Ankylosing spondylitis

Infliximab Anti-TNFa Inflammatory bowel disease, rheumatoid arthritis, ankylosing spondylitis... 

Adalimumab (Humira ) is a folly human anti-TNF monoclonal antibody that is mainly used in combination with methotrexate to treat rheumatoid arthritis in adults [3]. Meanwhile, it is also used against arthritis of psoriasis and ankylosing spondylitis. Its therapeutic value in Crohn s disease is under clinical trial. 

The corticosteroids may be used to treat rheumatic disorders such as ankylosing spondylitis, rheumatoid arthritis, gout, bursitis (inflammation of the bursa, usually the bursa of the shoulder), and osteoarthritis. 

Short-term management of acute ankylosing spondylitis, acute and subacute bursitis, acute nonspecific tenosynovitis, acute gouty arthritis, psoriatic arthritis, rheumatoid arthritis, post-traumatic osteoarthritis, synovitis of osteoarthritis, epicondylitis... 

AOSD, adult onset Still disease AS, ankylosing spondylitis CA, crystal-induced arthritis ERA, enthesitis-related arthritis JA, juvenile arthritis PA, psoriatic arthritis RA, rheumatoid arthritis SE, synovium explants SLE, systemic lupus erythematosus SPCIA, solid phase 2 site chemiluminescent immunometric assay RP, relapsing polychondritis. 

Yang PT, Kasai H, Zhao LJ, Xiao WG, Tanabe F, Ito M. Increased CCR4 expression on circulating CD4(+) T cells in ankylosing spondylitis, rheumatoid arthritis and systemic lupus erythematosus. Clin Exp Immunol 2004 138(2) ... 

Suggested Alternatives for Differential Diagnosis Influenza, infectious mononucleosis, hepatitis, leptospirosis, infective endocarditis, malaria, tuberculosis, typhoid fever, cryptococcosis, histoplasmosis, ankylosing spondylitis and undifferentiated spondyloarthropathy, collagen vascular disease, chronic fatigue syndrome, malignancy, and osteomyelitis. 

Diclofenac possesses all of the properties unique to the series of propionic acid drugs, yet in terms of anti-inflammatory and analgesic strength it exceeds that of aspirin, analgin, and ibnprofen. It is used in acnte rheumatism, rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, arthrosis, back pain, neuralgia, and myalgia. It rarely causes side effects. The most common synonym is voltaren. 

As was already mentioned, piroxicam also is a nonsteroidal, anti-inflammatory drug. It is used in inflammatory and degenerative diseases of the musculoskeletal system that are accompanied by painful symptoms. It is used for rheumatic heart disease, nonspecific infectious polyarthritis, gouty arthritis, rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, arthrosis, back pain, nenralgia, myalgia, and other diseases associated with inflammation. Synonyms for piroxicam are feldene, dexicam, roxenan, and others. 

Rheumatic disorders Adjunctive therapy for short-term use (acute episode or exacerbation) in psoriatic arthritis rheumatoid arthritis (RA), including juvenile RA ankylosing spondylitis acute and subacute bursitis acute, nonspecific tenosynovitis acute gouty arthritis posttraumatic osteoarthritis synovitis of osteoarthritis epicondylitis. 

Nonsteroidal anti-inflammatory drug (NSAID)-associated gastric ulcers For reducing the risk of NSAID-associated gastric ulcers in patients with a history of documented gastric ulcer who require the use of an NSAID for treatment of the signs and symptoms of rheumatoid arthritis, osteoarthritis, and ankylosing spondylitis. 

Moderate to severe rheumatoid arthritis (including acute flares of chronic disease), ankylosing spondylitis, and osteoarthritis - 25 mg 2 or 3 times/day. If this is well tolerated, increase the daily dose by 25 or 50 mg at weekly intervals until a satisfactory response is obtained or until a daily dose of 150 to 200 mg is reached. 

Osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis - Initial dosage is 150 mg twice a day. 

Ankylosing spondylitis For reducing signs and symptoms in patients with active ankylosing spondylitis. 

X-rays were also used to treat disease. From 1905 to 1960, X-rays were used to treat ringworm in children. Well into the 1950s, X-rays were used to treat a degenerative bone disease called ankylosing spondylitis. 

Sulfasalazine (Azulfidine, Azulfidine EN) [Anti-inflammatory/ Antirheumatic (DMARD)/Sulfonamide] Uses Ulcerative colitis, RA, juvenile RA, active Crohn Dz, ankylosing spondylitis, psoriasis Action Sulfonamide actions unclear Dose Adults. Initial, 1 g PO tid-qid T to a max of 8 g/d in 3 -5- doses maint 500 mg PO qid Feds. Initial 40-60 mg/kg/24 h PO -s- q4-6h maint 20-30 mg/kg/24 h PO q6h RA >6 y 30-50 mg/kg/d in 2 doses, start w/ 1/4-1/3 maint dose, T wkly until dose reached at 1 mo, 2 g/d max -i in renal failure... 

Sulfasalazine has been used for the management of RA and ankylosing spondylitis with apparently similar effectiveness as penicillamine and with less toxicity. While 5-aminosalicylic acid is the active agent in inflammatory bowel disease, it is believed that sulfapyridine is mostly responsible for the antirheumatoid effects. Gastrointestinal complaints, dizziness and photosensitivity are the most frequently observed adverse events. With levamisole and also with sulfasalazine and olsalazine a delay of 2-3 months is to be expected before positive responses will be observed. 

Wailoo A, Bansback N, Chilcott J. Infliximab, etaner-cept and adalimumab for the treatment of ankylosing spondylitis cost-effectiveness evidence and NICE... 

Infliximab is a monoclonal antibody against TNF-a (see Chapter 26, Section III.d.1). It has been approved for the treatment of psoriasis, Crohn s disease, ankylosing spondylitis, psoriatic arthritis, rheumatoid arthritis and ulcerative colitis. Similar immunosuppressants are etanercept, and adali-mumab. 

With the advent of biological-DMARD combinations with Methotrexate (MTX) a new era of therapy in autoimmune disease is introduced. DMARD-refractory autoimmune diseases are treated with combinations of a biological with MTX with achievement of improvements of ACR 20 and ASAS 20 in the majority of patients. A small minority of around 20% obtains improvements of ACR 70 and ASAS 70. ACR responses are American College of Rheumatology response criteria and ASAS stands for Assessment in Ankylosing Spondylitis. ACR and ASAS 20, 50 or 70 scores are exactly defined improvements of respectively 20%, 50% or 70%. 

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