scholarly journals Medical management of ankylosing spondylitis

2008 ◽  
Vol 24 (1) ◽  
pp. E4 ◽  
Author(s):  
Alexander A. Khalessi ◽  
Bryan C. Oh ◽  
Michael Y. Wang
Keyword(s):  
Ankylosing Spondylitis ◽  
Medical Management ◽  
Treatment Guidelines ◽  
Therapy Response ◽  
Current Treatment ◽  
Nonsteroidal Antiinflammatory Drugs ◽  
Antiinflammatory Drugs ◽  
Tuberculosis Screening ◽  
Axial Disease ◽  
Factor Α

✓ In the following literature review the authors consider the available evidence for the medical management of patients with ankylosing spondylitis (AS), and they critically assess current treatment guidelines. Medical therapy for axial disease in AS emphasizes improvement in patients' pain and overall function. First-line treatments include individualized physical therapy and nonsteroidal antiinflammatory drugs (NSAIDs) in conjunction with gastroprotective therapy. After an adequate trial of therapy with two NSAIDs exceeding 3 months or limited by medication toxicity, the patient may undergo tumor necrosis factor–α blockade therapy. Response should occur within 6–12 weeks, and patients must undergo tuberculosis screening. Evidence does not currently support the use of disease modifying antirheumatic drugs, corticosteroids, or radiotherapy in AS.

Outcomes of Children Treated for Lyme Arthritis: Results of a Large Pediatric Cohort

2010 ◽  
Vol 37 (5) ◽  
pp. 1049-1055 ◽  
Author(s):  
HEATHER O. TORY ◽  
DAVID ZURAKOWSKI ◽  
ROBERT P. SUNDEL
Keyword(s):  
Antibiotic Therapy ◽  
Treatment Guidelines ◽  
Tertiary Care ◽  
Laboratory Data ◽  
Current Treatment ◽  
Nonsteroidal Antiinflammatory Drugs ◽  
Chronic Arthritis ◽  
Lyme Arthritis ◽  
Joint Involvement ◽  
Antiinflammatory Drugs

Objective.Children often develop arthritis secondary to Lyme disease; however, optimal treatment of Lyme arthritis in pediatric patients remains ill-defined. We sought to characterize the outcomes of a large cohort of children with Lyme arthritis treated using the approach recommended by the American Academy of Pediatrics and the Infectious Diseases Society of America.Methods.Medical records of patients with Lyme arthritis seen by rheumatologists at a tertiary care children’s hospital from 1997 to 2007 were reviewed. Patients were classified with antibiotic responsive or refractory arthritis based on absence or presence of persisting joint involvement 3 months after antibiotic initiation. Treatment regimens and outcomes in patients with refractory arthritis were analyzed.Results.Of 99 children with Lyme arthritis, 76 had arthritis that responded fully to antibiotics, while 23 developed refractory arthritis. Most patients with refractory arthritis were successfully treated with nonsteroidal antiinflammatory drugs (6 patients), intraarticular steroid injections (4), or disease-modifying antirheumatic drugs (DMARD) (2). Five were lost to followup. Six patients with refractory arthritis were initially treated elsewhere and received additional antibiotic therapy, with no apparent benefit. Three subsequently required DMARD, while 3 had gradual resolution of arthritis without further therapy. Antibiotic responsiveness could not be predicted from our clinical or laboratory data.Conclusion.Lyme arthritis in children has an excellent prognosis. More than 75% of referred cases resolved with antibiotic therapy. Of patients with antibiotic refractory arthritis, none in whom followup data were available developed chronic arthritis, joint deformities, or recurrence of infection, supporting current treatment guidelines.

scholarly journals The Minimum Clinically Important Improvement and Patient-acceptable Symptom State in the BASDAI and BASFI for Patients with Ankylosing Spondylitis

