Obesity is highly overrepresented in patients with psoriatic arthritis (PsA) and associated with increased disease activity and inferior treatment outcome. We have previously reported in 41 patients with PsA and body mass index (BMI) ≥ 33 kg/m2 that weight loss treatment with Very Low Energy Diet (VLED) resulted in a median weight loss of 18,6

Objective High-intensity interval training (HIIT) has been shown to improve cardiovascular health and physical fitness in patients with rheumatoid arthritis (RA). However, patient perspectives on this type of exercise remain insufficiently explored. The aim of this study was to describe experiences of supervised HIIT among patients with RA and to elucidate how patients maintain exercise on their own after completing the supervised intervention.Design A qualitative study based on semistructured in-depth individual interviews analysed using qualitative content analysis.Participants Patients were recruited from a multicentre randomised controlled trial in Western Sweden. Twenty patients (16 women) with RA who had participated in the high-intensity exercise programme for 12 weeks were included in this qualitative interview study.Setting The supervised HIIT was conducted in a hospital setting.Results The results were divided into two domains, corresponding to the two broad open-ended questions. The first domain comprises four categories: (1) challenging and effective with HIIT, (2) belonging to a group facilitates exercise, (3) feeling confident when exercising and (4) stimulating to feel the effect of exercise on the body. The second domain comprises two themes: (1) taking responsibility for one’s health and (2) a feeling of resignation.Conclusion HITT was perceived as challenging yet manageable. Follow-up visits with a knowledgeable physiotherapist were requested, since exercise was perceived as a lifelong treatment and just as crucial as pharmacological treatment. Most patients described taking responsibility for their health and maintaining their exercise regime after the supervised intervention; however, some expressed a feeling of resignation and were unready for lifestyle changes. Nevertheless, having RA can be a motivator when exercise is viewed as an important part of medical treatment.

Prolonged fatigue is prevalent in people with rheumatoid arthritis (RA), and physical activity is recommended as an adjunct treatment option to managing fatigue. However, the type and dose of physical activity is not established. The purpose of this randomized controlled multicenter study was to evaluate the effect of high-intensity interval training (HIIT) and strength exercise on fatigue, sleep, mood, pain and health-related quality of life in people with RA. In total, 87 participants diagnosed with RA, mean age 48 (SD 9.66) Years and 84

In this interventional weight loss study, health-related quality of life (HRQoL), anxiety, depression and fatigue were compared at baseline (BL) and at 12 months (M12) in patients with psoriatic arthritis (PsA) and controls. PsA patients (n = 39) between 25 and 75 years of age, with body mass index (BMI) ≥ 33 kg/m2 were included in a weight loss intervention with very low energy diet (VLED) for 12 or 16 weeks depending on BL BMI < 40 or ≥ 40 kg/m2. The 36-item short-form health survey (SF-36) was used to assess HRQoL. Anxiety and depression were assessed by the Hospital Anxiety and Depression Scale. Assessments were done at BL, M3, M6 and M12. As controls (n = 39), obese individuals, already planned for VLED treatment were recruited and matched for sex, age and weight to the PsA patients. In PsA patients, physical HRQoL, as demonstrated by the physical component summary (PCS) of SF-36, improved from median (IQR) 34 (25–45) at BL to 43 (34–50) at M12, p = 0.009. No significant effect on mental HRQoL, demonstrated by the mental component summary (MCS) score, was seen. Similarly in controls, PCS significantly improved (median IQR, 44 (36–50) at BL to 52 (44–55) at M12, p < 0.001), whereas no significant improvement was seen in MCS. Anxiety and depression decreased significantly in both PsA patients and controls. The weight loss intervention was associated with significant improvements in physical HRQoL, as well as anxiety and depression, in PsA patients and controls. ClinicalTrials.gov identifier: NCT02917434, registered on September 21, 2016, retrospectively registered. • Improved physical HRQoL and reductions in anxiety, and depression were seen in both PsA patients and controls after a weight loss intervention.

Background: Rheumatoid arthritis (RA) is associated with an increased risk of cardiovascular disease (CVD) which is linked to the systemic inflammation and increased prevalence of traditional CVD risk factors, including physical inactivity. There is an inverse association between cardiorespiratory fitness (CRF) and CVD risk profile in RA. High intensity aerobic interval training is a time efficient method with the potential for greater physiological response than continuous moderate intensity exercise on CRF. However, randomized controlled trials evaluating the effects of high-intensity interval training in RA is sparse. Objectives: To evaluate the effect of 12-weeks of high-intensity exercise on cardiorespiratory fitness and body compositions in patients with RA. Methods: Patients with RA (ACR/EULAR 1987/2010 criteria), disease duration > 12 months, were recruited and randomised to either an intervention group (n=43) or a control group (n=44). The exercise program of 12 weeks comprised supervised high-intensity interval training 4x4 minutes at 90-95% of HRmax, and strength exercise two times per week, plus an additional non-supervised aerobic session on moderate intensity of the patient´s own choice. The controls received individual information for physical activity according to the general health recommendations and were encouraged to be active on moderate intensive level ≥150 minutes/week. Primary outcome was change in cardiorespiratory fitness; maximal oxygen uptake (VO2mL/ kg/min) from baseline and 3 months obtained with a maximal cardiopulmonary exercise test (CPET) on a stationary cycle ergometric. Secondary outcome was change in body composition; weight, BMI-score and waist circumference and disease activity from baseline and 3 months. Group differences were assessed with the change from baseline to 3 months using Fisher´s non-parametric permutation test. Results: In total, 87 patients, 85% female and mean age 48 years were included in the assessor blinded multicentre controlled study. A total of 77 patients completed the CPET at 3 months, 41 in the intervention group (IG) and 36 in the control group (CG). The IG had a 3.54 (95% CI 2.05; 5.00) mL/kg/min (p< 0.001) higher VO2max compared to the CG at 3 months. A significant between group difference of change was found for waist circumference -2.6 (95% CI -5.09; -0.18) cm (p=0.035), in favour for the IG, while the weight and BMI-score did not change. Disease activity assessed with DAS28-ESR did not change and remained low in both groups, Table 1. Conclusion: A 12-weeks supervised exercise program of high intensity had beneficial effects on cardiorespiratory fitness and body composition without deterioration in disease activity. This indicates that the exercise intervention is feasible and can be used to improve important cardiovascular risk factors in patients with RA with a low disease activity. REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests: None declared.

