Pavliuk O. The state of bone mineral density in men with ankylosing spondylitis and its relationship with the course of the disease. Reumatologia 2024; 62: 43–51, DOI: 10.5114/reum/184028.
32.
Maas F, Arends S, Van der Veer E, et al. Obesity is common in axial spondyloarthritis and is associated with poor clinical outcome. J Rheumatol 2016; 43: 383–387, DOI: 10.3899/jrheum.150648.
33.
Bakirci S, Dabague J, Eder L, et al. The role of obesity on inflammation and damage in spondyloarthritis: a systematic literature review on body mass index and imaging. Clin Exp Rheumatol 2020; 38: 144–148.
34.
Wensveen FM, Valentić S, Šestan M, et al. Interactions between adipose tissue and the immune system in health and malnutrition. Semin Immunol 2015; 27: 322–333, DOI: 10.1016/j.smim.2015.10.006.
35.
Lange U, Teichmann J, Stracke H. Correlation between plasma TNF-alpha, IGF-1, biochemical markers of bone metabolism, markers of inflammation/disease activity, and clinical manifestations in ankylosing spondylitis. Eur J Med Res 2000; 5: 507–511.
36.
Fassio A, Atzeni F, Rossini M, et al. Osteoimmunology of spondyloarthritis. Int J Mol Sci 2023; 24: 14924, DOI: 10.3390/ijms241914924.
37.
Rotta D, Fassio A, Rossini M, et al. Osteoporosis in inflammatory arthritides: new perspective on pathogenesis and treatment. Front Med 2020; 7: 613720, DOI: 10.3389/fmed.2020.613720.
38.
Chen J, Zhou R, Feng Y, et al. Molecular mechanisms of exercise contributing to tissue regeneration. Signal Transduct Target Ther 2022; 7: 383, DOI: 10.1038/s41392-022-01233-2.
39.
Korkosz M, Gąsowski J, Leszczyński P, et al. Effect of tumour necrosis factor- inhibitor on serum level of dickkopf-1 protein and bone morphogenetic protein-7 in ankylosing spondylitis patients with high disease activity. Scand J Rheumatol 2014; 43: 43–48, DOI: 10.3109/03009742.2013.805241.
40.
Daoussis D, Filippopoulou A, Liossis SN, et al. Anti-TNF treatment decreases the previously increased serum Indian hedgehog levels in patients with ankylosing spondylitis and affects the expression of functional Hedgehog pathway target genes. Semin Arthritis Rheum 2015; 44: 646–651, DOI: 10.1016/ j.semarthrit.2015.01.004.
41.
Horváth Á, Pusztai A, Gulyás K, et al. Effects of anti-TNF therapy on markers of bone homeostasis in rheumatoid arthritis and ankylosing spondylitis. Ann Rheum Dis 2015; 74: 175, DOI: 10.1136/annrheumdis-2015-eular.1552.
42.
Siu S, Haraoui B, Bissonnette R, et al. Meta-analysis of tumor necrosis factor inhibitors and glucocorticoids on bone density in rheumatoid arthritis and ankylosing spondylitis trials. Arthritis Care Res 2015; 67: 754–764, DOI: 10.1002/acr.22519.
43.
Haroon NN, Sriganthan J, Al Ghanim N, et al. Effect of TNF- alpha inhibitor treatment on bone mineral density in patients with ankylosing spondylitis: a systematic review and meta-analysis. Semin Arthritis Rheum 2014; 44: 155–161, DOI: 10.1016/j.semarthrit.2014.05.008.
44.
Eun IS, Park SH, Goh TS, et al. Effect of bisphosphonates on ankylosing spondylitis: a meta-analysis. J Clin Neurosci 2021; 92: 153–158, DOI: 10.1016/j.jocn.2021.08.016.
45.
Orsini F, Crotti C, Cincinelli G, et al. Bone involvement in rheumatoid arthritis and spondyloarthritis: an updated review. Biology (Basel) 2023; 12: 1320, DOI: 10.3390/biology12101320.
46.
Kim MY, Kang KY, Hong YS. AB0952 comparison of the effect between bisphosphonate and denosumab on bone mineral density and radiographic progression in patients with ankylosing spondylitis: a pilot study. Ann Rheum Dis 2023; 82: 1694, DOI: 10.1136/annrheumdis-2023-eular.929.
47.
Kim S, Lee S-H, Song R. Efficacy of denosumab against osteoporosis determined using quantitative computed tomography in treatment-naïve male patients with ankylosing spondylitis: case series of six patients. Scand J Rheumatol 2024; 53: 288–290, DOI: 10.1080/03009742.2024.2316960.
48.
