From the Guidelines
The primary treatment for ankylosing spondylitis (AS) and nonradiographic axial spondyloarthritis involves the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and tumor necrosis factor inhibitors (TNFi), with secukinumab or ixekizumab recommended for patients with active disease who have contraindications to TNFi. The 2019 update of the American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network recommendations for the treatment of AS and nonradiographic axial SpA emphasizes the role of NSAIDs and TNFi in managing these conditions 1.
Key Recommendations
- NSAIDs are conditionally recommended for continuous treatment over on-demand treatment in adults with active AS 1.
- TNFi are strongly recommended for treatment in adults with active AS despite NSAID treatment 1.
- Secukinumab or ixekizumab may be considered for patients with contraindications to TNFi, such as heart failure or demyelinating disease, but not for those with inflammatory bowel disease (IBD) or recurrent uveitis, where TNFi monoclonal antibodies are preferred 1.
- Tofacitinib is a potential second-line option for patients with contraindications to TNFi other than infections, pending the results of larger clinical trials 1.
Treatment Considerations
- The decision to use NSAIDs continuously may depend on symptom severity, patient preferences, and comorbidities, particularly gastrointestinal and kidney comorbidities, and cardiovascular disease 1.
- Sulfasalazine or methotrexate may be considered for patients with prominent peripheral arthritis or when TNFi are not available, but evidence for their efficacy in axial skeleton symptoms is limited 1.
- Regular monitoring of blood counts, lipids, and liver function is necessary for patients on TNFi or other biologic treatments.
Recent Updates
- The 2019 recommendations update the previous guidelines by incorporating new treatment options and modifying existing recommendations based on the latest evidence 1.
- The use of secukinumab, ixekizumab, and tofacitinib expands the treatment arsenal for AS and nonradiographic axial SpA, offering alternatives for patients who cannot tolerate or do not respond to TNFi 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Summary of the Article
The article with the identifier PMC10374066 discusses the effectiveness of ibuprofen plus paracetamol combination in preventing musculoskeletal pain persistence in primary care patients 2.
Key Findings
- The study found that the fixed-dose ibuprofen plus paracetamol combination was significantly more effective in preventing pain persistence compared to other systemic analgesics, with an adjusted hazard ratio of 0.72 (95% confidence interval 0.61-0.85) 2.
- The combination of ibuprofen and paracetamol has been shown to be effective in controlling musculoskeletal pain persistence, with a mean duration of treatment of 7.23 ± 2.68 days 2.
- Other studies have also investigated the safety and efficacy of nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen for the treatment of acute pain, including in children and adults 3, 4.
Related Research
- A systematic review of the safety profiles of oral medications for acute nonsurgical pain in children found that ibuprofen and acetaminophen have similar reported adverse effects and notably less adverse events than opioids 3.
- Another study discussed the role of patient safety in medical care and proposed patient- and family-driven processes to improve patient safety 5.
- A scoping review of patient safety training programs for health care professionals found that these programs provide tools and techniques to recognize adverse incidents and promote communication, teamwork, and organizational culture concerning patient safety 6.