Ankylosing spondylitis, treatment

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. 

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. 

NSAID-refractory-AS is defined when after treatment with at least 2 different NS AID over a period of at least 2 months, ASAS 20 is not obtained, and ESR, CRP, and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score do not improve, or worsens versus baseline. Indications for therapy with SBC-5-IMNs are in NSAID-refractory AS with ESR > 40 mm and a Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) > 4. Less than 5% of patients with NSAID-refractory AS in the community at large fulfill these conditions. Remission is defined when ESR and VAS have declined to <10 mm (men <5 mm) and the disease activity scores are <1 (scale 0-10). Remission with oral drugs is defined when remission is maintained with oral drugs for at least 2 years. Remission without drugs is defined when remission without drugs is sustained without relapse for at least 2 years. 

Baraliakos X, Listing J, Brandt J, Zink A, Alien R, Burmester G et al. Clinical response to discontinuation of anti-TNE therapy in patients with ankylosing spondylitis after 3 years of continuous treatment with infliximab. Arthritis Res Ther 2005 7 439-44. 

Darmawan J, Nasution AR, Chen Shun-le, Haq SA, Zhao DB, Zeng GY et al. Excellent endpoints from Step-Down Bridge Comhination of 5 immunosuppressants in NSAID-refractory ankylosing Spondylitis 6 year international study in Asia - WHO-ILAR COP-CORD Stage II treatment of the autoimmune diseases. J Rheumatol 2006 33 2484-92. 

The sahcylates are useful in the treatment of minor musculoskeletal disorders such as bursitis, synovitis, tendinitis, myositis, and myalgia. They may also be used to relieve fever and headache. They can be used in the treatment of inflammatory disease, such as acute rheumatic fever, rheumatoid arthritis, osteoarthritis, and certain rheumatoid variants, such as ankylosing spondylitis, Reiter s syndrome, and psoriatic arthritis. However, other NS AIDS are usually favored for the treatment of these chronic conditions because of their lower incidence of GI side effects. Aspirin is used in the treatment and prophylaxis of myocardial infarction and ischemic stroke. 

Indomethacin (Indocin) is used in the treatment of acute gouty arthritis, rheumatoid arthritis, ankylosing spondylitis, and osteoarthritis. It is not recommended for use as a simple analgesic or antipyretic because of its potential for toxicity. While indomethacin inhibits both COX-1 and COX-2, it is moderately selective for COX-1. It produces more CNS side effects than most of the other NSAIDs. Severe headache occurs in 25 to 50% of patients vertigo, confusion, and psychological disturbances occur with some regularity. GI symptoms also are more frequent and severe than with most other... 

Sulfasalazine (Azulfidine) is approved for the treatment of rheumatoid arthritis and ulcerative colitis. It is also used to treat ankylosing spondylitis and Crohn s disease. Comparisons of sulfasalazine with other DMARDs suggest that it is more effective than hydroxychloroquine, azathioprine, and oral gold compounds. It is at least as effective as intramuscular gold and penicillamine. It has a greater degree of toxicity than hydroxychloroquine but less than gold compounds and penicillamine. After 5 years, approximately 75% of patients have discontinued sulfasalazine therapy, primarily because of a lack of efficacy as opposed to intolerable side effects. 

Unlabeled Uses Treatment of ankylosing spondylitis, psoriatic arthritis, vascular headaches... 

Uniabeied Uses Treatment of acute gouty arthritis, psoriatic arthritis, ankylosing spondylitis, vascular headache... 

It is used in the treatment of inflammatory and degenerative forms of rheumatism, rheumatoid arthritis, ankylosing spondylitis, osteoarthritis and spondyloarthritis. 

Smith, RG. and Doll, R. (1982). Mortality among patients with ankylosing spondylitis after a sin e treatment course with x rays, Br. Med. J. 284,449. 

The compound is approved for the treatment of rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, juvenile idiopathic arthritis, plaque psoriasis, and Crohn s disease. It decreases the rate of formation of new erosions. It is effective both as monotherapy and in combination with methotrexate and other DMARDs. 

Clinical use Ketoprofen (Hommeril et al., 1994) is a nonsteroidal anti-inflammatory drug used for the treatment of a variety of acute and chronic pain and inflammatory conditions including rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, postoperative pain and dysmenorrhoea. It is given by oral, rectal, topical or intramuscular application (100-200 mg/day, maximal dose 300 mg/day) as the sodium or lysine salt. 

It is used orally (8-24 mg/day) for the treatment of mild to moderate pain including postoperative pain, rheumatoid arthritis, osteoarthritis and ankylosing spondylitis (Balfour et al., 1996). 

Clinical use Oxyphenbutazone is a nonsteroidal antiinflammatory drug used for the acute treatment of ankylosing spondylitis, chronic polyarthritis and gout. 

Clinical use Phenylbutazone (Brogden, 1986) is a nonsteroidal anti-inflammatory drug used for the acute treatment of ankylosing spondylitis, chronic polyarthritis and gout. Phenylbutazone on its own shows only weak inhibition of COX-1 and COX-2 with IC50s >30 pM (Brideau et al., 1996) and active metabolites are mainly responsible for its actions. 

Etanercept is a genetically engineered protein that is soluble TNF-a receptor. Its molecular weight is 75kDa. It binds to TNF-a. It is used for the treatment of rheumatoid arthritis, juvenile rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis. Structurally, two TNF-a receptors are linked to an Fc portion of an... 

In the years after World War II (1946 to 1950), repeated injections of radium-224 were given to adults and children in Germany for treatment of tuberculosis, ankylosing spondylitis, and other diseases. Out of about 2,000 persons who received this treatment, 816 of these cases are currently being followed (Spiess et al. 1978). Of the 816, 204 were injected as juveniles (ages 1 to 20 years) and 612 as adults. The average total injected activity was 18 pCi/kg (666 kBq/kg) (Mays et al. 

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