ther binding partners may also be PubMed ID:http://www.ncbi.nlm.nih.gov/pubmed/19717844 involved. We removed terminal sialic acids on neuronal surface by pre-incubation of neuraminidase and observed drastic decrease of MBP surface binding. This result suggests that sialic acid may be the main binding partner of MBP on neuronal surface. However, the possibility still exists that other uncommon acidic components, such as acidic carbohydrate chains, which are specifically located on the outer leaflets of neuronal plasma membrane, mediate MBP-induced neurotoxicity. Axial spondyloarthritis including ankylosing spondylitis is characterized by inflammatory back pain and reduced spinal mobility. Over the past decades, the management of many rheumatic diseases has been revolutionized 
by improve- ments in diagnostic techniques and medication leading to a more active treatment approach for patients with axSpA. Physical therapy with supervised exercise is a cornerstone in the treatment of axSpA together with anti-inflammatory medications such as non-steroidal anti-inflammatory drugs and tumor necrosis factor -inhibitors. There are no definite 1 High Intensity Exercise in Axial Spondyloarthritis recommendations on type of exercise and intensity, and traditionally flexibility exercises at a low intensity level have been recommended. A Cochrane review concluded that physical therapy interventions, mainly consisting of flexibility exercises, have beneficial effects on pain, spinal mobility, physical function and patient global assessment in AS patients, but the effect sizes are small. Additional support for exercise as a part of the treatment repertoire in axSpA is the evidence of increased risk of cardiovascular diseases in these patients. For healthy adults, buy 936091-26-8 cardiorespiratory exercise is recommended in guidelines for CVD prevention, and high intensity endurance exercise has been shown to be more effective than low intensity endurance exercise. In addition, PubMed ID:http://www.ncbi.nlm.nih.gov/pubmed/19717794 the health benefits of strength exercise in CVD prevention are well established. However, the evidence for effects of high intensity endurance and strength exercise on disease activity and cardiovascular -risk is limited in patients with axSpA. Therefore, the aim of this study was to investigate the efficacy of high intensive endurance and strength exercise on disease activity and CV-risk in patients with active axSpA. Methods The protocol for this trial and supporting CONSORT checklist are available as supporting information; se Checklist S1 and Protocol S1. Design This study was a single blinded randomized controlled pilot study comparing an exercise group with a treatment as usual control group. The intervention lasted for 12 weeks, and participants were examined at baseline and post intervention. All the participants provided written informed consent to participate, and all procedures followed the Helsinki declaration. The study was approved by the Regional Committee for medical and health research Ethics of South East Norway and is listed in ClinicalTrials.gov. training was high intensity interval training on a treadmill for 40 minutes . The strength training was 20 minutes with external load for major muscle groups. The strength program consisted of the following exercises: bench press with weight manuals or seated in a chest press machine, squat with weight or leg press machine, rowing exercise with weight manuals, exercises for triceps and biceps in a fitness machine and an abdominal stabilization exercise. Once a week the participants exerci