{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T17:51:21Z","timestamp":1790790681174,"version":"4.1.0"},"reference-count":16,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2023,12,1]],"date-time":"2023-12-01T00:00:00Z","timestamp":1701388800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Rheumazentrum Erlangen"},{"name":"AGJR Verbundprojekt"},{"DOI":"10.13039\/501100010767","name":"Innovative Medicines Initiative","doi-asserted-by":"publisher","award":["101007757"],"award-info":[{"award-number":["101007757"]}],"id":[{"id":"10.13039\/501100010767","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004336","name":"Novartis","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004336","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["RMD Open"],"accepted":{"date-parts":[[2023,11,13]]},"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To assess the impact of low to moderate biomechanical stress on entheses in patients with psoriasis and psoriatic arthritis (PsA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a prospective interventional study on a cohort of psoriasis and PsA patients who underwent a 60\u2009min badminton training session. Pain assessment by Visual Analogue Scale (VAS), physical examination of 29 entheses (SPARCC, LEI, MASES) and bilateral ultrasound at the lateral humeral epicondyle, inferior patellar pole and Achilles tendon were performed before and after training. Ultrasound changes were assessed using the OMERACT scoring system. A follow-up assessment of pain and adverse events was performed at 1\u2009week.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Sixteen patients were included (n=7\u2009PsA; n=9 psoriasis) and 196 entheseal ultrasound scans were acquired. At baseline, median VAS pain (IQR) was 0.5\u2009cm (0\u20132.3) and the total number of tender entheses was 12\/464. Mean (min; max) Disease Activity Index for Psoriatic Arthritis was 6.1 (0.8; 19) and 5\/7 PsA patients had an Minimal Disease Activity status. After training, no significant change in VAS pain (0.0\u2009cm (0.0\u20132.0)) nor in tender entheses (13\/464) emerged. Four patients (n=2\u2009PsA, n=2 psoriasis) developed a grade-1 power Doppler-signal at six entheses, which, however, remained non-tender. At 1\u2009week, median VAS pain remained stable (0.0\u2009cm (0.0\u20133.0); p&gt;0.05) and only one participant with active PsA at baseline reported increased arthralgias in three joints.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Low to moderate physical strain, as in the context of leisure sport activity, seems well tolerated in psoriatic patients without increases in tenderness, pain and ultrasound-proven inflammation. Evidence-based recommendations for physical activity in PsA are direly needed and larger controlled studies should be conducted to define safe exercise thresholds.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/rmdopen-2023-003612","type":"journal-article","created":{"date-parts":[[2023,12,1]],"date-time":"2023-12-01T12:21:29Z","timestamp":1701433289000},"page":"e003612","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Tolerability of low to moderate biomechanical stress during leisure sport activity in patients with psoriasis and psoriatic arthritis"],"prefix":"10.1136","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6122-0774","authenticated-orcid":false,"given":"Filippo","family":"Fagni","sequence":"first","affiliation":[{"name":"Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-N\u00fcrnberg and Universit\u00e4tsklinikum, Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melek Yalcin","family":"Mutlu","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-N\u00fcrnberg and Universit\u00e4tsklinikum, Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Selahattin Alp","family":"Temiz","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-N\u00fcrnberg and Universit\u00e4tsklinikum, Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioanna","family":"Minopoulou","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-N\u00fcrnberg and Universit\u00e4tsklinikum, Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuel","family":"Krieter","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Paracelsus Medical University, N\u00fcrnberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georg","family":"Schett","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-N\u00fcrnberg and Universit\u00e4tsklinikum, Erlangen, Germany"},{"name":"Deutsches Zentrum f\u00fcr Immuntherapie (DZI), Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arnd","family":"Kleyer","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-N\u00fcrnberg and Universit\u00e4tsklinikum, Erlangen, Germany"},{"name":"Deutsches Zentrum f\u00fcr Immuntherapie (DZI), Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Simon","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-N\u00fcrnberg and Universit\u00e4tsklinikum, Erlangen, Germany"},{"name":"Deutsches