ObjectiveIn this post hoc analysis of a previously published study, we compared cytokines and adipokine levels in women and men with psoriatic arthritis (PsA) at baseline (BL) and 6 months (M6) following a weight loss intervention.MethodsPatients with PsA (n=41) between 25 and 75 years of age, with body mass index (BMI)≥33 kg/m2were included in a weight loss intervention with a very low energy diet (VLED) for 12 or 16 weeks depending on BL BMI<40 or ≥40 kg/m2. As controls (n=39), obese individuals, already planned for VLED treatment were recruited and matched for sex, age and weight to the patients with PsA. Cytokines and adipokines were measured at BL and M6.ResultsAt BL, serum levels of interleukin (IL)-23, leptin and high molecular weight-adiponectin were higher in women with PsA compared with men, whereas serum levels of interferon (IFN)-γ, IL-12/IL-23 p40 and IL-13 were significantly lower in women. Serum IL-23 was significantly reduced at M6 compared with BL in women but not in men with PsA. In women with PsA, the reduction in IL-23 at M6, ∆IL-23, were positively correlated with ∆Disease Activity Score 28 C reactive protein (CRP) (Spearman’s correlation (rS)=0.486, p=0.016), ∆CRP (rS=0.468, p=0.021), ∆leptin (rS=0.683, p<0.001) and negatively correlated with ∆total-adiponectin (rS=−0.433, p=0.035). Also in women, ∆Disease Activity in Psoriatic Arthritis was positively correlated with ∆tumour necrosis factor-α (rS=0.417, p=0.034), ∆IL-1β (rS=0.550, p=0.034), ∆IFN-γ (rS=0.414, p=0.035) and ∆leptin (rS=0.410, p=0.038). None of these correlations were significant in men with PsA.ConclusionsWomen and men with PsA differed with regard to serum levels of cytokines and adipokines before and after weight loss.

Background: Obesity is over-represented in psoriatic arthritis (PsA) and associated with increased disease activity and poorer effect of treatment. A large body of evidence suggest that alterations in gut microbiota play a role in the development of metabolic syndrome. Deviations from the normal gut microbiome, dysbiosis, has also been demonstrated in psoriasis and PsA.We have previously reported that a structured weight loss treatment including Very Low Energy Diet (VLED) in 39 patients with PsA and obesity and matched controls with obesity resulted in a reduction of body weight by 16%, along with significantly lowered disease activity in joints, entheses and skin in the PsA patients at 12 months follow-up. Objectives: The objective of this sub-study was to study the interplay between PsA, obesity, weight loss and gut bacteria, by comparing the fecal microbiota composition in the same PsA patients and controls (matched for sex, age and body weight) at baseline (BL) and 12 months (M12) after the weight loss treatment. Methods: PsA patients and controls underwent treatment with VLED (640 kcal/d during 12-16w) followed by a structured reintroduction of food and were followed for 12 months. Fecal samples were collected at BL and M12 and analyzed by the GA-map Dysbiosis Test Lx v2 (Genetic Analysis, Oslo, Norway), which uses DNA probes that target the variable regions of the bacterial 16S rRNA in 48 preselected bacterial species or groups (e.g., species, class, phylum), covering a wide range of gut bacteria. The microbiota profile of the participants was also compared with that of a healthy reference population in the lab with the GA-map algorithm which calculates a Dysbiosis Index score (DI) of 1 to 5. A DI of 1–2 indicates normobiosis, DI 3 mild dysbiosis, and DI 4–5 more severe dysbiosis. The microbiota composition of the PsA patients and controls was analyzed with principal component analysis (PCA) and Orthogonal partial least squares discriminant analyses (OPLS-DA). Results: In total 36 PsA patients (69% women, mean age 54.5 and body weight 104 kg) and 45 controls (73% women, mean age 54 and body weight 108 kg) were included. At M12 weight loss since BL in patients and controls was 16 (IQR 11–23) kg and 17 (IQR 8–24) kg respectively.Dysbiosis, defined as a DI≥3, was fond in 17/36 (47.2%) of PsA patients and 16/45 (35.6%) of controls at BL (p=0.288). Both patients and controls had lower levels of Faecalibacterium prausnitzii and higher levels of Ruminococcus gnavus than the healthy lab population. No significant differences in fecal microbiota composition could however be identified between patients and controls at BL. (Figure 1) After weight loss significant decreases in Actinobacteria and Bifidobacterium spp and increase in Akkermansia muciniphila was detected in the in PsA patients, whereas in controls there was a significant decrease in Lachnospiraceae, Veillonella spp, Firmicutis (various), Ruminococcus gnavus, Eubacterium rectale, Dorea spp. and Clostridium methylpentosum at M12 (Figure 2a and 2b). Conclusion: Fecal microbiota composition did not differentiate between PsA patients and matched controls both with obesity, but dysbiosis was common in both groups. Weight loss was associated with changed levels of several bacteria, indicative of improved intestinal health. REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests: None declared.

