What is the treatment for spinal inflammation?

From the Guidelines

The treatment for spinal inflammation should start with NSAIDs/COXIBs in maximum tolerated and approved dosage for 2−4 weeks, as recommended by the expert consensus guidelines 1.

Treatment Approach

The goal of treatment is to reduce inflammation, relieve symptoms, maintain or regain functional capacity, and prevent structural musculoskeletal damage.

• The treatment approach is based on the level of disease activity, which is assessed by clinical symptoms, radiological measures, and biochemical markers.
• The expert consensus guidelines recommend the following treatment steps:
  • First-line treatment: NSAIDs/COXIBs in maximum tolerated and approved dosage for 2−4 weeks.
  • Second-line treatment: IVBP (generally preferred) or TNFi, depending on patient characteristics.
  • Third-line treatment: Referral to an expert center for consideration of other treatment options.

Medications

• NSAIDs/COXIBs: Naproxen 375−1100 mg/day, Diclofenac 150 mg/day, Indomethacin 150 mg/day, Ibuprofen 1800 mg/day, Celecoxib 200−400 mg/day, Etoricoxib 90 mg/day, Piroxicam 20 mg/day, Meloxicam 15 mg/day.
• IVBP: Pamidronate intravenously 3× 30 mg on 3 consecutive days, every 3 months, or Pamidronate intravenously 45−90 mg (or 1 mg/kg), every month or every 3 months.
• TNFi: Infliximab 3−5 mg/kg intravenously at 0,2, and 6 weeks, and henceforth 3−5 mg/kg every 6−8 weeks, or subcutaneously 120 mg/2 weeks, Etanercept 50 mg/week, subcutaneously, Adalimumab 40 mg/2 weeks, subcutaneously, Golimumab 50 mg/4 weeks, subcutaneously.

Monitoring and Adjustments

• Treatment response should be evaluated at 2−4 weeks for NSAIDs/COXIBs and at 3−6 months for IVBP and TNFi.
• In case of sufficient response, treatment can be continued, and tapering or on-demand treatment can be considered.
• In case of insufficient response, the treatment can be adjusted by adding or advancing to second-line or third-line treatments.

Important Considerations

• The treatment approach should be individualized based on patient characteristics, disease activity, and treatment response.
• Patients with spinal bone lesions with risk of vertebral collapse or significant accumulated skeletal damage may require more aggressive treatment, including IVBP and TNFi.
• The risk of complications, such as atypical femoral fractures and osteonecrosis of the jaw, should be monitored, especially in patients receiving IVBP.
• Patients receiving TNFi should be monitored for infection risk and screened for latent infection and vaccinated for relevant pathogens before starting treatment.

From the FDA Drug Label

2 Rheumatic Disorders As adjunctive therapy for short-term administration (to tide the patient over an acute episode or exacerbation) in: ... Ankylosing spondylitis 3. Collagen Diseases During an exacerbation or as maintenance therapy in selected cases of: 6 Ophthalmic Diseases Severe acute and chronic allergic and inflammatory processes involving the eye and its adnexa such as: 12 Miscellaneous Tuberculous meningitis with subarachnoid block or impending block when used concurrently with appropriate antituberculous chemotherapy.

The treatment for spinal inflammation may include prednisone (PO) as an adjunctive therapy for short-term administration, particularly in cases of ankylosing spondylitis or other inflammatory conditions. However, it is essential to note that the treatment should be used under the guidance of a healthcare professional and as part of a comprehensive treatment plan 2.

• Key points:
  • Prednisone (PO) may be used to treat spinal inflammation.
  • The treatment should be used for short-term administration.
  • It is essential to use the treatment under the guidance of a healthcare professional.

From the Research

Treatment for Spinal Inflammation

The treatment for spinal inflammation can vary depending on the underlying cause and severity of the condition.

• Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to reduce pain and stiffness in patients with ankylosing spondylitis, a type of spinal inflammation 3.
• Analgesics, muscle relaxants, and low-dose corticosteroids can be used as adjuvant therapy in patients who do not respond to NSAIDs or have severe symptoms 3.
• Disease-modifying antirheumatic drugs (DMARDs) such as sulfasalazine can be effective in treating patients with longstanding severe or refractory ankylosing spondylitis 3.
• Anti-TNF-alpha therapy with infliximab has been shown to be clinically efficacious and safe in treating patients with active ankylosing spondylitis, especially those who do not respond to NSAIDs 4.

Diagnostic Approaches

• Magnetic resonance imaging (MRI) is the method of choice for detecting early abnormalities of the spinal cord and providing detailed information for differential diagnosis in cases of inflammatory diseases of the spine and spinal cord 5, 6.
• MRI patterns can vary depending on the type of inflammatory lesion, and a reliable diagnosis of a specific inflammatory lesion can be difficult to achieve 6.

Associated Health Risks

• Systemic inflammation after spinal cord injury can contribute to a number of comorbid pathological conditions, including progressive multi-system health problems and acquired diseases 7.
• Individuals with chronic traumatic spinal cord injury are at risk of developing clinical illness and disability due to systemic inflammation 7.