2016 ◽  
Vol 43 (9) ◽  
pp. 1680-1686 ◽  
Author(s):  
Milla Johanna Kviatkovsky ◽  
Sofia Ramiro ◽  
Robert Landewé ◽  
Maxime Dougados ◽  
Florence Tubach ◽  
...  
Keyword(s):  
Ankylosing Spondylitis ◽  
Disease Duration ◽  
Activity Index ◽  
Disease Activity Index ◽  
Nonsteroidal Antiinflammatory Drugs ◽  
Cumulative Distribution ◽  
Antiinflammatory Drugs ◽  
Important Improvement ◽  
Patient Acceptable Symptom State ◽  
Active Disease

Objective.To establish cutoffs for the minimum clinically important improvement (MCII) and the patient-acceptable symptom state (PASS) for the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Bath Ankylosing Spondylitis Functional Index (BASFI) in patients with ankylosing spondylitis (AS).Methods.Patients with AS who started nonsteroidal antiinflammatory drugs were included. After 4 weeks, the PASS and the MCII were defined using external anchor questions (for the PASS, patients considering their condition of AS over the prior 48 h as “acceptable” forever; and for the MCII, those reporting moderate or slightly important improvement). Consistency of the MCII and PASS were tested according to HLA-B27 status, presence/absence of SpA extraarticular manifestations, age, sex, disease duration, and baseline BASDAI/BASFI score. The 75th percentile of the cumulative distribution was used to determine the MCII and PASS.Results.In total, 283 patients from a multinational cohort were included. Overall cutoffs for the PASS were 4.1 in the BASDAI and 3.8 in the BASFI. Cutoffs for the MCII were 0.7 and 0.4 for the BASDAI and BASFI, respectively. Subgroup analyses revealed that disease duration and baseline BASDAI/BASFI were significantly associated with the PASS and MCII. In a subanalysis limited to patients with active disease (baseline BASDAI ≥ 4), the MCII was 1.1 for the BASDAI and 0.6 for the BASFI.Conclusion.The conceptual viability of the PASS for the BASDAI is questionable because levels approach those required for the start of biological therapy. Because the MCII is less variable than the PASS, we propose its exclusive use, with cutoffs of 1.1/0.6 for the BASDAI/BASFI in patients with active disease. Because these values are based on a subset of the study population, we recommend confirmation in larger studies focused on patients with baseline BASDAI ≥ 4.

Comprehensive Treatment of Dactylitis in Psoriatic Arthritis

2014 ◽  
Vol 41 (11) ◽  
pp. 2295-2300 ◽  
Author(s):  
Shawn Rose ◽  
Sergio Toloza ◽  
Wilson Bautista-Molano ◽  
Philip S. Helliwell
Keyword(s):  
Psoriatic Arthritis ◽  
Primary Outcome ◽  
Treatment Options ◽  
Current Treatment ◽  
Nonsteroidal Antiinflammatory Drugs ◽  
Clinical Feature ◽  
Comprehensive Treatment ◽  
Limited Data ◽  
Disease Modifying Antirheumatic Drugs ◽  
Antiinflammatory Drugs

Dactylitis, a hallmark clinical feature of psoriatic arthritis (PsA) and other spondyloarthropathies, may also be a severity marker for PsA and psoriasis. Traditionally, clinicians have used nonsteroidal antiinflammatory drugs and local corticosteroid injections to treat dactylitis, although conventional disease-modifying antirheumatic drugs are also used. We performed a systematic literature review to determine the most efficacious current treatment options for dactylitis in PsA. Effect sizes were greatest for the biologic agents ustekinumab, certolizumab, and infliximab, suggesting that therapy with one of these agents should be initiated in patients with dactylitis. However, the limited data highlight the need for randomized, placebo-controlled trials, with dactylitis as a primary outcome, to determine a valid, reliable, and responsive clinical outcome measure for PsA patients with dactylitis.

