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Appropriate management of axial spondyloarthritis

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Abstract

The management of axial spondyloarthritis includes a structured baseline assessment of the disease and follow-up of treatment efficacy using validated instruments. The treatment will depend on the severity and predominant manifestations of the disease. The cornerstone of management remains physical therapy and nonsteroidal anti-inflammatory drugs. Disease-modifying antirheumatic drugs such as sulfasalazine have shown efficacy only in treating peripheral arthritis, whereas thalidomide and pamidronate have shown some efficacy in treating axial inflammation. Antitumor necrosis factor-α agents are an efficacious option for treating signs and symptoms of axial disease, peripheral arthritis, and enthesitis, and for improving functional outcomes. They have not shown efficacy in reducing radiographic progression in axial disease. Recent evidence suggests that the new bone formation in ankylosing spondylitis may be due to upregulation of Wnt signaling in the osteoblastic pathway secondary to low serum DKK-1 levels, which are further suppressed by tumor necrosis factor inhibitor therapy.

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References and Recommended Reading

  1. Khan MA: Update on spondyloarthropathies. Ann Intern Med 2002, 136:896–907.

    PubMed  Google Scholar 

  2. Zochling J, Braun J, van der Heijde D: Assessments in ankylosing spondylitis. Best Pract Res Clin Rheumatol 2006, 20:521–537.

    Article  PubMed  Google Scholar 

  3. Anderson JJ, Baron G, van der Heijde D, et al.: Ankylosing spondylitis assessment group preliminary definition of short-term improvement in ankylosing spondylitis. Arthritis Rheum 2001, 44:1876–1886.

    Article  PubMed  CAS  Google Scholar 

  4. Calin A, Garrett SL, Whitelock HC, et al.: A new approach to defining functional ability in ankylosing spondylitis: the development of the Bath Ankylosing Spondylitis Functional Index. J Rheumatol 1994, 21:2281–2285.

    PubMed  CAS  Google Scholar 

  5. Garrett SL, Jenkinson T, Kennedy LG, et al.: New approach to defining disease status in ankylosing spondylitis: the Bath ankylosing spondylitis disease activity index. J Rheumatol 1994, 21:2286–2291.

    PubMed  CAS  Google Scholar 

  6. Barlow JH, Barefoot J: Group education for people with arthritis. Pt Educat Counsel 1996, 27:257–267.

    Article  CAS  Google Scholar 

  7. Dagfinrud H, Hagen K, Kvien TK: Physiotherapy interventions for ankylosing spondylitis. Cochrane Database Syst Rev 2006, (4):CD002822.

  8. van Tubergen A, Landewe R, van der Heijde D, et al.: Combined spa-exercise therapy is effective in patients with ankylosing spondylitis: A randomized controlled trial. Arthritis Rheum 2001, 45:430–438.

    Article  PubMed  Google Scholar 

  9. Zochling J, van der Heijde D, Burgos-Vargas R, et al.: ASAS/EULAR recommendations for the management of ankylosing spondylitis. Ann Rheum Dis 2006, 65:442–452.

    Article  PubMed  CAS  Google Scholar 

  10. van der Heijde D, Dijkmans B, Geusens P, et al.: Efficacy and safety of infliximab in patients with ankylosing spondylitis: results of a randomized, placebo-controlled trial (ASSERT). Arthritis Rheum 2005, 52:582–591.

    Article  PubMed  CAS  Google Scholar 

  11. Gorman JD, Sack KE, Davis JC Jr: Treatment of ankylosing spondylitis by inhibition of tumor necrosis factor alpha. N Engl J Med 2002, 346:1349–1356.

    Article  PubMed  CAS  Google Scholar 

  12. van der Heijde D, Kivitz A, Schiff M, et al.: Efficacy and safety of adalimumab in patients with ankylosing spondylitis. Arthritis Rheum 2006, 54:2136–2146.

    Article  PubMed  CAS  Google Scholar 

  13. Chen J, Liu C: Sulfasalazine for ankylosing spondylitis. Cochrane Database Syst Rev 2005, (2):CD004800.

  14. Dougados M, van der Linden SM, Leirisalo-Repo M, et al.: Sulfasalazine in the treatment of spondylarthropathy: a randomized, multicenter, double-blind, placebo-controlled study. Arthritis Rheum 1995, 38:618–627.

    Article  PubMed  CAS  Google Scholar 

  15. Chen J, Liu C: Methotrexate for ankylosing spondylitis. Cochrane Database Syst Rev 2004, (3):CD004524.

  16. van Denderen JC, van der Paardt M, Nurmohamed MT, et al.: Double blind, randomised, placebo controlled study of leflunomide in the treatment of active ankylosing spondylitis. Ann Rheum Dis 2005, 64:1761–1764.

