Spondyloarthropathy medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Medical Therapy
Albiet, no drugs have been proved to modify the natural history of disease, some new medications such as tumor necrosis factor antagonists (TNF-) are seem to be effective in modifying the disease course. Most of the patients with SpA can be managed inpatient except those with extra-articular manifestation. Progression of the disease and its response to medication are monitored by the laboratory findings such as Erythrocyte sedimentation rate (ESR) and C-reative protein (CRP).
Medication for treatment of spondyloarthropathies are included:
- Non-steroidal anti inflammatory drugs
- Corticosteroid
- Sulfasalazine
- TNF-a inhibitor (infliximab, etenercept, adalimumAb, certolizomab, golimumab)
Nonsteroidal anti-inflammatory drugs
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are helpful for reducing pain and also anti-inflammatory role, however, dosage for anti-inflammatory role is much more than pain reduction usage. Though, using NSAIDs in full anti-inflammatory doses can lead to reduction of radiographic progression sign, but it has some other adverse effect which mostly involve gasterointestinal (GI) tract such as nausea, dyspepsia, ulceration, and bleeding. Other organs that can be involved throughout treatment are kidneys and centeral nervous system (CNS).
- Side effects and efficacy of each category of NSAIDs may differ among groups.
Sulfasalazine
- Sulfasalazine is a second line medication in patients with SpA, who can not use NSAIDs. Usage of this drug in spinal stiffness and peripheral arthritis have been seen through numerous studies, but there is not enough evidence to prove its advantages in improving spinal motility, enthesitis or physical examination.
TNF-ɑ inhibitor
- TNF-ɑ inhibitor have been proved their advantages in treatment of SpA especially in AS.
- Their onset of action vary from 2 weeks unto 6 weeks.
- Studies demonstrated the efficacy of these drugs in the reduction of inflammation sites in MRI and also laboratory findings such as Erythrocyte sedimentation rate (ESR) and C-reative protein (CRP).
- Some of the most important adverse effect of these medication are included:
- Reactivation of tuberculosis, in previously infected individuals.
- Sever bacterial infection
- Fungal infection
- Congestive heart failure (in patient with rheumatoid arthritis at the onset of drug administration), (not common)
- Demyelinating syndrome (rare and not approved properly)
- Contraindications:
- In patients with active hepatitis B ( in chronic hepatitis C is not contraindicated)
- Patient with latent tuberculosis
- HIV infected individuals
Corticosteroid
- Short-term use of oral corticosteroid seem to be helpful, but long-term usage of oral corticosteroid demonstrated the risk of spinal fractures due to osteoporosis
- long-term usage of oral corticosteroid does not have effect on changing the outcome of the disease.
- Local injection have been used to suppress the inflammation of sacroiliitis, enthesitis, and other peripheral arthritis.
Interlukin inhibitors
Inhibition of inflammatory interleukins such as IL-17A, which is a proinflammatory cytokine, have shown benefits in patients with SpA.
Secukinumab is a human IgG1 monoclonal anti IL-17A.