Zentrum f\u00fcr Immuntherapie (DZI), Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Axel J","family":"Hueber","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-N\u00fcrnberg and Universit\u00e4tsklinikum, Erlangen, Germany"},{"name":"Klinikum N\u00fcrnberg, Division of Rheumatology, Paracelsus Medical University, N\u00fcrnberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,12,1]]},"reference":[{"key":"2025090313474542000_9.4.e003612.1","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2017-212681"},{"key":"2025090313474542000_9.4.e003612.2","doi-asserted-by":"crossref","unstructured":"Simon D , Kleyer A , Bayat S , et al . Biomechanical stress in the context of competitive sports training triggers enthesitis. Arthritis Res Ther 2021;23. doi:10.1186\/s13075-021-02530-x","DOI":"10.1186\/s13075-021-02530-x"},{"key":"2025090313474542000_9.4.e003612.3","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2013-203643"},{"key":"2025090313474542000_9.4.e003612.4","doi-asserted-by":"crossref","DOI":"10.1186\/s12891-023-06871-3","article-title":"Changes of inflammation in patients with psoriatic arthritis after high intensity interval training assessed by ultrasound and MRI, a randomized controlled trial","volume":"24","author":"Thomsen","year":"2023","journal-title":"BMC Musculoskelet Disord"},{"key":"2025090313474542000_9.4.e003612.5","doi-asserted-by":"crossref","first-page":"1323","DOI":"10.1093\/ptj\/pzaa086","article-title":"High-intensity exercise improves fatigue, sleep, and mood in patients with axial spondyloarthritis: secondary analysis of a randomized controlled trial","volume":"100","author":"Sveaas","year":"2020","journal-title":"Phys Ther"},{"key":"2025090313474542000_9.4.e003612.6","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2016-209775"},{"key":"2025090313474542000_9.4.e003612.7","doi-asserted-by":"crossref","first-page":"1603","DOI":"10.1002\/acr.25117","article-title":"2022 American college of rheumatology guideline for exercise, rehabilitation, diet, and additional integrative interventions for rheumatoid arthritis","volume":"75","author":"England","year":"2023","journal-title":"Arthritis Care Res"},{"key":"2025090313474542000_9.4.e003612.8","doi-asserted-by":"publisher","DOI":"10.1002\/acr.21780"},{"key":"2025090313474542000_9.4.e003612.9","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.hkpj.2015.10.001","article-title":"Relationship between self-efficacy, beliefs, and physical activity in inflammatory arthritis","volume":"34","author":"Larkin","year":"2016","journal-title":"Hong Kong Physiother J"},{"key":"2025090313474542000_9.4.e003612.10","doi-asserted-by":"crossref","unstructured":"Fagni F , Yalcin Mutlu M , Minopoulou I , et al . Effects and tolerability of low to moderate biomechanical stress during leisure sport activity in patients with psoriasis and psoriatic arthritis [abstract]. Arthritis Rheumatol 2023;75 (suppl 9).","DOI":"10.1136\/rmdopen-2023-003612"},{"key":"2025090313474542000_9.4.e003612.11","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2015-207507"},{"key":"2025090313474542000_9.4.e003612.12","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.170449"},{"key":"2025090313474542000_9.4.e003612.13","doi-asserted-by":"crossref","first-page":"1730","DOI":"10.1136\/annrheumdis-2018-213609","article-title":"Reliability of a consensus-based ultrasound definition and scoring for enthesitis in spondyloarthritis and psoriatic arthritis: an OMERACT US initiative","volume":"77","author":"Balint","year":"2018","journal-title":"Ann Rheum Dis"},{"key":"2025090313474542000_9.4.e003612.14","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.180782"},{"key":"2025090313474542000_9.4.e003612.15","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1111\/jdv.12607","article-title":"Psoriasis and sport: a new ally","volume":"29","author":"Balato","year":"2015","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"2025090313474542000_9.4.e003612.16","doi-asserted-by":"crossref","first-page":"e212","DOI":"10.1111\/jdv.13971","article-title":"Soccer helps in controlling the development of psoriasis in Italian second league players","volume":"31","author":"Megna","year":"2017","journal-title":"J Eur Acad Dermatol Venereol"}],"container-title":["RMD Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/rmdopen-2023-003612","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T20:47:57Z","timestamp":1756932477000},"score":1,"resource":{"primary":{"URL":"https:\/\/rmdopen.bmj.com\/lookup\/doi\/10.1136\/rmdopen-2023-003612"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12]]},"references-count":16,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2023,12,1]]},"published-print":{"date-parts":[[2023,12]]}},"alternative-id":["10.1136\/rmdopen-2023-003612"],"URL":"https:\/\/doi.org\/10.1136\/rmdopen-2023-003612","relation":{},"ISSN":["2056-5933"],"issn-type":[{"value":"2056-5933","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12]]}}}