Treatment of ankylosing spondylitis

Abstract

IntroductionAnkylosing spondylitis (AS) is a chronic, inflammatory, rheumatic disease involving primarily the spine and sacroiliac joints. It is a prototype of spondyloarthritis (SpA) group diseases and its prevalence in Turkey has been reported as 0.49% (1). It is encountered in mostly young adults and in 80% of the cases symptoms appear before 30 years of age (2). Studies have revealed that the quality of life is reduced and the risk of disability and mortality is increased in patients with AS (3,4). It has been reported that the direct (due to health expenses) and indirect (as a result of workforce loss) economic losses associated with the disease are similar to those of rheumatoid arthritis (RA) in the long term (5).Management of AS consists of pharmacological and nonpharmacological treatment modalities (6-11). The pharmacological treatment options are limited; however, with the recent introduction of biological drugs, remarkable improvements have been reported in this field. In general, the treatment targets include control of symptoms and inflammation (pain, stiffness, and joint swelling), preservation/normalization of physical function, prevention of progressive structural damage and disabilities, and eventually maximizing the longterm health-related quality of life (6,11). The aim of this review article is to present an updated overview of the pharmacologic treatment of AS, as defined by the modified New York criteria (Table 1) (12). Nonpharmacological treatment modalities including physiotherapy and exercise are only briefly mentioned and surgical treatment is not discussed. Nonpharmacological treatment approaches: physiotherapy and exerciseThe nonpharmacological treatment for AS comprises patient training and regular exercise. Pharmacological treatment and nonpharmacological treatment approaches complement each other. Physiotherapy and exercise for the treatment of AS are also cost-effective (13). A recent Cochrane article summarized the available scientific evidence on the effectiveness of physiotherapy interventions in the management of AS ( 14). Personal home exercising and training, when compared to AS patients without such interventions, lead to significant improvement in some spinal mobility parameters (finger tips-to-floor distance); however, they have no effect on disease activity, pain, stiffness, and global patient evaluation (14). Studies comparing group physiotherapy programs applied with a supervisor with personal home exercise programs showed that there were no differences among groups in regard to pain, stiffness, and function; however, some spinal mobility parameters (Schober's distance) and patient global

Expression and function of Toll‑like receptors in peripheral blood mononuclear cells in patients with ankylosing spondylitis

“…The disease frequently occurs in young adults (4). AS progresses slowly, with the development of long-term disability in 20–30% of cases (5). At present, there is no cure available for AS, with treatment limited to the relief of symptoms (6,7).…”

Safety of tumor necrosis factor-alpha inhibitors for treatment of ankylosing spondylitis

“…AS is currently managed through a multidisciplinary approach that involves exercise, physiotherapy, and drug therapy. [5,6] Nonsteroidal anti-inflammatory drugs (NSAIDs) are the mainstay of AS therapy, reducing the stiffness and pain of inflammation. However, at least one-third of the patients were less responsive to NSAID treatment or severe side effects, and therefore need disease control drugs, in addition to improving symptoms treatment.…”

Cross-cultural adaptation and validation of the Turkish version of the pain catastrophizing scale among patients with ankylosing spondylitis

“…Pain generally starts in the lower back or hip and persists for more than three months. Inflammatory back pain is associated with prolonged morning stiffness lasting 30 minutes or longer, and 70–80% of patients have a good response to non-steroidal anti-inflammatory drugs (NSAIDs) 1 , 2 , 3 ) . The quality of life of patients with ankylosing spondylitis is negatively affected by chronic pain and functional changes 3 , 4 ) .…”