Tang T, Wan B, Zhang A, et al. Efficacy of denosumab in treatment of osteoporosis in patients with rheumatoid arthritis: a meta-analysis of randomized controlled trial. BMC Musculoskelet Disord 2025; 26: 450, DOI: 10.1186/s12891-025-08688-8.
49.
Carter MI, Hinton PS. Physical activity and bone health. Mo Med 2014; 111: 59–64.
50.
Gasparyan AY, Ayvazyan L, Blackmore H, et al. Writing a narrative biomedical review: considerations for authors, peer reviewers, and editors. Rheumatol Int 2011; 31: 1409–1417, DOI: 10.1007/s00296-011-1999-3.
51.
Van der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum 1984; 27: 361–368, DOI: 10.1002/art.1780270401.
52.
Rudwaleit M, Van der Heijde D, Landewé R, et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis 2009; 68: 777–783, DOI: 10.1136/ard.2009.108233.
53.
Taylor W, Gladman D, Helliwell P, et al. Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum 2006; 54: 2665–2673, DOI: 10.1002/art.21972.
54.
Slouma M, Dhia SB, Kharrat L, et al. Exercise is effective for disease activity control with various effects on entheses: an ultrasound-based study. Muscle Ligaments Tendons J 2024; 14: 352, DOI: 10.32098/mltj.02.2024.16.
55.
Chronaiou I, Giskeødegård GF, Neubert A, et al. Evaluating the impact of high intensity interval training on axial psoriatic arthritis based on MR images. Diagnostics 2022; 12: 1420, DOI: 10.3390/diagnostics12061420.
56.
Thomsen RS, Nilsen TIL, Haugeberg G, et al. Changes of inflammation in patients with psoriatic arthritis after high intensity interval training assessed by ultrasound and MRI: a randomized controlled trial. BMC Musculoskelet Disord 2023; 24: 743, DOI: 10.1186/s12891-023-06871-3.
57.
Thomsen RS, Nilsen TIL, Haugeberg G, et al. Effect of high- intensity interval training on cardiovascular disease risk factors and body composition in psoriatic arthritis: a randomized controlled trial. RMD Open 2018; 4: e000729, DOI: 10.1136/rmdopen-2018-000729.
58.
Ramiro S, Van der Heijde D, Van Tubergen A, et al. Higher disease activity leads to more structural damage in the spine in ankylosing spondylitis: 12-year longitudinal data from the OASIS cohort. Ann Rheum Dis 2014; 73: 1455–1461, DOI: 10.1136/annrheumdis-2014-205178.
59.
Reveille JD, Lee M, Gensler LS, et al. The changing profile of ankylosing spondylitis in the biologic era. Clin Rheumatol 2020; 39: 2641–2651, DOI: 10.1007/s10067-020-05260-8.
60.
Mbuyi MK, Kavangh HS, Grubišić F, et al. Is vitamin D associated with disease activity in patients with axial or peripheral spondyloarthritis? A real-life study. Rheumatol Int 2024; 44: 2079–2087, DOI: 10.1007/s00296-024-05674-6.
61.
Fernandes S, Etcheto A, Van der Heijde D, et al. Vitamin D status in spondyloarthritis: results of the ASAS-COMOSPA international study. Clin Exp Rheumatol 2018; 36: 210–214.
62.
Appel H, Rudwaleit M, Sieper J. Relevance of osteoproliferation as an outcome parameter in ankylosing spondylitis. Nat Clin Pract Rheumatol 2008; 4: 578–579, DOI: 10.1038/ncprheum0930.
63.
Coiffier G, Bouvard B, Chopin F, et al. Common bone turnover markers in rheumatoid arthritis and ankylosing spondylitis: a literature review. Joint Bone Spine 2013; 80: 250–257, DOI: 10.1016/j.jbspin.2012.08.004.
64.
Żuchowski P, Dura M, Jeka D, et al. Osteoporosis in axial radiographic spondyloarthritis: diagnostic limitations of bone mineral density and the need for comprehensive fracture risk assessment. Reumatologia 2024; 62: 466–474, DOI: 10.5114/reum/194107.
65.
Chimenti MS, Triggianese P, Conigliaro P, et al. Self-reported adherence to a home-based exercise program among patients affected by psoriatic arthritis with minimal disease activity. Drug Dev Res 2014; 75 (Suppl 1): S57–S59, DOI: 10.1002/ddr.21197.
66.
Schaller A, Rudolf K, Dejonghe L, et al. Influencing factors on the overestimation of self-reported physical activity: a cross- sectional analysis of low back pain patients and healthy controls. Biomed Res Int 2016; 2016: 1497213, DOI: 10.1155/ 2016/1497213.
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