A systematic medline analysis of therapeutic approaches in ankylosing spondylitis

Abstract

Ankylosing spondylitis (AS) is a chronic inflammatory disorder involving the sacroiliac joints (SIJs), spine and less frequently the peripheral joints. Traditionally, it is well recognised that AS is a challenging disease to manage due to the lack of effective therapeutic options. Current evidence would suggest this has changed and there are now a number of therapies available that provide persistent control of inflammatory symptoms with improvement in daily function. NSAIDs remain the first step in patient treatment. Sulphasalazine may be effective in peripheral arthritis and there are emerging data to support its use in early inflammatory back pain. Studies have shown that pamidronate and steroid injection into SIJ have a symptom-modifying effect in AS. Current data suggest that anti-TNF treatment promises early benefit which is likely to continue in the longer term. Treatment with biologics should be considered sooner rather than later in the management of AS.

Updated consensus statement on biological agents for the treatment of rheumatic diseases, 2012: Table 1

“…Two RCTs failed to demonstrate the superiority of a combination of MTX with infliximab versus infliximab alone in the treatment of active AS over 1 year (category B evidence102 257 280). Regular treatment with infliximab was more effective than ‘on-demand’ treatment for treating AS (category A evidence 405 405a). …”

“…In a head-to-head comparison trial of a conventional DMARD (sulfasalazine) with a TNFi (etanercept), the latter was more effective, including for heel enthesitis (category A evidence327 405 406). Enthesitis scores have also been shown to improve in studies with other TNFi.…”

“…Although improvement may be seen more rapidly, a reduction in signs and symptoms, and improvement in function and QoL will usually be seen by 6–12 weeks in response to treatment with a TNFi (category A evidence288 405). …”

“…TNFi (adalimumab, etanercept, infliximab) remain efficacious for 2–7 years in open-label studies (category A/B/D evidence396 401 403 405 413). The disease usually flares after discontinuation of TNFi category C evidence396 401 403 413 414).…”

Fractured Care: Doctor of Nursing Practice Opportunities

“…A systematic analysis of this newer approach demonstrated that patients who are diagnosed early, often with a simple x-ray, and begin treatment with biologics early will have a slower progression of the disease (Goh & Samanta, 2009).…”