    Article  PubMed  CAS  Google Scholar 

  17. Miceli-Richard C, Dougados M: NSAIDs in ankylosing spondylitis. Clin Exp Rheumatol 2002, 20:S65–S66.

    PubMed  CAS  Google Scholar 

  18. van der Heijde D, Baraf H, Ramos-Remus C, et al.: Evaluation of the efficacy of etoricoxib in ankylosing spondylitis. Arthritis Rheum 2005, 52:1205–1215.

    Article  PubMed  CAS  Google Scholar 

  19. Luukkainen R, Nissila M, Asikainen E, et al.: Periarticular corticosteroid treatment of the sacroiliac joint in patients with seronegative spondyloarthropathy. Clin and Exp Rheumatol 1999, 17:88–90.

    CAS  Google Scholar 

  20. Karabacakoglu A, Karakose S, Ozerbil OM, Odev K: Fluoroscopy-guided intraarticular corticosteroid injection into the sacroiliac joints in patients with ankylosing spondylitis. Acta Radiol 2002, 43:425–427.

    Article  PubMed  CAS  Google Scholar 

  21. Peters N, Ejstrup L: Intravenous methylprednisolone pulse therapy in ankylosing spondylitis. Scand J Rheumatol 1992, 21:134–138.

    PubMed  CAS  Google Scholar 

  22. Braun J, Zochling J, Baraliakos X, et al.: Efficacy of sulfasalazine in patients with inflammatory back pain due to undifferentiated spondyloarthritis and early ankylosing spondylitis: a multicentre randomised controlled trial. Ann Rheum Dis 2006, 65:1147–1153.

    Article  PubMed  CAS  Google Scholar 

  23. Gonzalez-Lopez L, Garcia-Gonzalez M, Vazque-Del-Mercado M, et al.: Efficacy of methotrexate in ankylosing spondylitis: a randomized, double blind, placebo controlled trial. J Rheumatol 2004, 31:1568–1574.

    PubMed  CAS  Google Scholar 

  24. Marzo-Ortega H, McGonagle D, Jarrett S, et al.: Infliximab in combination with methotrexate in active ankylosing spondylitis: a clinical and imaging study. Ann Rheum Dis 2005, 64:1568–1575.

    Article  PubMed  CAS  Google Scholar 

  25. Perez-Guijo V, Cravo A, Castro Mdel C, et al.: Increased efficacy of infliximab associated with methotrexate in ankylosing spondylitis. Joint Bone Spine 2007, 74:254–258.

    Article  PubMed  CAS  Google Scholar 

  26. Maksymowych W, Jhangri GS, Fitzgerald A, et al.: A six-month randomized, controlled, double-blind, dose-response comparison of intravenous pamidronate (60mg versus 10mg) in the treatment of nonsteroidal antiinflammatory drug-refractory ankylosing spondylitis. Arthritis Rheum 2002, 46:766–773.

    Article  PubMed  CAS  Google Scholar 

  27. Maksymowych W, Lambert RG, Jhangri GS, et al. Clinical and radiological amelioration of refractory peripheral spondyloarthritis by pulse intravenous pamidronate therapy. J Rheumatol 2001, 28:144–155.

    PubMed  CAS  Google Scholar 

  28. Toussirot E, Lohse A, Le Huede G, et al.: Treatment of refractory and active spondylarthropathies with pamidronate: an open study [abstract #SAT0026]. Presented at the European League Against Rheumatism. Berlin; June 19–24, 2004.

  29. Wei JC, Chan TW, Lin HS, et al.: Thalidomide for severe refractory ankylosing spondylitis: a 6-month open-label trial. J Rheumatol 2003, 30:2627–2631.

    PubMed  CAS  Google Scholar 

  30. Huang F, Gu J, Zhao W, et al.: One-year open-label trial of thalidomide in ankylosing spondylitis. Arthritis Rheum 2002, 47:249–254.

    Article  PubMed  CAS  Google Scholar 

  31. Haibel H, Rudwaleit M, Listing J, Sieper J: Open label trial of anakinra in active ankylosing spondylitis over 24 weeks. Ann Rheum Dis 2005, 64:296–298.

    Article  PubMed  CAS  Google Scholar 

  32. Braun J, Brandt J, Listing J, et al.: Treatment of active ankylosing spondylitis with infliximab: a randomised controlled multicentre trial. Lancet 2002, 359:1187–1193.

    Article  PubMed  CAS  Google Scholar 

  33. Braun J, Baraliakos X, Brandt J, et al.: Persistent clinical response to the anti-TNF-alpha antibody infliximab in patients with ankylosing spondylitis over 3 years. Rheumatology (Oxford) 2005, 44:670–676.