Background: Obesity is highly overrepresented in individuals with psoriatic arthritis (PsA) and associated with increased disease activity and inferior treatment effect. We have earlier demonstrated in 39 patients with PsA and body mass index (BMI) ≥33 kg/m2 that a 12-month (M12) weight loss regime was associated with significant improvements in C-reactive protein (CRP) and disease activity in joints, entheses and skin. Objectives: Based on the same PsA patients from the previous study, this sub-study has also included a control group of 39 individuals with obesity, matched for sex, age, and body weight to the patients. The objectives are to investigate the effects of weight loss on serum biomarkers related to inflammation, cartilage and bone metabolism along with the effects of weight loss on bone mineral density (BMD). Methods: The weight loss treatment included 12-16 weeks with VLED (640 kcal/day), followed by an energy restricted diet. Support for health-enhancing physical activity was given by a physiotherapist. Disease-modifying anti-rheumatic drugs (DMARDs) were held unchanged from three months before baseline (BL) until M6. All participants were assessed with Dual Energy X-ray Absorptiometry (DXA) and blood samples were collected at BL and M12. Serum levels of vascular endothelial growth factor (VEGF), S100A8, S100A9, matrix metalloproteinases (MMP-3 and 8), hepatocyte growth factor (HGF), B-cell activating factor (BAFF), Dickkopf (Dkk)-1, sclerostin (SOST), soluble receptor activator of nuclear factor-kB ligand (RANKL) and osteprotegerin (OPG) were measured with Magnetic Luminex Assays (R&D-systems) following the manufacturer’s instructions using a Bio-Plex 200 system (BioRad). Serum cartilage oligomeric matrix protein (COMP) (R&D-systems), carboxyterminal telopeptide of type-1 collagen (CTX-1) (Immunodiagnostics systems: IDS) and osteocalcin (IDS) were measured with enzyme-linked immunosorbent assay (ELISA). Mann-Whitney U-test was used in comparisons between groups and Wilcoxon Signed Rank Test was used to compare related continuous variables within groups. Results: A total of 39 PsA patients, 64.1% women, median age 56 (49-63) years, participated in the study from BL to M12, together with 39 controls, 74.4% women, median age 57 (49-61) years. At M12, both groups had lost approximately 16% in weight, which was associated with significant increases in serum CTX-1, osteocalcin, SOST, Dkk-1 and OPG, while significant reductions were seen in serum RANK-L, HGF, S100A8, S100A9, BAFF and MMP-3. (Table 1) There was no significant difference in biomarker levels between the PsA patients and the control group at BL or M12, and the change in biomarker levels (Δ-values BL-M12) was similar in the PsA patients and controls. DXA on the PsA patients (N=37) at BL and M12 showed significant reductions in total bone mineral density (1.234 (1.129-1.325) g/cm2 vs. (1.217 (1.116-1.286) g/cm2 and total bone mineral content (2704 (2457-3162) g vs. 2643 (2397-3092, p<0.001) g, p<0.001). Similar DXA scan results were found in the control group (N=22). Conclusion: After 12 months, weight loss was strongly associated with significant changes of biomarkers for bone turnover and lowered serum levels of biomarkers related to inflammation, along with a reduction of bone mass. The study supports the strong relationship between obesity, bone turnover and inflammation.Table 1. Comparison of patients with psoriatic arthritis (PsA) and controls at baseline (BL) and 12-month (M6) follow-up. Figures are median and interquartile range (IQR). REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests: None declared.

Background: Adult patients with chronic inflammatory joint diseases have been shown to develop various strategies to cope with daily life. Coping strategies may change over time, depending on the illness progression or which phase of the disease the patient is experiencing. Still, there is a knowledge gap about how adolescents with recent onset inflammatory joint disease cope with their situation in daily life. Objectives: The objective of this study was to describe how adolescents aged 18–25 years, experience and manage the disease and daily life during the first year after being diagnosed with a chronic inflammatory joint disease. Methods: A qualitative research design was chosen, individual semi-structured interviews were conducted to understand the respondents' experiences of managing their life and the disease during the first year of an inflammatory joint disease diagnosis. The interview texts were subjected to qualitive content analysis, including both manifest content and interpretations of underlying latent meaning. The data was analyzed using subcategories and categories that corresponds to the aim of the study [1]. A total of 21 patients were invited of whom 14, eight woman and six men, median age 24 (range 18–25 years), within one year of being diagnosed with a chronic inflammatory joint disease, agreed to participate in the study. Results: The analysis resulted in five categories and twelve subcategories that described the adolescents' experiences during the first year after receiving a chronic inflammatory joint disease diagnosis. The five categories were 1) Processing towards diagnosis; the respondents described the time taken to reach a diagnosis long and frustrating before they finally got a correct diagnosis. When they eventually came to specialist care, they were listened to and met with the right competence. 2) Struggling with the consequences of the disease, the respondents described experiencing a crisis when diagnosed with the disease, which could affect them both physically and mentally. 3) Managing the new situation; the respondents found that they had to find strategies and tools to manage and cope with the new situation. 4) Receiving support; the experienced support from family, friends, healthcare, employers, and co-workers were important for the respondents to cope in daily life. 5) Accepting the situation; the respondents experienced that it was tough to be in transitioning to adulthood and becoming ill with a chronic disease at the same time, however they felt that they were growing as individuals and that they became more open to changes in their lives. Conclusion: The main finding of the study is that the adolescents' lifeworld changed in many ways, and that they were passing through several processes, both physically and mentally during their first year after being diagnosed with an inflammatory joint disease. However, they found coping strategies to manage their new situation. During this process, support from significant others were crucial. The study also points to the need to listen to adolescents, to involve them more in their own treatment, to understand their lifeworld and to strengthened them as the experts on themselves. REFERENCES: [1] Graneheim UH, Lundman B. Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness. Nurse Education Today. 2004;24 (2), 105-112. DOI 10.1016/j.nedt.2003.10.001. Acknowledgements: NIL. Disclosure of Interests: None declared.

