Add-on Therapy for Axial Spondyloarthritis

Rationale: Recent investigations suggest that, through certain concentration/meditation techniques, it is possible to modulate autonomic activity. The results of a recent randomized controlled trial investigating the \"Wim Hof Method\" have shown a direct biological effect on in-vivo cytokine production and are strongly encouraging the clinical evaluation of the technique\'s efficacy in immune-mediated inflammatory diseases. Objective: To investigate whether an add-on mindset \& physical therapy program based on the \"Wim Hof Method\" can safely and efficaciously be applied in patients with active axial spondyloarthritis. Study design: Prospective open-label randomized controlled trial, safety and efficacy. Study population: Twenty-four patients with active axial spondyloarthritis between 18 and 45 years of age. Intervention: A 30-day training program of add-on mindset and physical therapy for axial spondyloarthritis, using the methodology as designed and instructed by Wim Hof. It involves breathing techniques, training of mindset and concentration, and gradual cold exposure. Main study parameters/endpoints: Safety evaluation of the program is the primary aim of the study. Secondary endpoint is the modulation of serum CRP levels. Exploratory objectives include modulation of clinical disease activity (ASDAS), quality of life (SF-36, EQ-5D), depressive symptoms (HADS), and predictive role of generalized and specific outcome expectancies (EPQ-N, LOT-R, VAS scales).