    Article  CAS  Google Scholar 

  34. Visvanathan S, Deodhar A, Braun J, et al.: Modulation of biomarkers of inflammation and bone turnover and associations with bone mineral density in ankylosing spondylitis patients treated with infliximab [abstract #Sat0317]. Presented at the European League Against Rheumatism. Amsterdam; June 21–24, 2006.

  35. Davis JC Jr, van der Heijde D, Braun J, et al.: Recombinant human tumor necrosis factor receptor (etanercept) for treating ankylosing spondylitis. Arthritis Rheum 2003, 48:3230–3236.

    Article  PubMed  CAS  Google Scholar 

  36. Davis JC Jr, van der Heijde D, Braun J, et al.: Sustained durability and tolerability of etanercept in ankylosing spondylitis for 96 weeks. Ann Rheum Dis 2005, 64:1557–1562.

    Article  PubMed  CAS  Google Scholar 

  37. Spondyloarthritis Research and Treatment Network: SPARTAN Educational Slide Set. Available at http://www.spartangroup.org. Accessed July 23, 2007.

  38. Wanders A, van der Heijde D, Landewe, et al.: Nonsteroidal antiinflammatory drugs reduce radiographic progression in patients with ankylosing spondylitis. Arthritis Rheum 2005, 52:1756–1765.

    Article  PubMed  CAS  Google Scholar 

  39. Braun J, Landewe R, Hermann KG, et al.: Major reduction in spinal inflammation in patients with ankylosing spondylitis after treatment with infliximab. Arthritis Rheum 2006, 54:1646–1652.

    Article  PubMed  CAS  Google Scholar 

  40. Braun J, Baraliakos X, Golder W, et al.: Magnetic resonance imaging examinations of the spine in patients with ankylosing spondylitis, before and after successful therapy with infliximab. Arthritis Rheum 2003, 48:1126–1136.

    Article  PubMed  CAS  Google Scholar 

  41. van der Heijde D: Two-year etanercept therapy does not inhibit radiographic progression in patients with AS [abstract #OP0090]. Presented at the European League Against Rheumatism. Amsterdam; June 21–24, 2006.

  42. van der Heijde D, Landewe R, Deodhar A, et al.: Radiographic progression in patients with ankylosing spondylitis after 2 years of treatment not inhibited with infliximab [abstract #OPO111]. Presented at the European League Against Rheumatism. Barcelona; June 13–16, 2007.

  43. Brandt J, Listing J, Krause A, et al.: Socioeconomic consequences for patients with active ankylosing spondylitis treated for two years with infliximab in a clinical trial [abstract #FRI0201]. Presented at the European League Against Rheumatism. Lisbon; June 18–21, 2003.

  44. van der Heijde D, DeVlam K, Burmester G, et al.: Infliximab improves productivity in employed patients with ankylosing spondylitis: results of a randomized, placebo-controlled trial (ASSERT) [abstract #SAT0044]. Presented at the European League Against Rheumatism. Berlin; June 9–12, 2004.

  45. Kobelt G, Andlin-Sobocki P, Maksymowych W: The cost-effectiveness of infliximab (Remicade) in the treatment of ankylosing spondylitis in Canada. J Rheumatol 2006, 33:732–740.

    PubMed  CAS  Google Scholar 

  46. Sweeney S, Gupta R, Taylor G, Calin A: Total hip arthroplasty in ankylosing spondylitis: outcome in 340 patients. J Rheumatol 2001, 28:1862–1868.

    PubMed  CAS  Google Scholar 

  47. van Royen BJ, De Gast A: Lumbar osteotomy for correction of thoracolumbar kyphotic deformity in ankylosing spondylitis. A structured review of three methods of treatment. Ann Rheum Dis 1999, 58:399–406.

    Article  PubMed  Google Scholar 

  48. Toussirot E, Saas P, Pouthier F, et al.: Increased levels of soluble Ctla-4 molecule in serum of patients with spondyloarthropathies [abstract #1103–362]. Presented at the American College of Rheumatology Annual Meeting. Washington, DC; November 10–15, 2006.

  49. Diarra D, Stolina M, Polzer K, et al.: Dickkopf-1 is a master regulator of joint remodeling. Nature Med 2007, 13:156–163.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Division of Arthritis and Rheumatic Diseases OP-09, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, Portland, OR, 97239, USA

    Atul A. Deodhar

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  1. Sean P. LaSalle
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Correspondence to Atul A. Deodhar.

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LaSalle, S.P., Deodhar, A.A. Appropriate management of axial spondyloarthritis. Curr Rheumatol Rep 9, 375–382 (2007). https://doi.org/10.1007/s11926-007-0060-8

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