Treatment of Spondyloarthropathy: Difference between revisions

m (Protected "Treatment in Spondyloarthropathy" ([Edit=Allow only autoconfirmed users] (indefinite) [Move=Allow only autoconfirmed users] (indefinite)))
No edit summary
Line 1: Line 1:
Spondyloarthropathy is an umbrella term for a group of seronegative inflammatory conditions. Included in this family of diseases are:
[[Overview of Spondyloarthropathies|Spondyloarthropathy]] is an umbrella term for a group of seronegative inflammatory conditions. Included in this family of diseases are:
* [[Ankylosing Spondylitis|Axial spondyloarthritis]]
* [[Psoriatic Arthritis|Psoriatic arthritis]]
* [[Enteropathic Spondylitis|Enteropathic arthritis]]
* [[Reactive Arthritis|Reactive arthritis]]
* Undifferentiated spondyloarthritis
A primary aim of treatment is to reduce inflammation. In addition, issues such as pain, stiffness, fatigue, sleep disturbance, depression, reduced physical activity levels, and increased cardiovascular disease risk need to be addressed.<ref name=":0">Martey C. Treatment in Spondyloarthropathy Course. Physioplus 2020. </ref>
 
Many different health care professionals are involved in the management of spondyloarthropathy, from diagnosis to treatment. This page will explore both the pharmacological and nonpharmacological treatment options for spondyloarthropathy.
 
== Pharmacological Treatment ==
 
=== Non-Steroidal Anti-Inflammatory Drugs ===
Initial treatment of spondyloarthropathy is focused on non-steroidal anti-inflammatory drugs (NSAIDs) and exercise management.<ref name=":0" />
 
NSAIDs are commonly used to manage pain and inflammation, and as an antipyretic (i.e. to treat fever / reduce temperature).<ref name=":0" /> NSAIDs work by blocking the enzyme cyclooxygenase (COX). There are two COX isoforms: COX-1 and COX-2. COX-1 has a homeostatic role while COX-2 generates the prostaglandins seen in fever, inflammation, and carcinogenesis.<ref name=":1">Wong RSY. Disease-Modifying Effects of Long-Term and Continuous Use of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) in Spondyloarthritis. Adv Pharmacol Sci. 2019; 2019: 5324170. </ref>
 
NSAIDs are available in tablets, capsules, suppositories, creams, gels and potentially as injections. Some NSAIDs can be bought over-the-counter while others require a prescription.<ref name=":0" /> Commonly used NSAIDs are:<ref name=":0" />
* Diclofenac
* Ibuprofen
* Neproxin
* Arcoxia
* Etoricoxib
For many years, NSAIDs have been used as the first-line treatment for spondyloarthropathy.<ref name=":1" /><ref>Toussirot E. Pharmacological management of axial spondyloarthritis in adults. Expert Opin Pharmacother. 2019; 20(12): 1483-91. </ref> Around 70 to 80 percent of patients with axial spondyloarthritis take NSAIDs with varying degrees of efficacy.<ref name=":2">Braun J, Sieper J. Therapy of ankylosing spondylitis and other spondyloarthritides: established medical treatment, anti-TNF-alpha therapy and other novel approaches. Arthritis Res. 2002; 4(5): 307-21. </ref> A positive response to NSAIDs has been included as a criterion for the diagnosis of inflammatory back pain and spondyloarthropathy in the ASAS criteria.<ref name=":2" /><ref>Slobodin G, Eshed I. Non-Radiographic Axial Spondyloarthritis. Isr Med Assoc J. 2015; 17(12): 770-6.</ref>
 
Patients can respond quite differently to NSAIDs, so it may be necessary to try different forms of NSAIDs to determine the best option. A poor response to NSAIDs is considered to be a poor prognostic sign in axial spondyloarthritis.<ref name=":2" />
 
Due to the chronic nature of these conditions, patients may need to take NSAIDs continuously or for long periods of time. This can cause various side effects:<ref name=":1" />
 
===== Gastrointestinal Effects =====
Gastrointestinal complications may be relatively minor (i.e. dyspepsia, nausea, and heartburn) or severe (life-threatening gastrointestinal bleed). The risk of adverse effects increases with age and for patients also taking other medications (such as aspirin and corticosteroids).<ref name=":1" />
 
===== Renal Adverse Effects =====
Around one to five percent of patients who require NSAIDs regularly go on to develop adverse renal effects. <ref name=":1" />These include:<ref name=":1" />
* Reduction in glomerular filtration rate
* Acute renal failure
* Renal papillary necrosis
* Nephrotic syndrome
* Acute interstitial nephritis
* Chronic renal failure
* Fluid and electrolyte retention
 
