Ankylosing Spondylitis Treatment
ankylosing spondylitis treatment
ankylosing spondylitis treatment for an individual is tailored according to his or her needs, the characteristics of the infirmity and its gravity. Any of the following could be the line of management.
An integral part of the treatment of any ankylosing spondylitis disease is exercise. These exercise could be performed at home by the individual by himself or they can be carried out under the supervision of a Physiotherapist, either individually or as a group. It could also include physical therapy treatments. Optimally, each patient the evaluation should be carried on an individual basis and accordingly instructed. These exercises should include deep breathing, posture training, back and other straightening exercises.
Safety Issues – For the reason that people suffering from ankylosing spondylitis are prone to slips and falls, care should be taken to avoid such accidents. One of the safety measures is the limited use of alcohol. Precautions should also be taken in the use of pain killers like codeine and narcotics, and sleeping pills(sedatives), in as much as these increase the risks. High impact activities and contact sports of any kind are taboo.
The chances of accidents can be minimized by the use of night lights and tub or shower grab-bars. The risks of tripping and falling are increased by the presence of loose rugs and as such they should be tacked down with removable adhesive pads or strips. The risk of injury in any vehicle crash can be reduced by the wearing of seat belts. For those whose neck and head movements are restricted, the use of wrap-around rear view mirrors can be of immense help. While sleeping a thin pillow is recommended rather than a thick one so as to avoid the development of neck deformities.
Nonsteroidal Anti-Inflammatory Drugs(NSAIDs) – NSAIDs are practically the universal treatment for people with ankylosing spondylitis for getting relief from stiffness and pain. A minimum of two weeks on these drugs is required before its effects can be judged. Quite a lot of prescription and over-the-counter NSAID medications are available. But since no single medication is suitable for an individual, a trial period of two weeks may be sufficient to judge its efficacy before switching to another NSAID till you find one drug that is effective.
Side Effects – An upset stomach is the most widespread side effect of NSAIDs. A past or current history of stomach or duodenal (small bowel) ulcers and bleeding problems and also the use of blood thinners or anticoagulants (including Coumadin®) precludes the use of NSAIDs. An alternative line of treatment could be the use of selective COX-2 inhibitors like Celecoxib (Celebrex®). But COX-2 inhibitors have their own serious side effects.
A combination of a NSAID and another that will inhibit the formation of stomach and duodenal ulcers is an alternative recommendation. These could be high dose Histamine H2 Blockers (including Famotidine), Misoprostol and Proton-Pump Inhibitors (like Omeprazole etc.).
Sulfasalazine – (Brand name Azulfidine®) is a Disease Modifying Anti-Rheumatic Drug (DMARD) that can be administered to retard or arrest the progress of ankylosing spondylitis. It can be given as a combination with NSAIDs. DMARDs are typically for relief from the symptoms of arthritis but is not of any use if ankylosing spondylitis is relegated only to the spine.
Side Effects – These include dizziness, nausea, rash and headache. The occurrence of low blood count cannot also be ruled out. Patients on Sulfasalazine should undergo regular blood tests for liver function and blood count.
Anti-Tumor Necrosis Factor(TNF) Therapy – Ankylosing spondylitis seem to respond favorably to a group of medications branded as Anti-Tumor Necrosis Factor(Anti TNF) drugs. Such drugs include Infliximab (Remicade®), Adalimumab(Humira®) and Etanercept(Enbrel®). One or another of these drugs can turn out to be effective for ankylosing spondylitis. It is estimated that 80% of ankylosing spondylitis patients respond well to Anti-TNF drugs and it can be seen in a few weeks and even in a few days from the commencement of the treatment. However, these drugs offer only symptomatic relief and show no effect in the halting or slowing of the advancement of the disease.
Who Needs Anti-YNF Therapy? – This treatment is not required for all ankylosing spondylitis patients. Those patients who have ankylosing spondylitis but have not responded favorably to NSAIDs may be potential contenders. Whether to use these drugs or not depends on the several factors and should best be left to the decision of your physician.
A Glucocorticoid injection may also be recommended by the attending physician, particularly for swollen or painful joints; more so if there only a couple of them that are causing the problem. But if the symptoms reappear, the treatment may have to revert to Anti-TNF drugs.
Glucocorticoids (steroids) – A Glucocorticoid injection into the sacroiliac joint may be necessary to provide relief to those patients suffering from sacroiliac pain that has refused to respond to other lines of management. There may be relief from pain for a period of six months or even more after the administration of the injection. In contrast, oral administration of Glucocorticoids is rarely given for ankylosing spondylitis.
Selective patients suffering from ankylosing spondylitis may require surgical intervention and could include:
Total Hip Replacement – Patients suffering from ankylosing spondylitis with persistent and severe pain in the hip may require the insertion of an artificial hip. Surgery may also be recommended in cases of patients with limited mobility because of hip joint arthritis.
Spinal Surgery – In cases of patients with dislocation of the spinal vertebrae, fusion of the bones by spinal surgery may be recommended. Spinal cord damage may be so prevented.
Wedge Osteotomy – This surgical procedure involves the removal, from the vertebra, a small wedged shaped piece of bone. This is then followed by a realignment of the spine. Braces are then applied and the spine is maintained in a better position and allowed to heal. This is a procedure that is highly recommended for those individuals who have developed sever deformities in the neck that rules out any movement in the forward direction.
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