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To the Editor: The introduction of tumor necrosis factor-a inhibitors (TNFi) in the treatment of spondyloarthritis was a landmark1,2, but ongoing research in health economics still questions the cost-effectiveness of this therapy3. In contrast, nonpharmacological measures, such as physical therapy, appear to be more economical in this setting and have also shown a positive effect on the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Bath Ankylosing Spondylitis Functionality Index (BASFI), as well as on pain and mobility4. Although the idea of combining these 2 treatment modalities is attractive, there is still a lack of high-quality studies that examine the effects of physical therapy in combination with drugs such as TNFi, particularly in everyday clinical settings5,6.To address this idea, we performed a proof-of-concept study, in which the dose of the TNFi etanercept (ETN) was 50% of the standard dose for adult patients (i.e., 25 mg/week subcutaneously) and combined with standard intensive physiotherapy (3 sessions of 30 min/week; … Address correspondence to Professor Uwe Lange, Department of Internal Medicine and Rheumatology, Justus-Liebig-University Giessen, Kerckhoff Clinic Bad Nauheim, Benekestr. 2-8, Bad Nauheim 61231, Germany. E-mail: u.lange{at}kerckhoff-klinik.de

Efficacy of Intensive Physiotherapy in Combination with Low-dose Etanercept in Active Spondyloarthritis: A Monocentric Pilot Study