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Ankylosing spondylitis and symptom-modifying vs disease-modifying therapy.
Nurullah Akkoc1, Sjef van der Linden, Muhammad Asim Khan
1Department of Internal Medicine, Division of Rheumatology and Immunology, Dokuz Eylul University School of Medicine, Balcova, 35340 Izmir, Turkey. nurullah.akkoc@deu.edu.tr
Best Practice & Research. Clinical Rheumatology
|June 17, 2006
Summary
Non-steroidal anti-inflammatory drugs (NSAIDs) effectively manage ankylosing spondylitis (AS) symptoms. Continuous NSAID use may slow radiological damage, warranting careful consideration of benefits versus risks.
Area of Science:
- Rheumatology
- Pharmacology
Background:
- Ankylosing spondylitis (AS) management aims to alleviate pain, stiffness, and fatigue while preventing structural damage.
- Therapeutic agents for AS are categorized as symptom-modifying and disease-controlling antirheumatic drugs (DMARDs).
Purpose of the Study:
- To review the efficacy of current medical therapies for ankylosing spondylitis.
- To evaluate the role of NSAIDs and DMARDs in AS management.
Main Methods:
- Review of current literature on medical therapies for AS.
- Analysis of evidence for NSAIDs, DMARDs, and corticosteroids in AS treatment.
Main Results:
- Non-steroidal anti-inflammatory drugs (NSAIDs) are first-line treatments, effective for symptom control and potentially slowing radiological progression with continuous use.
- Disease-modifying antirheumatic drugs (DMARDs) have limited evidence of efficacy in AS, with sulphasalazine showing some peripheral benefit but no axial effect.
- Local corticosteroids are effective, while oral corticosteroids and intravenous methylprednisolone offer temporary symptom relief.
Conclusions:
- NSAIDs remain crucial for symptom management and may offer disease modification in AS.
- Current DMARDs lack robust evidence for efficacy in AS, particularly for axial disease.
- Further research is needed for agents like pamidronate and thalidomide in refractory AS cases.