Objectives Patients with rheumatoid arthritis (RA) have substantially elevated risk for cardiovascular diseases, and low cardiorespiratory fitness (VO 2 max) is a major mediator. The aim of this assessor-blinded, two-armed multicentre randomised controlled trial was to evaluate the effects of high-intensity interval training (HIIT) and strength exercise on cardiovascular health, physical fitness and overall health in patients with RA. Methods In total, 87 patients (86% female; aged 20–60 years) were randomly assigned to an intervention group (IG) or a control group (CG). The IG performed HIIT and strength exercise for 12 weeks. The CG was instructed to be physically active on a moderately intensive level, ≥150 min/week. Primary outcome was change in VO 2 max. Secondary outcomes were changes in anthropometry measures, muscle strength, overall health (Visual Analogue Scale (VAS)-Global), Patient Global Impression of Change (PGIC), pain and disease activity (Disease Activity Score in 28 joints (DAS28)). Results There was a significant mean group difference of change on VO 2 max (3.71 mL/kg/min; 95% CI 2.16, 5.25) in favour of the IG. Significant mean group differences of change were also seen for O 2 -pulse (1.38; 95% CI 0.85 to 1.91), waist circumference (−2.6; 95% CI −5.09 to –0.18), 1-minute sit-to-stand (5.0; 95% CI 3.35 to 6.72), handgrip strength (28.5; 95% CI 3.80 to 52.8), overall health (−14.7; 95% CI –23.8 to –5.50) and PGIC (p<0.0001) in favour of the IG. No significant mean group differences of change were found for pain (−4.0; 95% CI −13.07 to 5.06), DAS28 (−0.25; 95% CI −0.60 to 0.10) and erythrocyte sedimentation rate (−0.64; 95% CI −3.23 to 1.90). Conclusion Supervised HIIT and strength exercise improved cardiovascular health, physical fitness and overall health without a deterioration in pain and disease activity and should be considered in patients with well-controlled RA. Trial registration number NCT05768165 .

Introduction Patients with psoriatic arthritis (PsA) are frequently obese. We have previously shown decreased disease activity in patients with PsA with a body mass index (BMI) ≥ 33 kg/m 2 following weight loss treatment with Very Low Energy Diet (VLED), resulting in a median weight loss of 18.6% at six months (M6) after baseline (BL). In this study we assessed the effects of VLED on cytokines and adipokines at M6 in the same patients with PsA and controls (matched on sex, age and weight). Methods VLED (640 kcal/day) during 12 or 16 weeks, depending on BL BMI < 40 or ≥ 40 kg/m 2 , was taken and followed by an energy-restricted diet. Cytokines and adipokines were measured with Magnetic Luminex Assays at BL and M6. Results Serum interleukin (IL)-23, (median (interquartile range) 0.40 (0.17–0.54) ng/mL vs. 0.18 (0.10–0.30) ng/mL, p < 0.001) and leptin (26.28 (14.35–48.73) ng/mL vs. 9.25 (4.40–16.24) ng/mL, p < 0.001) was significantly decreased in patients with PsA. Serum total (tot)-adiponectin and high molecular weight (HMW) adiponectin increased significantly. Similar findings were found in controls. Also, in patients with PsA, ∆BMI was positively correlated with ∆IL-23 (r S = 0.671, p < 0.001). In addition, significant positive correlations were found between ΔBMI and ΔDisease Activity Score (DAS28CRP), ΔCRP, Δtumor necrosis factor (TNF)-α, ΔIL-13, ∆IL-17 and Δleptin, and negative correlations between ΔBMI and Δtot-adiponectin. Conclusions Weight loss was associated with decreased levels of leptin and cytokines, in particular IL-23. These findings may partly explain the anti-inflammatory effect of weight reduction in PsA. Trial registration ClinicalTrials.gov identifier: NCT02917434, registered on September 21, 2016, retrospectively registered.

