Treatment for ankylosing spondylitis
There is no complete cure for ankylosing spondylitis. There is no proof that any specific diet can reduce the symptoms of ankylosing spondylitis. It's important to keep fit. Eat anything, especially protein rich diet, but don't get overweight. The main aim of the treatment for ankylosing spondylitis patient is that despite the disease patient should be able to lead an active life.
Aims of ankylosing spondylitis treatment are:
General measures to maintain a satisfactory posture and preserve movement. Physiotherapy and exercise are encouraged with the aim to remain as mobile as possible for as long as possible.
Pain and stiffness are controlled by NSAID's,disease modifying drugs or biologicals.
Surgery to correct deformity and restore mobility.
Rest and Exercise
When ankylosing spondylitis is very active, a spell of rest is good. This does not mean resting on bed, because this can hasten the stiffening of your joints. Therefore even at the time of rest
patients should do exercises that do not put load on the affected joints (like swimming or moving joints with the help of a helper). It is important to lie flat on your back to avoid curvature of the spine. Always use a firm bed. Patients should practice lying on their front. This is called 'Prone lying' and should be done before sleeping in the nights and before rising in the mornings.
Exercise is very good for ankylosing spondylitis to maintain posture and movement. Swimming is the best form of exercise. Swimming does not put load on your joints. It uses all muscles and joints without jerking them.
Applying heat on affected areas will help to relieve pain and stiffness.
Extraskeletal manifestations of ankylosing spondylitis are:
• Eyes: uveitis and conjunctivitis in 20%
• Heart: aortic valve disease, carditis (rare)
• Lungs: pulmonary fibrosis (rare)
Medical treatment for ankylosing spondylitis
Several drugs are used in treating ankylosing spondylitis. They are mainly intended to control pain and help maintain mobility. The medicines are basically classified into four types: Non-steroidal anti-inflammatory drugs (NSAIDs), disease modifying drugs, corticosteroids and biologicals.
Biological therapies
These are new drug treatments. In patients with ankylosing spondylitis or similar imflammatory diseases a protien called TNF (Tumor Necrosis Factor alpha) is present in blood and joints in excessive amounts. This causes inflammation. Anti-TNF drugs reduce inflammation by blocking the actions of TNF. Results of the treatment with these drugs show encouraging results of a prompt and dramatic improvements in symptoms of ankylosing spondylitis and other spondyloarthropathies.
Possible risks or side effects of anti-TNF drugs are infections like blocked or runny nose, fever, sore throat etc. Since the ability of the patients immune system to fight against infections are considerably reduced, patients should be considerably cautious against infectious diseases like chickenpox, TB etc.
Examples of biologicals are inflximab, etanercept and adalimumab.
Infliximab
Infliximab is a genetically engineered hybrid molecule made by combining human and mouse proteins. Infliximab is given by intravenous infusion. Patients will have to visit hospital for every infusion. The infliximab infusion is given over a period of two hours and patient may have to wait for another hour in the hospital. Sencond infliximab infusion is given after two weeks, third after four weeks and thereafter once in every eight weeks.
Etanercept
Another genetically engineered, human-derived molecule called etanercept (Enbrel) has a similar anti-TNF effect. Etanercept has to be given by subcutaneous injection (an injection under the skin) once or twice a week.
Adalimumab
Adalimumab is given by subcutaneous injection every other week (once every 2 weeks). It has anti-TNF effect and the normal dose is 40 mg.
Disease-modifying anti-rheumatic drugs (DMARDs)
These drugs may slow down or perhaps stop the progress of inflammatory arthritis in some people, but it may take a few months (which is why they are called slow-acting drugs). Some of the drugs like Methotrexate and Lefunomide are also known as immunosuppresent drugs. The examples for disease modifying drugs are Methotrexate, Sulfasalazine, Gold, Hydrochloroquine, Leflunomide and Rituximab.
Sulfasalazine (Salazopyrin) may be effective in ankylosing spondylitis patients who have peripheral arthritis. Sulfasalazine is taken with food and is available as enteric-coated tablets to decrease the chance of stomach upset. Therefore sulfasalazine tablets should not be broken. The dose should start with one tablet daily in the evening for the first week, twice daily for the second week, three tablets daily (one in the morning and two in the evening) for the third week, and then two tablets twice daily. Only after taking the full dose of 4–6 tablets per day for 4–6 months will you know whether it is going to be of any help. On rare occasions sulfasalazine may cause liver problems and abnormal white blood-cell counts due to bone marrow suppression, and that’s why blood count and liver function of the patient must be regularly monitored if you are taking sulfasalazine tablets.
