Mazen Elyan | PubMed Health

PubMed2006

The role of nonsteroidal anti-inflammatory medications and exercise in the treatment of ankylosing spondylitis.

Ankylosing spondylitis (AS) is a chronic systemic rheumatic disease that primarily affects the sacroiliac joints and spine. Even with the development of tumor necrosis factor-alpha inhibitors, which have revolutionized the treatment of this disease, the combination of nonsteroidal anti-inflammatory drugs (NSAIDs), physical therapy, and a life-long exercise program still form the first step in its management. Multiple clinical trials have addressed the efficacy and safety of both nonselective and selective NSAIDs. Gastrointestinal toxicity remains their major side effect, with increased concern about the potential of cardiovascular toxicity, especially with the selective cyclooxygenase-2 inhibitors. A specific set of recommendations has been proposed for the management of AS.

Anti-Inflammatory Agents, Non-Steroidal↗

PubMed2006

Diagnosing ankylosing spondylitis.

This article focuses on the early diagnosis and effective management of ankylosing spondylitis (AS), a disease that is not uncommon and that can cause early retirement and severe functional disability. AS, like most other rheumatologic diseases, has no diagnostic gold standard. Correct diagnosis depends largely on a constellation of clinical symptoms and signs in addition to radiological findings. Early diagnosis has become all the more important because effective therapies are available: tumor necrosis factor antagonists that suppress disease activity and improve functional ability in patients with AS refractory to conventional drug therapy. The biologic agents are probably even more effective if given early. Inflammation of the sacroiliac joints and the spine is a common, early feature and possibly the most frequent first manifestation of disease. Therefore, its early detection is important, and magnetic resonance imaging has proven useful in this regard. To optimize diagnostic accuracy of early disease, it is crucial to use a comprehensive approach and have a deep understanding of the disease and its clinical picture. The clinician should gather a complete history, paying close attention to all the elements of this multisystem disease, as well as judiciously ordering laboratory testing and imaging. New strategies are being developed to assist primary care physicians in their screening for these patients, which in turn should result in early referral to rheumatologists and early diagnosis.

Adult↗