ObjectivesTo assess sleep quality, and its associations with physical function, cardiorespiratory fitness, and spinal mobility, in axial spondyloarthritis (axSpA) patients.MethodBaseline data from the Exercise for Spondyloarthritis trial were used. Assessments included [Pittsburgh Sleep Quality Index (PSQI), 0-21, 21 = worst], performance-based physical function [Ankylosing Spondylitis Performance Index (ASPI), seconds, higher = worse], patient-reported physical function [Bath Ankylosing Spondylitis Functional Index (BASFI), 0-10, 10 = worst], cardiorespiratory fitness [peak oxygen uptake ($\rm V$VO2peak), mL/kg/min, lower = worse], and spinal mobility [Bath Ankylosing Spondylitis Metrology Index (BASMI), 0-10, 10 = worst]. Associations were examined in separate models using multiple linear regression.ResultsNinety-nine patients with axSpA were included, 53% female, mean age 46 years, and 72% with high disease activity (ASDAS-C-reactive protein >= 2.1), of whom 84 (85%) had reduced sleep quality. Sleep disturbance was most frequently reported (65%), followed by poor subjective sleep quality (53%), daytime dysfunction (41%), and increased sleep latency (41%). Positive associations were observed between PSQI and ASPI [beta = 0.10, 95% confidence interval (CI) 0.01, 0.19] and PSQI and BASFI (beta = 0.85, 95% CI 0.51, 1.20), and there was an inverse association between PSQI and $\rm V$VO2peak (beta = -0.14, 95% CI -0.27, -0.01), adjusted for age and sex. There was no association between PSQI and BASMI.ConclusionReduced sleep quality was common in axSpA patients with moderate to high disease activity. Better sleep quality was associated with better physical function and higher cardiorespiratory fitness. There was no association between sleep quality and spinal mobility.Trial registrationClinicalTrials.gov NCT02356874

Background Despite more effective control of inflammation by improved pharmacological therapies, persistent pain and fatigue are still a major problem among patients with rheumatoid arthritis (RA), which often leads to slow deterioration of function and general health. Objectives To evaluate the effect of high-intensity exercise on fatigue, pain, and general health in patients with established RA. Methods Patients with RA (ACR/EULAR 1987/2010 criteria), disease duration > 12 months, were recruited and randomised to either an exercise group or a control group. The exercise program of 12 weeks comprised supervised cardiorespiratory high-intensity interval exercise and strength exercise twice per week plus an additional non-supervised session of the patient´s own choice. The controls received individual information for physical activity according to the general health recommendations and were encouraged to be active on moderate intensive level ≥150 minutes/week.Outcomes. Self-reported ratings on symptoms were evaluated at baseline (BL) and 3 months (M3): Fatigue, using the Multidimensional Fatigue Inventory (MFI 20) scale, including five subscales; general fatigue, physical fatigue, mental fatigue, reduced activity and reduced motivation (range = 4 to 20 for each subscale, higher score = higher degree of fatigue); visual analogue scale (VAS) was used for the assessment of average pain intensity, fatigue and general health during the last week due to the rheumatic disease (0 = no symptom, 100 = worst possible). Results A total of 73 patients median age 49 (86.3% women), median disease activity 2.0 (1,34 to 2.56 IQR) (DAS28-ESR) were included in the study. At 3 months, there was a significant improvement on MFI-20 subscales general fatigue (p=0.002) and physical fatigue (p<0.001) in the intervention group when compared with the control group. No significant differences of change were found for the other subscales, general fatigue, reduced activity and reduced motivation or for VAS fatigue. A significant difference of change was found between the groups for VAS Global (p=0.026) while no significant differences of change was found for VAS pain between the groups. Table 1. Conclusion A 12-week exercise program of high intensity had beneficial effects on general fatigue and physical fatigue, in patients with established RA whereas the intervention did not influence pain intensity or general health. A multidimensional scale on fatigue appears to better distinguish changes in fatigue than a one-dimensional scale in patients with established RA. REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests None Declared.Table 1Differences between groups in assessment measures at 3 months compared to baselineIntervention group (n=37)Control group (n=36)Between groupBaselineΔ M3-BL(n=35)BaselineΔ M3-BL(n=29)Analysis of change Δp-valueMFI-20General fatigue13,0(11,0 to 17,5)-3,0(-5.0 to 1.0)**14,0(12,0 to 17,0)1.0(-2.0 to 3.0)0,002Physical fatigue13,0 (9,0 to17,05)-4.0(-8.0 to -1.0)***13,0(10,0 to 16,0)0.0(-2.75 to 1.75)<0.001Mental fatigue11,0(7,0 to 12,5)0.0(-3.0 to 1.0)11,0(9,0 to 13,0)0.0(-3.0 to 1.0)0,784Reduced motivation8,0(5,0 to10,0)0.0(-3.0 to 1.0)9,0(6,0 to 12,0)1.0(-1.0 to 2.0)0,110Reduced activity11,0(8,0 to13,0)-1.0(-5.0 to 1.0)*11,0(8,00 to 13,0)0.0(-3.0 to 2.75)0,159VAS,0-100 mmFatigue33.0(15,9 to 49,2)-2.0(-12.0 to 11.8)27,3(6,0 to 46.3)6.4(-2.6 to 17.8)*0.079Pain14,7(7.6 to 17.9)1,0(-10.5 to 8.7)12,6(4.0 to 31.5)1,4(-13.4 to 8.1)0.939G-health15.7(7,0 to 26,8)0,0(-10.5 to 5.5)14.0(4.0 to 25.2)2.5(-0.2 to 29.4)*0.026Variables are presented as median and IQR.MFI Multidimensional Fatigue Inventory, VAS Visual Analog Scale Fatigue, Pain, Global. Delta values were compared using the Mann–Whitney U test. Within-group comparisons were made with Wilcoxon signed rank test.*Significant difference, p < 0.05.**Significant difference, p < 0.01.***Significant difference, p < 0.001

