From the Guidelines
Anklosimf is likely a misspelling of ankylosing spondylitis, a chronic inflammatory disease that requires a comprehensive treatment approach to manage symptoms and prevent long-term damage. Based on the most recent and highest quality study available, the 2019 update of the American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network recommendations for the treatment of ankylosing spondylitis and nonradiographic axial spondyloarthritis 1 suggests that treatment with NSAIDs, such as naproxen or indomethacin, is recommended for pain and inflammation management. In addition to NSAIDs, the following treatment options are recommended:
- Physical therapy to maintain mobility and prevent disability
- Biologics, such as TNF inhibitors (adalimumab, etanercept) or IL-17 inhibitors (secukinumab), for patients with active disease despite NSAID treatment
- Regular exercise, particularly swimming and stretching, to maintain spinal flexibility
- Posture awareness and smoking cessation to prevent disease progression It is essential to note that the treatment approach should be individualized and based on a shared decision between the patient and healthcare provider, with the goal of achieving remission or low disease activity 1. The treatment plan should also consider extra-articular and extramusculoskeletal aspects, as well as comorbidities, to ensure comprehensive care. Regular follow-up examinations are necessary to monitor disease activity and adjust the treatment plan as needed. Overall, a multidisciplinary approach, including medication, physical therapy, and lifestyle modifications, is crucial for managing ankylosing spondylitis and improving patient outcomes.
From the Research
Ankylosing Spondylitis Treatment
- Ankylosing spondylitis (AS) is a systemic inflammatory rheumatic disease involving spinal and sacroiliac joints, characterized by back pain, stiffness, and discomfort 2.
- The main treatment for AS includes nonsteroidal anti-inflammatory drugs (NSAIDs), which reduce pain and stiffness in most patients 2, 3, 4, 5, 6.
NSAIDs Efficacy and Safety
- NSAIDs are effective in controlling clinical manifestations of AS, including pain, physical function, and perhaps progressive spinal fusion 4.
- A network meta-analysis of randomized controlled trials found that all NSAIDs were significantly more effective in reducing pain severity than placebo, with etoricoxib ranked as the most efficacious treatment for patients with AS 5.
- However, NSAIDs can have gastrointestinal side effects, and some patients may be inadequately relieved of pain and inflammation by NSAIDs 3, 5.
- The long-term safety profile of NSAIDs needs to be proven, and clinicians should take gastrointestinal toxicity into account when prescribing NSAIDs 4, 5.
Comparison of NSAIDs
- A Bayesian network meta-analysis compared the efficacy of 20 NSAIDs in the short-term treatment of AS and found that etoricoxib was superior to some other NSAIDs in pain reduction, but there was otherwise insufficient evidence to conclude that any particular NSAID was more effective in the treatment of AS 6.
- Another study found that etoricoxib was more effective in reducing pain in AS than some other NSAIDs, but comparisons were limited by small studies 6.
- The choice of NSAID should be individualized, taking into account the patient's specific needs and potential side effects 2, 3.