Hip Pelvis.  2014 Sep;26(3):129-135. 10.5371/hp.2014.26.3.129.

Medical Treatment of Ankylosing Spondylitis

Affiliations
  • 1Department of Orthopedic Surgery, Inha University School of Medicine, Incheon, Korea. moon@inha.ac.kr

Abstract

The diagnosis of ankylosing spondylitis is often delayed due to ambiguous clinical manifestations and strict diagnostic criteria. However, imaging techniques such as magnetic resonance imaging have been found effective for the early diagnosis of non-radiographic sacroiliitis. New tumor necrosis factor alpha (TNF-alpha) inhibitors have good efficacy for patients with persistently high disease activity despite conventional nonsteroidal anti-inflammatory drug treatment. Thus, early diagnosis and aggressive treatments are essential for ankylosing spondylitis patients. Because many patients complain of musculoskeletal pains, especially around the sacroiliac joint area, hip specialists should be informed of up-to-date knowledge. In this review, we discuss new diagnostic criteria for ankylosing spondylitis, administration methods of TNF-alpha inhibitors, and the long-term follow-up results for patients treated with TNF-alpha inhibitors.

Keyword

Ankylosing spondylitis; Medical treatment; TNF-alpha inhibitors

MeSH Terms

Diagnosis
Early Diagnosis
Follow-Up Studies
Hip
Humans
Magnetic Resonance Imaging
Musculoskeletal Pain
Sacroiliac Joint
Sacroiliitis
Specialization
Spondylitis, Ankylosing*
Tumor Necrosis Factor-alpha
Tumor Necrosis Factor-alpha

Figure

  • Fig. 1 Modified New York criteria for ankylosing spondylitis (AS).

  • Fig. 2 ASAS classification criteria for axial spondyloarthritis. ASAS: ASsessment of Ankylosing Spondylitis, NSAIDs: nonsteroidal anti-inflammatory drugs, HLA-B27: human leukocyte antigen B-27, CRP: C-reactive protein, mod NY criteria: modified New Yoirk criteria.

  • Fig. 3 Numerical rating scale of Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). VAS: visual analogue scale, ASAS: ASsessment of Ankylosing Spondylitis, NRS: numeric rating scale, AS: ankylosing spondylitis.


