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Biomedical subjects

Muhammad Asim Khan

Publications and source records attributed to Muhammad Asim Khan.

9 recordsLinked to original sources
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

Ankylosing spondylitis and symptom-modifying vs disease-modifying therapy.

The main objectives of medical therapy in ankylosing spondylitis (AS) are to relieve pain, stiffness and fatigue and to prevent structural damage. The Assessment in Ankylosing Spondylitis Working Group has proposed different domains with specific instruments to assess the efficacy of therapeutic agents classified as symptom-modifying and disease-controlling antirheumatic drugs. Non-steroidal antiinflammatory drugs (NSAIDs) are still the first-line treatment in the management of AS, and they are effective in controlling symptoms such as pain and stiffness and maintaining mobility in many patients. A recent randomized trial suggested that the progression of radiological damage occurs less on continuous use of celecoxib compared with on-demand use. If such findings were confirmed by other studies, the therapeutic value of NSAIDs in AS may extend beyond symptom control. However, for each individual patient, the expected advantages of treatment with NSAIDs should be weighted against any possible gastrointestinal and cardiovascular disadvantages. Disease-modifying antirheumatic drugs (DMARDs) are widely used for second-line therapy in AS, but the evidence for their efficacy is poor. The term 'DMARD' has been borrowed from rheumatoid arthritis, and none of the DMARDs have been shown to prevent or significantly decrease the rate of progression of structural damage which is required to be qualified as a disease-controlling antirheumatic drug for AS. Sulphasalazine is the most extensively studied DMARD and studies suggest some degree of clinical benefit confined to peripheral joint involvement, but no evidence of benefit in axial disease. Methotrexate, which is the gold standard DMARD in rheumatoid arthritis, does not seem to have a substantial therapeutic effect in AS on axial or peripheral joint involvement. Leflunomide appears to exert little beneficial effect, if any, even on peripheral joint involvement. There is also good evidence that local therapy with corticosteroids is effective and may be used in selected patients. Oral corticosteroids may be somewhat effective in relieving the symptoms of AS, but this has not been formally studied. Small studies have reported favourable results with intravenous methylprednisolone pulse therapy, but the effect is temporary. Pamidronate and thalidomide have been used in some preliminary trials but need further studies to assess their potential role in treating AS patients resistant or intolerant to other forms of treatment. Treatment with tumour necrosis factor blockers is not discussed in this review.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2006

Ankylosing spondylitis: a dual perspective of current issues and challenges.

This series of articles on ankylosing spondylitis (AS) provides insight into the burden of disease and focuses on early diagnosis and effective management. AS leads to progressive functional impairment over time and has tremendous impact on society at large in terms of economic costs and indirect costs associated with physical impairment and loss of employment. Early diagnosis is crucial now that we have more effective therapy with tumor necrosis factor (TNF) antagonists, which suppress disease activity and improve the functional ability of patients whose disease is refractory to conventional drug therapy. Early identification of variables that help predict severe disease with bad functional prognosis is needed. If biological therapy with TNF inhibitors is proven to retard disease progression and prevent or delay functional limitations, insight into such prognosticators will help us offer the correct treatment to the correct patient at the correct time. There is also a need to demonstrate longterm benefits of such a therapy as well as a favorable cost/benefit ratio to help convince healthcare authorities, insurance companies, and others of the utility of these drugs for treating patients with AS refractory to conventional drug therapy.

Humans↗
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↗
PubMed2002

Age at disease onset and diagnosis delay in HLA-B27 negative vs. positive patients with ankylosing spondylitis.

OBJECTIVE: To investigate differences between HLA-B27(-) and HLA-B27(+) patients with ankylosing spondylitis (AS). METHODS: A total of 1080 patients with AS responded to a questionnaire containing 30 questions; 945 (87.5%) knew their HLA-B27 status, 10% of them being B27(-). RESULTS: The average age at disease onset was 27.7 years in B27(-) and 24.8 years in B27(+) AS (P < 0.01). The average age at diagnosis was 39.1 and 33.2 years and the average diagnosis delay 11.4 and 8.5 years, respectively. The distribution in age at disease onset was significantly wider in B27(-) (standard deviation 10.0 years) than in B27(+) AS (8.3 years). The percentages with childhood (age < 16 years) disease onset did not differ significantly (7.6% vs. 6.2%, respectively), whereas the percentage of late onset (age > 40 years) was significantly greater among B27(-) (13%) than among B27(+) (5%) patients with AS. There is a difference in average age at disease onset between male (25.7 years) and female (24.2 years) AS patients, and no difference between patients with primary AS and AS associated with psoriasis, inflammatory bowel disease, or reactive arthritis. Acute anterior uveitis was significantly less frequent in B27(-) (26%) than in B27(+) (41%) patients with AS. CONCLUSIONS. This study of a much larger number of B27(-) AS patients than have been studied previously confirms earlier reports indicating a significantly older average age at disease onset and a less frequent prevalence of acute anterior uveitis in B27(-) than in B27(+) AS. The frequency of late disease onset (after 40 years of age) is significantly higher in B27(-) AS. We provide the first report on significant differences in the distribution curves for the age at disease onset and for the age at diagnosis between B27(-)and B27(+) patients with AS. The average delay between the first spondyloarthritic symptoms and the diagnosis is significantly longer in B27(-) than in B27(+) AS. The frequency of juvenile disease onset (before age 16 years) is nearly the same, irrespective of the B27 status.

Acute Disease↗
PubMed2002

Update on spondyloarthropathies.

Spondyloarthropathies are a cluster of interrelated and overlapping chronic inflammatory rheumatic diseases that primarily include ankylosing spondylitis, reactive arthritis, and the arthritis associated with psoriasis and inflammatory bowel diseases. The primary pathologic sites are the entheses (the sites of bony insertion of ligaments and tendons); the axial skeleton, including the sacroiliac joints; the limb joints; and some nonarticular structures, such as the gut, skin, eye, and aortic valve. Although spondyloarthropathies are not associated with rheumatoid factor, they show a strong association with HLA-B27; however, this association varies markedly among various spondyloarthropathies and among ethnic groups. The most widely used classification criterion, from the European Spondyloarthropathy Study Group, encompasses the currently recognized wider disease spectrum, with a sensitivity and specificity that generally exceed 85%. Spondyloarthropathies occur in genetically predisposed persons and are triggered by environmental factors, but the cellular and molecular mechanisms of inflammation are not yet fully understood. Chlamydial and many enterobacterial infections can trigger reactive arthritis, but an infectious trigger for ankylosing spondylitis has not yet been established. HLA-B27 itself is involved in enhancing genetic susceptibility, but the underlying molecular basis is still unknown; additional genes include the putative susceptibility genes for Crohn disease, ulcerative colitis, and psoriasis. A specific susceptibility gene for Crohn disease, NOD2, is located on chromosome 16q12, and one of the candidate genes for psoriasis, PSORS1, has been mapped to a 60-kb fragment on chromosome 6p, which is telomeric to the HLA-C locus. This paper reviews the efficacy of anti-tumor necrosis factor-alpha therapy and other therapeutic advances.

Arthritis, Psoriatic↗