NSAIDs in ankylosing spondylitis.
Miceli-Richard C, Dougados M.
Rheumatology Department, René Descartes University, Paris, France.
Abstract
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) effects in Ankylosing Spondylitis (AS) are only suspensive but because of their rapid efficacy on inflammatory symptoms they are the first-line treatment in AS. Short term efficacy of NSAIDs in AS is observed for most patients but the correlation of NSAID intake with the long term prognosis and its potential influence on the structural progression of the disease is still unknown. Therefore, and due to the gastrointestinal side effects of these drugs, daily practice is mostly in favour of discontinuous intake of NSAIDs, following the clinical relapses. However, the recent introduction of specific Cox-2 inhibitors, with a lower risk of severe gastrointestinal adverse events, may modify this attitude. Moreover, some patients are inadequately relieved of pain and inflammation by NSAIDs. The number of NSAIDs to be tested and for each NSAID, the optimal dosage that must be used before categorizing a patient as "refractory to NSAID therapy" have to be clarified. The recent determination of response and remission criteria for NSAIDs therapy is the first step towards well-defined guidelines for short-term and long-term management of NSAIDs in AS.
PMID: 12463450 [PubMed - indexed for MEDLINE]
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Gastrointestinal lesions associated with spondyloarthropathies.
Orlando A, Renna S, Perricone G, Cottone M.
Department of General Medicine, Pneumology and Nutrition Clinic, V Cervello Hospital, Palermo University, Palermo, Italy. ambrogiorlando@alice.it
Abstract
Subclinical gut inflammation has been described in up to two-thirds of patients with spondyloarthropathies (SpA). Arthritis represents an extra-intestinal manifestation of several gastrointestinal diseases, including inflammatory bowel disease (IBD), Whipple's disease, Behcet's disease, celiac disease, intestinal bypass surgery, parasitic infections of the gut and pseudomembranous colitis. Moreover about two-thirds of nonsteroidal anti-inflammatory drug users demonstrate intestinal inflammation. Arthritis may manifest as a peripheral or axial arthritis. The spondyloarthropathy family consists of the following entities: ankylosing spondylitis, undifferentiated spondyloarthritis, reactive arthritis, psoriatic arthritis, spondyloarthritis associated with IBD, juvenile onset spondyloarthritis. This topic reviews the major gastrointestinal manifestations that can occur in patients with SpA and in nonsteroidal anti-inflammatory drugs users.PMID: 19468992 [PubMed - indexed for MEDLINE]PMCID: PMC2686900Free PMC Article
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Ankylosing Spondylitis
Ankylosing spondylitis, commonly referred to as arthritis of the spine, .... Long-term use of NSAIDs may have a damaging effect on chondrocyte (cartilage) ...
ankylosing-spondylitis.blogspot.com/ - Similar
[PDF] Pharmacotherapy (excluding biotherapies) for ...
continuous use of NSAIDs is not advisable. Grade D. 96.8%. 4. Systemic glucocorticoid therapy is not recommended in patients with ankylosing spondylitis, ...
www2.courses.vcu.edu/ptxed/as/download/Joint%20Bone%20Spin...
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Cannot get away from the fact that gut and the spondy monster are indeed all too often bedfellows. Even one-third would be sufficient to raise the lid on the matter - which cannot be ignored, nor brushed under the carpet. One has to be aware, very aware, of the problems associated with and between gut and AS. (V. lucky for those who are not so compromised! Sure do wish I were not. 'Smile'.)
Rafts of info out there covering the problem. So think we can lay it to rest. Some are affected, some are not. But to be aware, that one might indeed be in the majority, of those who are affected.