Reference

1. van Royen BJ, Dijkmans BAC. Ankylosing spondylitis: diagnosis and management. New York: Taylor & Francis;2006.
2. Zochling J, Maxwell L, Beardmore J, Boonen A. TNF-alpha inhibitors for ankylosing spondylitis. Cochrane Database Systemic Rev. 2005; 3:CD005468.
Article
3. Khan MA. Update on spondyloarthropathies. Ann Intern Med. 2002; 136:896–907.
Article
4. Zochling J, van der Heijde D, Burgos-Vargas R, et al. ASAS/EULAR recommendations for the management of ankylosing spondylitis. 'ASsessment in AS' international working group; European League Against Rheumatism. Ann Rheum Dis. 2006; 65:442–452.
5. Braun J, de Keyser F, Brandt J, Mielants H, Sieper J, Veys E. New treatment options in spondyloarthropathies: increasing evidence for significant efficacy of anti-tumor necrosis factor therapy. Curr Opin Rheumatol. 2001; 13:245–249.
Article
6. Braun J, van den Berg R, Baraliakos X, et al. 2010 update of the ASAS/EULAR recommendations for the management of ankylosing spondylitis. Ann Rheum Dis. 2011; 70:896–904.
7. Sieper J, Braun J, Rudwaleit M, Boonen A, Zink A. Ankylosing spondylitis: an overview. Ann Rheum Dis. 2002; 61:Suppl 3. iii8–iii18.
Article
8. Rudwaleit M, Metter A, Listing J, Sieper J, Braun J. Inflammatory back pain in ankylosing spondylitis: a reassessment of the clinical history for application as classification and diagnostic criteria. Arthritis Rheum. 2006; 54:569–578.
Article
9. Bennett AN, McGonagle D, O'Connor P, et al. Severity of baseline magnetic resonance imaging-evident sacroiliitis and HLA-B27 status in early inflammatory back pain predict radiographically evident ankylosing spondylitis at eight years. Arthritis Rheum. 2008; 58:3413–3418.
Article
10. Haibel H, Rudwaleit M, Listing J, et al. Efficacy of adalimumab in the treatment of axial spondylarthritis without radiographically defined sacroiliitis: results of a twelve-week randomized, double-blind, placebo-controlled trial followed by an open-label extension up to week fifty-two. Arthritis Rheum. 2008; 58:1981–1991.
Article
11. Barkham N, Keen HI, Coates LC, et al. Clinical and imaging efficacy of infliximab in HLA-B27-Positive patients with magnetic resonance imaging-determined early sacroiliitis. Arthritis Rheum. 2009; 60:946–954.
Article
12. Evans DM, Spencer CC, Pointon JJ, et al. Interaction between ERAP1 and HLA-B27 in ankylosing spondylitis implicates peptide handling in the mechanism for HLA-B27 in disease susceptibility. Nat Genet. 2011; 43:761–767.
13. Wanders A, Heijde Dv, Landewe´ R, et al. Nonsteroidal antiinflammatory drugs reduce radiographic progression in patients with ankylosing spondylitis: a randomized clinical trial. Arthritis Rheum. 2005; 52:1756–1765.
Article
14. El Miedany Y, Youssef S, Ahmed I, El Gaafary M. The gastrointestinal safety and effect on disease activity of etoricoxib, a selective cox-2 inhibitor in inflammatory bowel diseases. Am J Gastroenterol. 2006; 101:311–317.
Article
15. Braun J, Bollow M, Neure L, et al. Use of immunohistologic and in situ hybridization techniques in the examination of sacroiliac joint biopsy specimens from patients with ankylosing spondylitis. Arthritis Rheum. 1995; 38:499–505.
Article
16. Baraliakos X, Listing J, Fritz C, et al. Persistent clinical efficacy and safety of infliximab in ankylosing spondylitis after 8 years--early clinical response predicts long-term outcome. Rheumatology (Oxford). 2011; 50:1690–1699.
Article
17. Martĺn-Mola E, Sieper J, Leirisalo-Repo M, et al. Sustained efficacy and safety, including patient-reported outcomes, with etanercept treatment over 5 years in patients with ankylosing spondylitis. Clin Exp Rheumatol. 2010; 28:238–245.
18. Baraliakos X, Haibel H, Fritz C, et al. Long-term outcome of patients with active ankylosing spondylitis with etanercept-sustained efficacy and safety after seven years. Arthritis Res Ther. 2013; 15:R67.
Article
19. Sieper J, van der Heijde D, Dougados M, Brown LS, Lavie F, Pangan AL. Early response to adalimumab predicts long-term remission through 5 years of treatment in patients with ankylosing spondylitis. Ann Rheum Dis. 2012; 71:700–706.
Article
20. Khalessi AA, Oh BC, Wang MY. Medical management of ankylosing spondylitis. Neurosurg Focus. 2008; 24:E4.
Article
21. Bruner V, Atteno M, Spano´ A, Scarpa R, Peluso R. Biological therapies for spondyloarthritis. Ther Adv Musculoskelet Dis. 2014; 6:92–101.
Article
22. Adams K, Bombardier C, van der Heijde D. Safety and efficacy of on-demand versus continuous use of nonsteroidal antiinflammatory drugs in patients with inflammatory arthritis: a systematic literature review. J Rheumatol Suppl. 2012; 90:56–58.
Article
23. Baraliakos X, Listing J, Brandt J, et al. Clinical response to discontinuation of anti-TNF therapy in patients with ankylosing spondylitis after 3 years of continuous treatment with infliximab. Arthritis Res Ther. 2005; 7:R439–R444.
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