===== Cardiovascular adverse effects =====
NSAIDs can worsen hypertension and have been linked to a heightened risk for myocardial infarction.<ref name=":1" />
 
[[Category:Course Pages]]
[[Category:Course Pages]]
[[Category:Rheumatology]]
[[Category:Rheumatology]]

Revision as of 02:23, 27 November 2020

Spondyloarthropathy is an umbrella term for a group of seronegative inflammatory conditions. Included in this family of diseases are:

A primary aim of treatment is to reduce inflammation. In addition, issues such as pain, stiffness, fatigue, sleep disturbance, depression, reduced physical activity levels, and increased cardiovascular disease risk need to be addressed.[1]

Many different health care professionals are involved in the management of spondyloarthropathy, from diagnosis to treatment. This page will explore both the pharmacological and nonpharmacological treatment options for spondyloarthropathy.

Pharmacological Treatment[edit | edit source]

Non-Steroidal Anti-Inflammatory Drugs[edit | edit source]

Initial treatment of spondyloarthropathy is focused on non-steroidal anti-inflammatory drugs (NSAIDs) and exercise management.[1]

NSAIDs are commonly used to manage pain and inflammation, and as an antipyretic (i.e. to treat fever / reduce temperature).[1] NSAIDs work by blocking the enzyme cyclooxygenase (COX). There are two COX isoforms: COX-1 and COX-2. COX-1 has a homeostatic role while COX-2 generates the prostaglandins seen in fever, inflammation, and carcinogenesis.[2]

NSAIDs are available in tablets, capsules, suppositories, creams, gels and potentially as injections. Some NSAIDs can be bought over-the-counter while others require a prescription.[1] Commonly used NSAIDs are:[1]

  • Diclofenac
  • Ibuprofen
  • Neproxin
  • Arcoxia
  • Etoricoxib

For many years, NSAIDs have been used as the first-line treatment for spondyloarthropathy.[2][3] Around 70 to 80 percent of patients with axial spondyloarthritis take NSAIDs with varying degrees of efficacy.[4] A positive response to NSAIDs has been included as a criterion for the diagnosis of inflammatory back pain and spondyloarthropathy in the ASAS criteria.[4][5]

Patients can respond quite differently to NSAIDs, so it may be necessary to try different forms of NSAIDs to determine the best option. A poor response to NSAIDs is considered to be a poor prognostic sign in axial spondyloarthritis.[4]

Due to the chronic nature of these conditions, patients may need to take NSAIDs continuously or for long periods of time. This can cause various side effects:[2]

Gastrointestinal Effects[edit | edit source]

Gastrointestinal complications may be relatively minor (i.e. dyspepsia, nausea, and heartburn) or severe (life-threatening gastrointestinal bleed). The risk of adverse effects increases with age and for patients also taking other medications (such as aspirin and corticosteroids).[2]

Renal Adverse Effects[edit | edit source]

Around one to five percent of patients who require NSAIDs regularly go on to develop adverse renal effects. [2]These include:[2]

  • Reduction in glomerular filtration rate
  • Acute renal failure
  • Renal papillary necrosis
  • Nephrotic syndrome
  • Acute interstitial nephritis
  • Chronic renal failure
  • Fluid and electrolyte retention
Cardiovascular adverse effects[edit | edit source]

NSAIDs can worsen hypertension and have been linked to a heightened risk for myocardial infarction.[2]

  1. ↑ 1.0 1.1 1.2 1.3 1.4 Martey C. Treatment in Spondyloarthropathy Course. Physioplus 2020.
  2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 Wong RSY. Disease-Modifying Effects of Long-Term and Continuous Use of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) in Spondyloarthritis. Adv Pharmacol Sci. 2019; 2019: 5324170.
  3. ↑ Toussirot E. Pharmacological management of axial spondyloarthritis in adults. Expert Opin Pharmacother. 2019; 20(12): 1483-91.
  4. ↑ 4.0 4.1 4.2 Braun J, Sieper J. Therapy of ankylosing spondylitis and other spondyloarthritides: established medical treatment, anti-TNF-alpha therapy and other novel approaches. Arthritis Res. 2002; 4(5): 307-21.
  5. ↑ Slobodin G, Eshed I. Non-Radiographic Axial Spondyloarthritis. Isr Med Assoc J. 2015; 17(12): 770-6.
Retrieved from "https://www.physio-pedia.com/index.php?title=Treatment_of_Spondyloarthropathy&oldid=260550"