OBJECTIVE:To evaluate the effect of a 3-month supervised high-intensity exercise program on exercise health beliefs in patients with axial spondyloarthritis.METHODS:This was secondary analysis of a randomized controlled trial. Participants (ages 23-69 years) were randomized to an exercise group (n = 50) or a control group (n = 50). The intervention was an individually guided cardiorespiratory and strength exercise program performed 2 times per week, plus an additional individual exercise session of personal choice. The control group received standard care and instructions to maintain their physical activity level. Exercise health beliefs using the Exercise Health Beliefs questionnaire (range 20-100, 100 = best), i.e., barriers, benefits, self-efficacy and exercise impact on arthritis, and physical activity, were assessed with self-reported questionnaires at baseline, 3 months, and 12 months after inclusion.RESULTS:The majority of the participants in the exercise group (76%) followed ≥80% of the prescribed exercise protocol. There was a significant effect of the intervention on exercise health beliefs at 3 months (estimated mean group differences 4.0 [95% confidence interval (95% CI) 1.4, 6.6]; P = 0.003) and the effect persisted at 12 months follow-up (estimated mean group differences 3.8 [95% CI 1.0, 6.6]; P = 0.008). Participants with higher exercise health beliefs had a higher odds ratio (1.1 [95% CI 1.0, 1.20]; P = 0.003) for being physically active at 12 months follow-up.CONCLUSION:A supervised high-intensity exercise program had beneficial short- and long-term effects on participants' exercise health beliefs. Stronger exercise health beliefs were positively associated with a higher chance to be physically active on a health-enhancing level at 12 months follow-up.

Objectives To evaluate the effects of weight loss treatment on physical fitness in patients with psoriatic arthritis (PsA) and obesity compared to matched controls. Methods In total, 46 patients with PsA (CASPAR) and BMI ≥ 33 kg/m 2 and 52 obese persons were included in this 12-month prospective open intervention study with a very low energy diet (640 kcal/day), followed by structured reintroduction of an energy-restricted diet and brief support for physical activity. The primary outcome was muscle strength assessed with hand-grip strength (Grippit) and leg muscle strength (timed stand test). Secondary outcomes were cardiorespiratory fitness, body composition, and physical functioning (SF-36PCS). Outcomes were assessed at baseline, 6 (M6), and 12 months (M12). Nonparametric statistics were used. Results Median weight reduction at M6 was 18.9 kg in patients and 23.0 kg in controls, ( p = 0.546). At M12, patients’ median weight loss from baseline was 16.1 kg, corresponding with significant loss of total fat mass (− 30.1%), and lean mass (total − 7.0%, arm − 13.7%, and leg − 6.0%). Leg muscle strength improved in patients and controls at M6 ( p < 0.001) and remained improved at M12 ( p < 0.01), while hand-grip strength was unchanged in both groups. Cardiorespiratory fitness increased in controls at M6 ( p = 0.018) and M12 ( p = 0.028) but not in patients. Physical functioning improved in both groups at M6 ( p < 0.001) and remained improved at M12 ( p = 0.008) and ( p < 0.01), respectively. Conclusion The intervention resulted in positive effects on body weight and total body fat. Despite reduced lean body mass, the muscle strength did not deteriorate in patients with PsA and controls. Trial registration ClinicalTrials.gov identifier: NCT02917434, registered on September 21, 2016-retrospectively registered. Key Points • Patients with PsA and obesity can benefit from weight loss treatment without the risk of deterioration in muscle strength and cardiorespiratory fitness. • Muscle strength and cardiorespiratory fitness were below suggested normative values for the majority of the patients at all time points, implying that more structured exercise strategies might be warranted to counteract physical fitness deficiencies in patients with PsA undergoing weight loss treatment.

