Medication toxicity among patients with ankylosing spondylitis

Abstract

Objective. To determine the role of medication toxicity in the discontinuation of antirheumatic treatment among patients with ankylosing spondylitis (AS), and to compare the toxicity of different medications. Methods. In a prospective longitudinal study of 241 patients with AS, we examined the duration of treatment and discontinuations due to side effects of new courses of sulfasalazine, methotrexate, ibuprofen, naproxen, indomethacin, diclofenac, piroxicam, nabumetone, and celecoxib. Results. Of the 241 patients, 167 reported having a new treatment course of either sulfasalazine (n ‫؍‬ 49), methotrexate (n ‫؍‬ 19), ibuprofen (n ‫؍‬ 105), naproxen (n ‫؍‬ 57), indomethacin (n ‫؍‬ 50), diclofenac (n ‫؍‬ 38), piroxicam (n ‫؍‬ 34), nabumetone (n ‫؍‬ 27), or celecoxib (n ‫؍‬ 25), for a total of 404 new treatment courses. Side effects were reported in 6.7% (ibuprofen) to 47.3% (methotrexate) of the courses. Between 2% (ibuprofen) and 23.5% (piroxicam) of courses were discontinued due to toxicity. For each medication, the duration of treatment was most often limited by factors other than toxicity. The time to drug discontinuation for any reason and the time to discontinuation due to toxicity did not differ between sulfasalazine and methotrexate. The time to drug discontinuation for any reason did not differ among nonsteroidal antiinflammatory drugs (NSAIDs), but discontinuations due to toxicity occurred earlier with piroxicam than with other NSAIDs. Conclusion. Although medication toxicity is common among patients with AS, it is an uncommon cause of discontinuation of antirheumatic treatment.

The Correlation between Pack-Years of Smoking and Disease Activity, Quality of Life, Spinal Mobility, and Sacroiliitis Grading in Patients with Ankylosing Spondylitis

“…[7,[13][14][15][16][17] However, the relationship between smoking and radiographic severity has not been consistent in the literature. [3][4][5][6][7][8][9][10][11][12][13][14][15]18] To our knowledge, the first survey which exposed the connection between smoking and AS patient outcomes was by Averns et al [15] in 1996. This investigation was included AS patients with a median duration of 20 years, and the authors found significant differences between smokers and non-smokers with regard to the finger-floor distance, Schober's test, total spinal involvement, occiput-to-wall distance, functional status, stiffness, and spinal radiographic damage.…”

“…), a family history of AS, and age at disease onset have been reported to affect the clinical manifestations or severity of AS. [3][4][5][6][7] Smoking is one of the modifiable lifestyle factors that has been proposed as being responsible for the more severe form of AS in recent years. [5] Conversely, to the best of our knowledge, only a few studies have focused on the relationship between the quantity of smoking (pack-years) and severity markers in AS.…”

Work Absenteeism and Its Determinant Factors in Patients with Ankylosing Spondylitis: A Cross-Sectional Study

“…Since there were multiple mechanisms that caused the increased amount of sick leave, including disease-related, work-related, sociodemographic, and psychosocial factors, 27 all of them should be considered when trying to predict which patients are at risk for long-term absenteeism.…”

Atividade física regular preserva a função pulmonar em pacientes com espondilite anquilosante sem doença pulmonar prévia

“…The longer the pathology extension, more restrictions are observed con- 18 this factor is one of the main causes that increment the incapacity at work and, then, disability retirement. This factor may be a determinant factor of the best performance of active individuals in their current job.…”