Treatment of Spondyloarthropathy

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.
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