Ankylosing spondylitis medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Pharmacologic medical therapies for ankylosing spondylitis(AS) include Nonsteroidal anti-inflammatory drugs (NSAIDs), tumor necrosis factor (TNF) blocker, and interleukin 17 (IL-17) inhibitors.Ankylosing spondylitis (AS) is a chronic inflammatory disease which is manifested by back pain and gradually to spinal stiffness.While treating the AS patients the primary goal is to maximize long-term health-related quality of life.
Medical Therapy
- Medical therapy for AS is according to the guidelines proposed by [1][2][3]
- Assessment of SpondyloArthritis international Society (ASAS)
- European League Against Rheumatism (EULAR)
- American College of Rheumatology (ACR)/Spondylitis Association of America (SAA)/Spondyloarthritis Research and Treatment Network (SPARTAN) collaboration
- Pharmacologic medical therapies for ankylosing spondylitis(AS) include Nonsteroidal anti-inflammatory drugs (NSAIDs), tumor necrosis factor (TNF) blocker, analgesics, sulfasalazine,intraarticular injections and interleukin 17 (IL-17) inhibitors.
Nonsteroidal antiinflammatory drugs(NSAIDs)[4][5][6][7][8][9]
- The first line treatment for all the patients who are having symptomatic ankylosing spondylitis (AS) are with Nonsteroidal antiinflammatory drugs(NSAIDs).
- 70 to 80 percent patients who are taking NSAIDs report substantial relief of back pain and stiffness.
- Play a crucial role in delaying the progression of ankylosing spondylitis.
- Regardless of which NSAID used, the maximum dose is usually required to manage AS.
- Treating with NSAIDs in AS especially in patients with increased erythrocyte sedimentation rate (ESR) shows especially effective in decreasing the ESR.[10]
Adult
- Preferred regimen (1): Indomethacin: Initial: 75 mg once daily, may increase to 75 mg twice daily (maximum dose: 150 mg/day) for at least 4 weeks.[11]
- Preferred regimen (2): Celecoxib or Etoricoxib: Oral: 200 mg once daily or 100 mg twice daily.[12][13][14][15][16][17]
Tumor necrosis factor alpha antagonists(TNF-alpha)[18][19]
- infliximab, etanercept, adalimumab, certolizumab, and golimumab are the available tumor necrosis factor alpha inhibitors(TNF-alpha) to treat AS.
- In AS there is no much of a use in adding immunomodulatory drug, such as methotrexate (MTX) as the evidence shows no additional benefit but may increase the cost and the risk of adverse effects.[20]
References
- ↑ Braun J, van den Berg R, Baraliakos X, Boehm H, Burgos-Vargas R, Collantes-Estevez E, Dagfinrud H, Dijkmans B, Dougados M, Emery P, Geher P, Hammoudeh M, Inman RD, Jongkees M, Khan MA, Kiltz U, Kvien T, Leirisalo-Repo M, Maksymowych WP, Olivieri I, Pavelka K, Sieper J, Stanislawska-Biernat E, Wendling D, Ozgocmen S, van Drogen C, van Royen B, van der Heijde D (June 2011). "2010 update of the ASAS/EULAR recommendations for the management of ankylosing spondylitis". Ann. Rheum. Dis. 70 (6): 896–904. doi:10.1136/ard.2011.151027. PMC 3086052. PMID 21540199.
- ↑ Zochling J, van der Heijde D, Burgos-Vargas R, Collantes E, Davis JC, Dijkmans B, Dougados M, Géher P, Inman RD, Khan MA, Kvien TK, Leirisalo-Repo M, Olivieri I, Pavelka K, Sieper J, Stucki G, Sturrock RD, van der Linden S, Wendling D, Böhm H, van Royen BJ, Braun J (April 2006). "ASAS/EULAR recommendations for the management of ankylosing spondylitis". Ann. Rheum. Dis. 65 (4): 442–52. doi:10.1136/ard.2005.041137. PMC 1798102. PMID 16126791.
- ↑ Ward MM, Deodhar A, Akl EA, Lui A, Ermann J, Gensler LS, Smith JA, Borenstein D, Hiratzka J, Weiss PF, Inman RD, Majithia V, Haroon N, Maksymowych WP, Joyce J, Clark BM, Colbert RA, Figgie MP, Hallegua DS, Prete PE, Rosenbaum JT, Stebulis JA, van den Bosch F, Yu DT, Miller AS, Reveille JD, Caplan L (February 2016). "American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network 2015 Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis". Arthritis Rheumatol. 68 (2): 282–98. doi:10.1002/art.39298. PMC 5123840. PMID 26401991.
- ↑ Ardoin SP, Sundy JS (May 2006). "Update on nonsteriodal anti-inflammatory drugs". Curr Opin Rheumatol. 18 (3): 221–6. doi:10.1097/01.bor.0000218940.04613.cc. PMID 16582683.
- ↑ Zochling J, van der Heijde D, Dougados M, Braun J (April 2006). "Current evidence for the management of ankylosing spondylitis: a systematic literature review for the ASAS/EULAR management recommendations in ankylosing spondylitis". Ann. Rheum. Dis. 65 (4): 423–32. doi:10.1136/ard.2005.041129. PMC 1798100. PMID 16126792.
- ↑ van den Berg R, Baraliakos X, Braun J, van der Heijde D (August 2012). "First update of the current evidence for the management of ankylosing spondylitis with non-pharmacological treatment and non-biologic drugs: a systematic literature review for the ASAS/EULAR management recommendations in ankylosing spondylitis". Rheumatology (Oxford). 51 (8): 1388–96. doi:10.1093/rheumatology/kes066. PMID 22513148.