Background: Obesity is highly overrepresented in psoriatic arthritis (PsA) and associated with increased disease activity. We have previously shown in 41 patients with PsA (Caspar criteria) and obesity (here body mass index BMI ≥33 kg/m 2 ) that weight loss treatment including Very Low Energy Liquid Diet (VLED) resulted in a median weight loss of 18.6% and concomitantly a significant improvement in CRP and disease activity in joints, entheses and skin at six months (M6) follow up. Objectives: To analyze serum biomarkers associated with inflammation, cartilage and bone metabolism before and after weight loss treatment in PsA patients compared with controls, without PsA or psoriasis, matched for age, sex and weight. Methods: The weight loss treatment included VLED (640 kcal/day) during 12 or 16 weeks (depending on baseline (BL) BMI <40 or ≥40 kg/m 2 ), followed by a structured reintroduction of an energy restricted diet. cs/bDMARDs were held unchanged from 3 months before BL until M6. The patients were assessed with 66/68 joints counts. Serum levels of vascular endothelial growth factor (VEGF), S100A8, S100A9, matrix metalloproteinases (MMP-3, 8 and 13), hepatocyte growth factor (HGF), B-cell activating factor (BAFF), Dickkopf (DKK)-1, sclerostin (SOST), soluble receptor activator of nuclear factor-kB ligand (RANKL), osteprotegerin (OPG) and aggrecan were measured at BL and M6 in PsA patients and controls with Magnetic Luminex Assays (R&D-systems) following the manufacturer’s instructions using a Bio-Plex 200 system (BioRad). Serum cartilage oligomeric matrix protein (COMP) (R&D-systems), carboxyterminal telopeptide of type-1 collagen (CTX-1) (Immunodiagnostics systems: IDS) and osteocalcin (IDS) were measured with enzyme-linked immunosorbent assay (ELISA). Results: Totally 41 PsA patients [age median 54 (IQR 48-62) yrs; 63 % women] and 39 controls [age 55 (46-60) yrs, 72 % women] were included. At M6 the weight-loss since BL was 18.7 (14.6-26.5) kg in the PsA patients and 22.6 (14.7-28.4) kg in the controls (p=0.546). Significant reductions in DAS28CRP [2.9 (2.1–3.7) vs. 2.4 (1.7–3.0)] and DAPSA [15.3(6.6-29.1) vs. 11.0 (2.8–17.6)] (p<0.001) were seen in the PsA patients. At BL serum levels of the biomarkers were not significantly different in patients vs. controls. After weight-loss significant reductions were seen in serum VEGF, S100A8, MMP-8, HGF, BAFF, COMP and DKK-1, whereas serum SOST and CTX-1 were significantly increased in both patients and controls (Table 1). The other biomarkers were not significantly changed. Conclusion: Weight loss in patients with PsA and controls was associated with lowered serum levels of several biomarkers related to inflammation and cartilage degradation, along with increased levels of biomarkers for bone turnover. Table 1. PsA (N=41 ) BL median (IQR ) PsA (N=41 ) M6 median (IQR ) PsA p-value Ctrl (N=39 ) BL median (IQR ) Ctrl (N=39 ) M6 median (IQR ) Ctrl p-value BMI (kg/m 2 ) 35.2 (34.1-38.1) 29.8 (26.6-31.5) <0.001 37.7 (36.7–41.5) 30.4 (27.9–33.2) <0.001 CRP (mg/L) 4 (2–8.5) 2 (1–6.5) 0.041 4 (2–6) 2 (1–4) <0.001 VEGF (pg/mL) 79.6 (55.9–113.5) 69.6 (53.1–105.3) 0.010 82.3 (48.0–125.9) 65.0 (42.2-85.5) <0.001 S100A8 (pg/mL) 75.5 (48.0–99.5) 63.3 (42.8–93.6) 0.021 71.8 (40.5–101.0) 63.3 (40.3-85.7) 0.006 MMP-8 (pg/mL) 9975.4 (6811.8–14154.8) 9202.6 (5767.1–12049.6) 0.017 7494.7 (4805.2-12616.9) 7218.3 (3466.0-9785.3) 0.112 HGF (pg/mL) 327.9 (250.3–413.6) 271.3 (206.9–331.0) <0.001 307.9 (239.1–348.3) 239.8 (200.3-276.0) <0.001 BAFF (pg/mL) 794.4 (716.4–868.2) 674.6 (613.2–790.5) <0.001 760.8 (664.1–827.3) 678.1 (603.7–719.8) <0.001 COMP (pg/mL) 266.1 (209.8–366.0) 217.0 (156.0–272.0) 0.008 293.6 (185.2–340.5) 221.6 (163.5-300.0) 0.018 Dkk-1 (pg/mL) 3608.4 (3055.0–4401.3) 3382.6 (2802.5–4218.2) 0.002 3635.8 (3212.8-4380.6) 3480.4 (2948.9–4087.3) 0.007 SOST (pg/mL) 52.9 (32.5–65.4) 60.3 (37.2–85.6) 0.014 50.0 (30.8–79.3) 61.3(35.7–81.4) 0.019 CTX-1 (ng/mL) 0.27 (0.20–0.39) 0.51 (0.35–0.64) <0.001 0.23 (0.16–0.34) 0.50(0.30–0.61) <0.001 Disclosure of Interests: None declared.

Objective. To explore the longterm effect of a 3-month exercise program on leisure time physical activity level in individuals with axial spondyloarthritis (axSpA). Methods. A secondary analysis was performed on data from 100 individuals with axSpA who were included in a randomized controlled trial. The exercise group (EG) participated in a 3-month exercise program while the control group (CG) received no intervention. Physical activity during leisure time was measured with a questionnaire (physically active: ≥ 1 h/week with moderate/vigorous intensity physical activity). Disease activity was measured with the Ankylosing Spondylitis Disease Activity Scale (ASDAS; higher score = worst). Statistical analyses were performed on an intention-to-treat basis using chi-square tests, logistic regression, and mixed models. Results. At the 12-month followup, significantly more individuals in the EG than in the CG were physically active [29 (67%) vs 13 (30%), p < 0.001] and exercised 2–3 times/week [25 (58%) vs 15 (34%), p = 0.02], and fewer exercised at light intensity [3 (8%) vs 14 (44%), p = 0.002]. “Participation in the EG” (OR 6.7, 95% CI 2.4–18.6, p < 0.001) and “being physically active at baseline” (OR 4.7, 95% CI 1.4–15.8, p = 0.01) were the factors most associated with being physically active. There were no differences between the groups in ASDAS (p = 0.79). Conclusion. A 3-month exercise program had a beneficial longterm effect on leisure time physical activity in individuals with axSpA, thus indicating a more beneficial health profile. Still, few individuals continued the intensive program, and there was no difference between the groups in disease activity after 12 months. ( ClinicalTrials.gov : NCT02356874 )

