Treatment of Ankylosing Spondylitis and Spondyloarthropathies
The principles of treatment of anylosing spondylitis are to control the
inflammation so that scarring and calcification with subsequent
stiffening of the spine and of joints is minimized as much as
possible.
The usual anti-inflammatories that are used for other forms of arthritis
are utilized here as well, such as NSAIDs and COX-2 inhibitors.
Corticosteroids, which play a larger role in rheumatoid arthritis,
play less of a role for ankylosing spondylitis. However, for single
joints that are affected, these may be injected by the physician
or rheumatologist for easier rehabilitation.
There is an FDA approved non-drug method available, IceWave
patches from Lifewave, which will control pain. This is
mentioned in the book "Breakthrough" by Suzanne Somers
(Ref. 7) where newer insights of antiaging medicine are also reviewed.
Although the patches are placed over acupuncture points, there
are no needles involved. Nanotechnology, a newer technology, was
used in the manufacturing of these patches and infrared (heat)
waves from body heat are utilized to stimulate an acupuncture
point, which modifies pain perception and reduces pain to half
or less. Medically this would be considered an excellent pain
reliever. For more info on the patches see the IceWave patches
from Lifewave link above (click "products"). In the
US a 5 pack of the IceWave spray is available that can be directly
sprayed onto the skin in the area where the pain is located.
Acute iritis is treated by the ophthalmologist utilizing topical corticosteroid drops as well. Systemic corticosteroids are avoided because of the danger of osteoporosis that would develop much easier in these patients and the danger of septicemia with life threatening infections as a result of the immunosuppressive side effect of corticosteroids.
Reiter's Syndrome
is associated with Chlamydia trachomatis, a sexually transmitted disease, and treatment with doxycycline over a period of 3 months is usually required for the patients and their sexual partners. Otherwise treatment for the joint pains is as above with mainly NSAIDs and COX-2 inhibitors.
Psoriatic arthritis
This has to be treated with anti-inflammatory medications often alongside
any flare-up of psoriasis ( the skin disease) that may
be flaring up at the same time.
As the presence of arthritis alongside skin signs of psoriasis indicates a more severe form of psoriasis with significiant autoimmune reactions, immune modulating therapies are needed to quickly get the disease under control. These therapies that were only developed very recently are at the present time still fairly expensive. Infliximab is a monoclonal antibody against TNF and this medication has been released by the FDA for rheumatoid arthritis and Crohns disease. The above link shows that dermatologists in the US have found this medication to be useful in difficult to treat psoriasis cases. Enbrel is another anti-TNF medication, which has been accepted by the FDA for psoriasis and psoriatic arthritis. Other immune modulators are alefacept and efalizumab, both of which work by inhibiting T cells (Ref. 6).
Reactive arthritis
is treated symptomatically while the underlying diseases are also treated with the usual therapies specific for the underlying diseases.
Enteropathic arthritis
This is associated with Crohns disease or ulcerative colitis. The same principle applies that the underlying condition is specifically treated and the associated arthritis is treated symptomatically as well.
In all of the different forms of arthritis physical treatment modalities
such as hot baths, physical therapies, daily exercises aimed at
maintaining and regaining full range of motion and strength are
combined with the treatment modalities mentioned above. Infliximab
is a monoclonal antibody against TNF and this medication has been
released by the FDA for rheumatoid arthritis and Crohns disease.
It is an immunomodulator that addresses the autoimmune reaction
that is behind the joint and gut symptoms of enteropathic arthritis
(Ref.6).
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