- ↑ Lequesne M (February 1990). "Methodology issues in the evaluation of NSAID in inflammatory rheumatic diseases". J Rheumatol Suppl. 20: 25–8. PMID 2182853.
- ↑ Kroon FP, van der Burg LR, Ramiro S, Landewé RB, Buchbinder R, Falzon L, van der Heijde D (July 2015). "Non-steroidal anti-inflammatory drugs (NSAIDs) for axial spondyloarthritis (ankylosing spondylitis and non-radiographic axial spondyloarthritis)". Cochrane Database Syst Rev (7): CD010952. doi:10.1002/14651858.CD010952.pub2. PMID 26186173.
- ↑ Wanders A, Heijde D, Landewé R, Béhier JM, Calin A, Olivieri I, Zeidler H, Dougados M (June 2005). "Nonsteroidal antiinflammatory drugs reduce radiographic progression in patients with ankylosing spondylitis: a randomized clinical trial". Arthritis Rheum. 52 (6): 1756–65. doi:10.1002/art.21054. PMID 15934081. Vancouver style error: initials (help)
- ↑ Kroon F, Landewé R, Dougados M, van der Heijde D (October 2012). "Continuous NSAID use reverts the effects of inflammation on radiographic progression in patients with ankylosing spondylitis". Ann. Rheum. Dis. 71 (10): 1623–9. doi:10.1136/annrheumdis-2012-201370. PMID 22532639.
- ↑ Calin A, Elswood J (June 1990). "A prospective nationwide cross-sectional study of NSAID usage in 1331 patients with ankylosing spondylitis". J. Rheumatol. 17 (6): 801–3. PMID 1974927.
- ↑ van der Heijde D, Baraf HS, Ramos-Remus C, Calin A, Weaver AL, Schiff M, James M, Markind JE, Reicin AS, Melian A, Dougados M (April 2005). "Evaluation of the efficacy of etoricoxib in ankylosing spondylitis: results of a fifty-two-week, randomized, controlled study". Arthritis Rheum. 52 (4): 1205–15. doi:10.1002/art.20985. PMID 15818702.
- ↑ Barkhuizen A, Steinfeld S, Robbins J, West C, Coombs J, Zwillich S (September 2006). "Celecoxib is efficacious and well tolerated in treating signs and symptoms of ankylosing spondylitis". J. Rheumatol. 33 (9): 1805–12. PMID 16960941.
- ↑ Dougados M, Béhier JM, Jolchine I, Calin A, van der Heijde D, Olivieri I, Zeidler H, Herman H (January 2001). "Efficacy of celecoxib, a cyclooxygenase 2-specific inhibitor, in the treatment of ankylosing spondylitis: a six-week controlled study with comparison against placebo and against a conventional nonsteroidal antiinflammatory drug". Arthritis Rheum. 44 (1): 180–5. doi:10.1002/1529-0131(200101)44:1<180::AID-ANR24>3.0.CO;2-K. PMID 11212158.
- ↑ Matsumoto AK, Melian A, Mandel DR, McIlwain HH, Borenstein D, Zhao PL, Lines CR, Gertz BJ, Curtis S (August 2002). "A randomized, controlled, clinical trial of etoricoxib in the treatment of rheumatoid arthritis". J. Rheumatol. 29 (8): 1623–30. PMID 12180720.
- ↑ Lories RJ (December 2012). "Etoricoxib and the treatment of ankylosing spondylitis". Expert Opin Drug Metab Toxicol. 8 (12): 1599–608. doi:10.1517/17425255.2012.741120. PMID 23126318.
- ↑ Sieper J, Klopsch T, Richter M, Kapelle A, Rudwaleit M, Schwank S, Regourd E, May M (March 2008). "Comparison of two different dosages of celecoxib with diclofenac for the treatment of active ankylosing spondylitis: results of a 12-week randomised, double-blind, controlled study". Ann. Rheum. Dis. 67 (3): 323–9. doi:10.1136/ard.2007.075309. PMID 17616556.
- ↑ Sieper J (2009). "Developments in the scientific and clinical understanding of the spondyloarthritides". Arthritis Res. Ther. 11 (1): 208. doi:10.1186/ar2562. PMC 2688219. PMID 19232062.
- ↑ Breban M, Ravaud P, Claudepierre P, Baron G, Henry YD, Hudry C, Euller-Ziegler L, Pham T, Solau-Gervais E, Chary-Valckenaere I, Marcelli C, Perdriger A, Le Loët X, Wendling D, Fautrel B, Fournié B, Combe B, Gaudin P, Jousse S, Mariette X, Baleydier A, Trape G, Dougados M (January 2008). "Maintenance of infliximab treatment in ankylosing spondylitis: results of a one-year randomized controlled trial comparing systematic versus on-demand treatment". Arthritis Rheum. 58 (1): 88–97. doi:10.1002/art.23167. PMID 18163509.
- ↑ Li EK, Griffith JF, Lee VW, Wang YX, Li TK, Lee KK, Tam LS (September 2008). "Short-term efficacy of combination methotrexate and infliximab in patients with ankylosing spondylitis: a clinical and magnetic resonance imaging correlation". Rheumatology (Oxford). 47 (9): 1358–63. doi:10.1093/rheumatology/ken207. PMID 18573802.