Methotrexate is an immunosuppressant drug. It is used in chronic inflammatory arthritis. Methotrexate is a relatively slow acting anti-rheumatic drug. Since Methotrexate is a immunosuppressant, you should consult your doctor immediately if you get a dry cough or any other infections. Methotrexate is not suitable for people with liver and lung disease, alcoholism, an abnormal blood count, or active infection. Methotrexate may temporarily reduce fertility in men and women, but the risk appears to be very low, as far as we can tell at present. In men there is a theoretical risk of sperm damage. Therefore, it is sensible to wait for 6 months after discontinuing the drug before attempting to start a baby. This allows for drug washout and avoids any theoretical risk of fetal exposure.
There is no complete cure for ankylosing spondylitis. There is no proof that any specific diet can reduce the symptoms of ankylosing spondylitis. It's important to keep fit. Eat anything, especially protein rich diet, but don't get overweight. The main aim of the treatment for ankylosing spondylitis patient is that despite the disease patient should be able to lead an active life.
Aims of ankylosing spondylitis treatment are:
General measures to maintain a satisfactory posture and preserve movement. Physiotherapy and exercise are encouraged with the aim to remain as mobile as possible for as long as possible.
Pain and stiffness are controlled by NSAID's,disease modifying drugs or biologicals.
Surgery to correct deformity and restore mobility.
Rest and Exercise
When ankylosing spondylitis is very active, a spell of rest is good. This does not mean resting on bed, because this can hasten the stiffening of your joints. Therefore even at the time of rest
patients should do exercises that do not put load on the affected joints (like swimming or moving joints with the help of a helper). It is important to lie flat on your back to avoid curvature of the spine. Always use a firm bed. Patients should practice lying on their front. This is called 'Prone lying' and should be done before sleeping in the nights and before rising in the mornings.Exercise is very good for ankylosing spondylitis to maintain posture and movement. Swimming is the best form of exercise. Swimming does not put load on your joints. It uses all muscles and joints without jerking them.
Applying heat on affected areas will help to relieve pain and stiffness.
Extraskeletal manifestations of ankylosing spondylitis are:
• Eyes: uveitis and conjunctivitis in 20%
• Heart: aortic valve disease, carditis (rare)
• Lungs: pulmonary fibrosis (rare)
Medical treatment for ankylosing spondylitis
Several drugs are used in treating ankylosing spondylitis. They are mainly intended to control pain and help maintain mobility. The medicines are basically classified into four types: Non-steroidal anti-inflammatory drugs (NSAIDs), disease modifying drugs, corticosteroids and biologicals.
Biological therapies
These are new drug treatments. In patients with ankylosing spondylitis or similar imflammatory diseases a protien called TNF (Tumor Necrosis Factor alpha) is present in blood and joints in excessive amounts. This causes inflammation. Anti-TNF drugs reduce inflammation by blocking the actions of TNF. Results of the treatment with these drugs show encouraging results of a prompt and dramatic improvements in symptoms of ankylosing spondylitis and other spondyloarthropathies.
Possible risks or side effects of anti-TNF drugs are infections like blocked or runny nose, fever, sore throat etc. Since the ability of the patients immune system to fight against infections are considerably reduced, patients should be considerably cautious against infectious diseases like chickenpox, TB etc.
Examples of biologicals are inflximab, etanercept and adalimumab.
Infliximab
Infliximab is a genetically engineered hybrid molecule made by combining human and mouse proteins. Infliximab is given by intravenous infusion. Patients will have to visit hospital for every infusion. The infliximab infusion is given over a period of two hours and patient may have to wait for another hour in the hospital. Sencond infliximab infusion is given after two weeks, third after four weeks and thereafter once in every eight weeks.
Etanercept
Another genetically engineered, human-derived molecule called etanercept (Enbrel) has a similar anti-TNF effect. Etanercept has to be given by subcutaneous injection (an injection under the skin) once or twice a week.
