[Nonpharmacological treatment of patients with spondyloarthritides]

Despite the advances in the pharmacological therapy non-pharmacologic methods and especially therapeutic exercise are a cornerstone in management of spondyloarthritides. In this review studies of various physical therapy programs in ankylosing spondylitis and other spondyloarthritides are addressed with emphasis on their benefits and potential indications as well as on limitations in clinical practice and in studying these treatments. Formal physical therapy under the supervision of a physical therapist has been shown to diminish pain and stiffness and to improve posture, mobility, function and quality of life. Apart form land exercises water therapy (including balneotherapy) may be beneficial and in most severe cases, inpatient rehabilitation may be indicated, too. Physicians should implement such non-pharmacological therapy as a part of a comprehensive management strategy. Even though data are not sufficient to determine which specific physical therapy programme should be recommended this review demonstrates that physical therapy is an effective form of intervention and remains an essential part of the management with the importance of emphasis on continued and regular exercise therapy.