An integrated approach to the treatment of ankylosing spondylitis from the position of the international classification of functioning

Ankylosing spondylitis is a chronic, gradually progressive inflammatory disease characterized by lesions of the sacroiliac joints and / or spine, which can occur with simultaneous lesions of the enthesis and peripheral joints, leading to early disability and a decrease in the quality of life of patients, mainly young age. The international society for evaluation of spondylarthritis (ASAS) recommended a combination of nonpharmacological and pharmacological methods in the treatment and rehabilitation of patients with ankylosing spondylitis for the longest possible preservation of the quality of life of patients, which requires a multidisciplinary therapeutic approach.

Currently, in many European countries, the international classification of functioning, disability and health (IСF) is used as a universal approach to the assessment of human health. The IСF classifies the different areas of each patient’s life that are health-related and affect health, thus describing changes in their physical functioning and psychological well-being. It helps to introduce multidisciplinary, patient-centered, problem-oriented rehabilitation care into the real work of clinics.

The IСF shows a broader and more meaningful picture of the patient’s health, which allows the multidisciplinary team to consider the patient from different perspectives — biological, personal and social. Using the IСF in the process of complex therapy and rehabilitation of patients with ankylosing spondylitis, a multidisciplinary team can achieve a more complete coherence of views in the treatment of patients with ankylosing spondylitis, which is very important in achieving the success of therapy of this category of patients.

1. Van der Heijde D. 2016 update of the ASAS-EULAR management recommendations for axial spondyloarthritis. Annals of the rheumatic diseases. 2017; 76(6):978-91. doi: 10.1136/annrheumdis-2016-210770

2. Jerdes Sh.F., Rebrov A.P., Dubinina T.V. et al. Spondylitis: modern terminology and definitions. Therapeutic Archive. 2019; 5:84-8. DOI: 10.26442/00403660.2019.05.000208 [in Russian].

3. Ponomarenko G.N. Physical and rehabilitation medicine: national leadership. М., GEOTAR-Media. 2016; 688 p. ISBN 978-5-97043606-6 [in Russian].

4. Balabanova R.M., Jerdes Sh.F. Rheumatic diseases in adults in the federal districts of Russia. Scientific and practical rheumatology. 2014; 52(1):5-7. [in Russian]. DOI:10.14412/1995-4484-2014-5-7

5. Balabanova R.M., Jerdes Sh.F. The prevalence of rheumatic diseases in Russia in 2012-2013. Scientific and practical rheumatology. 2015; 53(2):120-124. [in Russian]. DOI:10.14412/1995-4484-2015-120-124

6. Nasonov E.L. Russian clinical guidelines. Rheumatology. M., GEOTAR-Media. 2019; 464 p. ISBN 978-5-9704-4816-8 [in Russian].

7. Smychek V.B., Kuskova S.P., Rjabceva T.D. New approaches to rehabilitation in the light of the main provisions of the International Classification of Functioning, Disability and Health. Medical news. 2015; 4:10-13. [in Russian].

8. Ivanova G.E., Aronov D.M., Belkin A.A. et al. Pilot project “Development of the system of medical rehabilitation in the Russian Federation”. Bulletin of regenerative medicine. 2016; 2(72):2-6. [in Russian].

9. Shmonin A.A., Maltseva M.N., Melnikova E.V., Ivanova G.E. Basic principles of medical rehabilitation, rehabilitation diagnosis in the categories of ICF and rehabilitation plan. Bulletin of regenerative medicine. 2017; 2:16-22. [in Russian].

10. Smychek V.B. Fundamentals of the IFF. Minsk, 2015; 432 p. [in Russian].

11. Karkavina A.N. The international classification of functioning, disability and health as a modern tool for assessing the quality of rehabilitation of patients with osteoarthritis. The success of gerontology. 2016; 29(1):168-172. [in Russian].

12. International classification of functioning, disability and health. Geneva, WHO. 2001. [in Russian].

13. Selb M., Escorpizo R., Kostanjsek N., et al. A guide on how to develop an International Classification of Functioning, Disability and Health Core Set. Eur J Phys Rehabil Med. 2015; 51(1):105-117.

14. Ponomarenko G.N. The international classification of functioning, disability and health is a tool for the scientific evaluation of the effectiveness of medical rehabilitation. Questions of balneology, physiotherapy and physiotherapy. 2013; 2:57-62. DOI:10.17116/kurort2016612-20 [in Russian].

15. Weigl M., Cieza A., Andersen C. et al. Identification of relevant ICF categories in patients with chronic health conditions: a Delphi exercise. J Rehabil Med. 2004; 44 (Suppl.):12-21. DOI: 10.1080/16501960410015443

16. Sigl T., Cieza A., van der Heijde D., Stucki G. ICF based comparison of disease specific instruments measuring physical functional ability in ankylosing spondylitis. Ann Rheum Dis. 2005; 64(11):1576-81. DOI: 10.1136/ard.2004.027185

17. Van Echteld I., Cieza A., Boonen A., et. al. Identification of the most common problems by patients with ankylosing spondylitis using the international classification of functioning, disability and health. J Rheumatol. 2006; 33(12):2475-83.

18. Boonen A., van Berkel M., Kirchberger I., et. al. Aspects relevant for functioning in patients with ankylosing spondylitis according to the health professionals: a Delphi study with the ICF as reference. Rheumatology (Oxford). 2009; 48(8):997-1002. doi: 10.1093/rheumatology/kep150

19. Boonen A., van Berkel M., Cieza A., et al. Which aspects of functioning are relevant for patients with ankylosing spondylitis: results of focus group interviews. J Rheumatol. 2009; 36(11):2501-11. doi: 10.3899/jrheum.090156.

20. Boonen A., Braun J., van der Horst Bruinsma I.E., et. al. ASAS/WHO ICF Core Sets for ankylosing spondylitis (AS): how to classify the impact of AS on functioning and health. Ann Rheum Dis. 2010; 69(1):102-7. doi: 10.1136/ard.2008.104117.

21. Kiltz U., Mau W., Repschläger U., et. al. German Society for Rheumatology S3 guidelines on axial spondyloarthritis including Bechterew’s disease and early forms: 9 International classification of functioning, disability and health (ICF). Z Rheumatol. 2014; 73(Suppl 2):104-8. doi: 10.1007/s00393-014-1433-9.