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. 2021 Feb 5;7(1):e001480. doi: 10.1136/rmdopen-2020-001480

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© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Proposed model of interaction of mechanical stress factors, genetics and environmental factors in the pathogenesis of enthesitis in SpA. The treatment approach with physical exercise and activity has showed to improve symptoms and sign of axSpA and to improve function and quality of life. However, potential harms could occur mainly for those patients with instability or heavy entheseal stress with a reduction of the Goldilocks zone. axSpA, axial spondyloarthritis; ERAP1, endoplasmic reticulum aminopeptidase-1; IL, interleukin.