Abstract Background Obesity is overrepresented in patients with psoriatic arthritis (PsA) and associated with increased disease activity. We have previously shown in 41 patients with PsA (Caspar criteria) and obesity (body mass index; BMI ≥33 kg/m2) that weight loss treatment with Very Low Energy Liquid Diet (VLED), 640 kcal/day during 12–16 weeks, followed by a structured reintroduction of an energy restricted diet resulted in a median weight loss of 18.6% and concomitantly a significant improvement of the disease activity in joints, entheses and skin. The objectives of this follow-up were to study the effects of the weight loss treatment on disease activity in longer term (12 and 24 months) and to study the effects on cardiovascular risk factors. Methods The patients were assessed with 66/68 joints count, Leeds enthesitis index (LEI), body surface area, blood pressure, BMI, questionnaires and fasting blood samples at the 12- and 24-month visits. Results In total, 39 and 35 PsA patients attended the 12- and the 24-month visits, respectively. Median weight loss since baseline was 16.0% (IQR 10.5–22.4) and 7.4% (IQR 5.1–14.0) at the 12- and 24-months follow-up. The 66/68 swollen/tender joints score, LEI, CRP and HAQ score were still significantly reduced at the 12- and 24-month visits compared to baseline. The number of patients with Minimal Disease Activity increased from 28.2% (11/39) at baseline, to 38.5% (15/39; p = 0.008) and 45.7% (16/35; p = 0.016) at the 12- and 24-month visits. The weight loss was also associated with improved levels of serum lipids, glucose and urate and the antihypertensive treatment was reduced or stopped in five patients during the follow-up. Conclusions Weight loss treatment, with VLED included in the program, was associated with long-term improvement of measures of disease activity, self-reported function and markers of the metabolic syndrome after 24-months follow-up. Trial registration ClinicalTrials.gov identifier: NCT02917434 , Registered September 28, 2016- Retrospectively registered.

ObjectiveIn a few studies, high‐intensity exercise has displayed beneficial effects on cardiovascular health among patients with rheumatic diseases, yet the high‐intensity exercise mode is still not fully accepted among health care professionals. The aim of this study was to investigate experiences of high‐intensity exercise among patients with axial spondyloarthritis.MethodsFourteen respondents who had participated in a high‐intensity exercise program for 12 weeks were included in this qualitative study with individual semistructured, in‐depth interviews. The respondents’ median age was 53, ranging from 23 to 63 years old, and both men and women of different ethnicities were represented. Interviews were analyzed by qualitative content analysis, including both manifest content and interpretations of underlying latent meaning.ResultsThe analysis resulted in five categories describing the respondents’ experiences with high‐intensity exercise: 1) high‐intensity exercise as a challenge for both body and mind, 2) increased faith in one's own body, 3) changed attitude toward exercise, 4) taking charge of one's own health by challenging the disease, and 5) exercise in a social context.ConclusionSupervised high‐intensity interval exercise was perceived as challenging for both body and mind but was also described as a positive experience, with rapid bodily effects that strengthened respondents’ faith in their own bodies. The new experience seemed to have changed the respondents’ attitude and motivation for exercise and made them start taking charge of their health by challenging the disease. Exercise in a social context, under professional leadership, enhanced exercise self‐efficacy and helped the respondents to adhere to the exercise program.

Objective. Although exercise is recommended in the treatment of axial spondyloarthritis (axSpa), the focus has been on flexibility, and the effect of high-intensity exercises is unknown. The purpose of this study was to investigate the effect of high-intensity exercises on fatigue, sleep, and mood in patients with axSpA. Methods. In this secondary analysis of a randomized controlled trial, participants were recruited from outpatient clinics at 4 hospitals in Scandinavia. A total of 100 patients with axSpA were randomized to either an exercise group (n = 50) or a control group (n = 50). High-intensity exercise was provided 3 times per week for 3 months and supervised by a physical therapist. The controls received no intervention. Measurements were self-reported at baseline, 3 months, and 12 months: fatigue, using the Fatigue Severity Scale (range = 0-7, 7 = worst, >= 5 = severe); vitality, using the RAND 36-item short-form health survey (SF-36, range = 0-100, 100 = best); sleep, using the Pittsburgh Sleep Quality Index (range = 0-21, 21 = worst, >5 = poor quality); mood, using the General Health Questionnaire 12 (range = 0-36, 36 = worst); and general health, using the EUROQoL (range = 0-100, 100 = best). Results. A total of 38 participants (76%) in the exercise group followed >= 80% of the exercise protocol. At 3 months, there was a significant beneficial effect on fatigue (mean group differences = -0.4, 95% CI = -0.7 to -0.1), vitality (5.0, 95% CI = 1.1 to 10.5), mood (-2, 95% CI = -3.7 to -0.04), and general health (9.0, 95% CI = 3.3 to 14.7) but no effect on sleep (-1.1, 95% CI = -2.1 to 0.2). Compared with the control group, the exercise group had a reduced rate of severe fatigue and poor sleep. No differences were seen between the groups at 12 months. Conclusions. A 3-month exercise program had a beneficial effect on fatigue, sleep, mood, and general health in patients with axSpA at the end of the intervention; however, no long-term effects were seen. Impact. High-intensity cardiorespiratory and strength exercises should be considered as important in exercise programs for patients with axSpA.