Nonsteroidal antiinflammatory drugs reduce radiographic progression in patients with ankylosing spondylitis: A randomized clinical trial

2005 ◽  
Vol 52 (6) ◽  
pp. 1756-1765 ◽  
Author(s):  
Astrid Wanders ◽  
Désirée van der Heijde ◽  
Robert Landewé ◽  
Jéhan-Michel Béhier ◽  
Andrei Calin ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Ankylosing Spondylitis ◽  
Randomized Clinical Trial ◽  
Radiographic Progression ◽  
Nonsteroidal Antiinflammatory Drugs ◽  
Antiinflammatory Drugs

scholarly journals Updated Guidelines for the Management of Axial Disease in Psoriatic Arthritis

2014 ◽  
Vol 41 (11) ◽  
pp. 2286-2289 ◽  
Author(s):  
Peter Nash ◽  
Ennio Lubrano ◽  
Alberto Cauli ◽  
William J. Taylor ◽  
Ignazio Olivieri ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Axial Spondyloarthritis ◽  
Nonsteroidal Antiinflammatory Drugs ◽  
Therapeutic Interventions ◽  
Limited Data ◽  
Spinal Disease ◽  
Antiinflammatory Drugs ◽  
Axial Disease ◽  
Traditional Therapies ◽  
Axial Involvement

Axial involvement in patients with psoriatic arthritis (PsA) remains common and can be defined in terms of spinal disease alone or in combination with peripheral manifestations. Diagnosis is based upon inflammatory spinal symptoms or the presence of radiological sacroiliitis and other radiographic signs of spondylitis, or by criteria for axial spondyloarthritis (SpA) defined by ASAS (Assessment of SpondyloArthritis International Society). Although recent data are scarce for efficacy of traditional therapies for axial disease (e.g., nonsteroidal antiinflammatory drugs, methotrexate, etc.), limited data are available for targeted biologics and novel agents. We identify and evaluate the efficacy of therapeutic interventions for treatment of axial disease in PsA. This review is an update of the axial PsA section of the treatment recommendations project by the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA).

Serum Osteopontin as a Predictive Marker of Responsiveness to Methotrexate in Juvenile Idiopathic Arthritis

2009 ◽  
Vol 36 (10) ◽  
pp. 2308-2313 ◽  
Author(s):  
LAURA MASI ◽  
LAURA RICCI ◽  
FRANCESCO ZULIAN ◽  
FRANCESCA DEL MONTE ◽  
GABRIELE SIMONINI ◽  
...  
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Predictive Marker ◽  
Serum Levels ◽  
Nonsteroidal Antiinflammatory Drugs ◽  
Healthy Children ◽  
Serum Concentrations ◽  
Antiinflammatory Drugs ◽  
Etanercept Treatment ◽  
Factor Α ◽  
Necrosis Factor

Objective.To evaluate if serum concentrations of osteopontin (OPN) at baseline in patients with juvenile idiopathic arthritis (JIA) represent a potential predictor of responsiveness to methotrexate (MTX).Methods.At diagnosis, 60 children with active JIA received MTX in addition to nonsteroidal antiinflammatory drugs. After 12 months of MTX treatment, 30 patients were defined as responders; the 30 nonresponders received anti-tumor necrosis factor-α therapy (etanercept) in addition to MTX; this group was then enrolled for an additional 12-month study period. No patient had received steroids within 6 weeks before entering the study. Fifty healthy children matched for sex and age acted as controls. OPN serum levels were measured at baseline, before MTX, and then at 6 and 12 months. In the nonresponder patients, OPN was evaluated again after 6 and 12 months of etanercept treatment.Results.At baseline, OPN values were significantly higher (p = 0.0003) in JIA patients than in controls, with no significant differences among the different JIA subtypes. At baseline, OPN levels were lower in responders than in nonresponder patients (14.16 ± 10.1 μg/ml vs 33.2 ± 18.1 μg/ml, respectively). After 12 months of MTX treatment, OPN levels were significantly reduced in comparison to baseline in both responder and nonresponder groups (p = 0.0017, p = 0.0048, respectively). In nonresponders, etanercept significantly reduced OPN levels at 6 and 12-month followup in comparison to baseline (p = 0.002, p = 0.008, respectively). No significant differences were found among OPN levels and disease activity.Conclusion.Serum levels of OPN at baseline represent a possible marker to predict the responsiveness to MTX in patients with JIA.

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