Adalimumab
Adalimumab is given by subcutaneous injection every other week (once every 2 weeks). It has anti-TNF effect and the normal dose is 40 mg.
Disease-modifying anti-rheumatic drugs (DMARDs)
These drugs may slow down or perhaps stop the progress of inflammatory arthritis in some people, but it may take a few months (which is why they are called slow-acting drugs). Some of the drugs like Methotrexate and Lefunomide are also known as immunosuppresent drugs. The examples for disease modifying drugs are Methotrexate, Sulfasalazine, Gold, Hydrochloroquine, Leflunomide and Rituximab.
Sulfasalazine (Salazopyrin) may be effective in ankylosing spondylitis patients who have peripheral arthritis. Sulfasalazine is taken with food and is available as enteric-coated tablets to decrease the chance of stomach upset. Therefore sulfasalazine tablets should not be broken. The dose should start with one tablet daily in the evening for the first week, twice daily for the second week, three tablets daily (one in the morning and two in the evening) for the third week, and then two tablets twice daily. Only after taking the full dose of 4–6 tablets per day for 4–6 months will you know whether it is going to be of any help. On rare occasions sulfasalazine may cause liver problems and abnormal white blood-cell counts due to bone marrow suppression, and that’s why blood count and liver function of the patient must be regularly monitored if you are taking sulfasalazine tablets.
Methotrexate is an immunosuppressant drug. It is used in chronic inflammatory arthritis. Methotrexate is a relatively slow acting anti-rheumatic drug. Since Methotrexate is a immunosuppressant, you should consult your doctor immediately if you get a dry cough or any other infections. Methotrexate is not suitable for people with liver and lung disease, alcoholism, an abnormal blood count, or active infection. Methotrexate may temporarily reduce fertility in men and women, but the risk appears to be very low, as far as we can tell at present. In men there is a theoretical risk of sperm damage. Therefore, it is sensible to wait for 6 months after discontinuing the drug before attempting to start a baby. This allows for drug washout and avoids any theoretical risk of fetal exposure.
Non-steroidal anti-inflammatory drugs (NSAIDs)
NSAIDs are mainly used to control pain and suppress inflammation. The medicine must be taken as prescribed. NSAIDs must be taken as prescribed. It should not be taken for just their pain relieving effect. common side-effects of NSAIDs are stomach irritation, heartburn, indigestion, and ulcers in the stomach. NSAIDs should be taken in full stomach.
Some of the NSAIDs are listed below.
Celecoxib
Choline magnesium trisalicylate
Diclofenac
Diclofenac sodium plus misoprostol
Diflunisal
Disalcid Salsalate
Etodolac
Flurbiprofen
Ibuprofen
Indomethacin
Ketoprofen
Ketorolac tromethamnine
Meloxicam
Nabumetone
Naproxen
Naproxen sodium
Oxaprozin
Piroxicam
Rofecoxib
Sulindac
Tolmetin
Valdecoxib
Corticosteroids (steroids)
Corticosteroids are very effective in controlling inflammation and may have some disease-modifying effects. The long term use has serious side effects. Steriods can cause osteoporosis (thinning of bones). This medicines should be taken only with the guidance of a doctor.
NSAIDs are mainly used to control pain and suppress inflammation. The medicine must be taken as prescribed. NSAIDs must be taken as prescribed. It should not be taken for just their pain relieving effect. common side-effects of NSAIDs are stomach irritation, heartburn, indigestion, and ulcers in the stomach. NSAIDs should be taken in full stomach.
Some of the NSAIDs are listed below.
Celecoxib
Choline magnesium trisalicylate
Diclofenac
Diclofenac sodium plus misoprostol
Diflunisal
Disalcid Salsalate
Etodolac
Flurbiprofen
Ibuprofen
Indomethacin
Ketoprofen
Ketorolac tromethamnine
Meloxicam
Nabumetone
Naproxen
Naproxen sodium
Oxaprozin
Piroxicam
Rofecoxib
Sulindac
Tolmetin
Valdecoxib
Corticosteroids (steroids)
Corticosteroids are very effective in controlling inflammation and may have some disease-modifying effects. The long term use has serious side effects. Steriods can cause osteoporosis (thinning of bones). This medicines should be taken only with the guidance of a doctor.
