Note
This topic is the continuation of our theme:
- Bechterew’s disease
Synonyms in a broader sense
Ankylosing spondylitis (AS), ankylosing spondylitis, spondylarthropathyrheumatism, rheumatoid arthritis, psoriatic arthritis, methotrexate
Introduction Therapy
The therapy is based on the inflammatory activity and the stage of ankylosing spondylitis. Furthermore, the physician must of course take into account the individual response and concomitant diseases of the patient. The BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) is often used as a measure of disease activity.
This is a questionnaire for patients that was developed in 1994 by a group from Bath in England. Questions are asked, for example, about the duration and severity of morning stiffness, pain and fatigue. Therapy goals are to slow down the inflammatory process, counteract the stiffening tendency of the spine, relieve pain and, if possible, to maintain the function and strength of the joints.
Physiotherapy
Physiotherapy (physiotherapy) improves or maintains joint mobility, stretches shortened muscle groups and strengthens weakened muscles. Furthermore, coordination is trained, evasive movements are learned and pain is reduced. Recommended sports are: Avoid strong vibrations, one-sided stress, sports with a high risk of injury as well as sports with kyphosis strengthening (humping) of the spine (correct handlebar adjustment when cycling!). For general information on physiotherapy, please see our topic:
- Swimming
- Cycling
- Cross-country skiing
- Forest run and
- Volleyball.
- Physiotherapy
- Special information is available from Medon. de – Physiotherapy for ankylosing spondylitis
Physical therapy
Physical therapy measures are e.g. heat-cold applications, medical baths, massage, electrotherapy, ultrasound, etc. They primarily serve to relieve pain and relax muscles.
Drug therapy
Basis of the drug therapy of Mb. Bechterew are the non-steroidal antirheumatic drugs (NSAIDs) and COX 2 inhibitors (such as Arcoxia® 90mg). They lead to pain relief in 60-80% of patients and probably also have a positive effect on stiffening.
Long-term disease-modifying antirheumatic drugs (DMARDs), which are essential for patients with rheumatoid arthritis, have virtually no effect on the inflammatory changes in the spine in ankylosing spondylitis. The best-studied drug from this group in Bekhterev’s disease is sulfasalazine (e.g. Pleon®). It has been found that patients with low disease activity and predominant spinal involvement do not usually benefit from treatment with sulfasalazine, whereas patients with predominantly peripheral joint inflammation and patients in a highly active early stage of spinal infarction may benefit from treatment with sulfasalazine.
Occasionally, patients with ankylosing spondylitis are also treated with methotrexate. The efficacy of methotrexate is judged very inconsistently. The effect of methotrexate seems to be mainly on the peripheral joints, i.e. knee joint, hip joint, shoulder joint, etc.
etc., seems to be limited. In contrast to rheumatoid arthritis, systemic steroids (cortisone) have little effect in Bekhterev’s disease. However, in acute cases of acute infestation of one or a few joints, the doctor can administer intra-articular injections (injection into the joint) of local anesthetics (= local anaesthetics) and steroids (cortisone).
This often leads to rapid pain relief and functional maintenance of the joint. If there is insufficient improvement after steroid injection, a radiosynoviorthesis (RSO = sclerotherapy of the inflamed joint mucosa with radionuclides, e.g. yttrium 90, rhenium 186 or erbium 169) or chemosynoviorthesis (CSO = sclerotherapy of the inflamed joint mucosa with so-called sclerosing drugs, e.g. morrhuate or osmic acid) may be performed.
Tendon attachments can be infiltrated locally with a local anaesthetic and, if necessary, a water-soluble steroid (cortisone). In recent years, therapy with TNF-alpha inhibitors (e.g. Humira®, Remicade®, Enbrel®) has been shown to be highly effective in active ankylosing spondylitis.According to the recommendations of the ASAS (Assessments in Ankylosing Spondylitis) Group, an international group of researchers, mostly rheumatologists, therapy with TNF-alpha inhibitors should be started when a reliable (confirmed by a rheumatologist) diagnosis of ankylosing spondylitis is available, a BASDAI > 4 was present for at least 4 weeks and if at least two different non-steroidal anti-inflammatory drugs over three months, an intra-articularly injected steroid or sulfasalazine did not show the desired effect in patients with predominantly peripheral joint inflammation. Contraindications for the use of TNF-alpha inhibitors such as tuberculosis or other serious infections and moderate to severe heart failure must be excluded by the physician in advance.
More recent studies exist on the effectiveness of thalidomide and pamidronate in the drug treatment of ankylosing spondylitis. However, further study results must first be awaited for a sound assessment. In contrast to rheumatoid arthritis, systemic steroids (cortisone) have little effect in Bekhterev’s disease.
However, in acute cases of acute infestation of one or a few joints, the physician can administer intra-articular injections (injection into the joint) of local anesthetics (= local anaesthetics) and steroids (cortisone). This often leads to rapid pain relief and functional maintenance of the joint. If there is insufficient improvement after steroid injection, a radiosynoviorthesis (RSO = sclerotherapy of the inflamed joint mucosa with radionuclides, e.g.
yttrium 90, rhenium 186 or erbium 169) or chemosynoviorthesis (CSO = sclerotherapy of the inflamed joint mucosa with so-called sclerosing drugs, e.g. morrhuate or osmic acid) may be performed. Tendon attachments can be infiltrated locally with a local anaesthetic and, if necessary, a water-soluble steroid (cortisone). In recent years, therapy with TNF-alpha inhibitors (e.g. Humira®, Remicade®, Enbrel®) has been shown to be highly effective in active ankylosing spondylitis.
According to the recommendations of the ASAS (Assessments in Ankylosing Spondylitis) Group, an international group of researchers, mostly rheumatologists, therapy with TNF-alpha inhibitors should be started when a reliable diagnosis (confirmed by a rheumatologist) of Bekhterev’s disease is available, a BASDAI > 4 was present for at least 4 weeks and if at least two different non-steroidal anti-inflammatory drugs over three months, an intra-articularly injected steroid or sulfasalazine did not show the desired effect in patients with predominantly peripheral joint inflammation. Contraindications for the use of TNF-alpha inhibitors such as tuberculosis or other serious infections and moderate to severe heart failure must be excluded by the physician in advance. More recent studies exist on the effectiveness of thalidomide and pamidronate in the drug treatment of ankylosing spondylitis.
However, further study results must first be awaited for a sound assessment. In recent years it has been shown that therapy with TNF-alpha inhibitors (e.g. Humira®, Remicade®, Enbrel®) shows good efficacy in active ankylosing spondylitis. According to the recommendations of the ASAS (Assessments in Ankylosing Spondylitis) Group, an international group of researchers, mostly rheumatologists, therapy with TNF-alpha inhibitors should be started when a reliable diagnosis (confirmed by a rheumatologist) of Bekhterev’s disease is available, a BASDAI > 4 was present for at least 4 weeks and if at least two different non-steroidal anti-inflammatory drugs over three months, an intra-articularly injected steroid or sulfasalazine did not show the desired effect in patients with predominantly peripheral joint inflammation.
Contraindications for the use of TNF-alpha inhibitors such as tuberculosis or other serious infections and moderate to severe heart failure must be excluded by the physician in advance. More recent studies exist on the effectiveness of thalidomide and pamidronate in the drug treatment of ankylosing spondylitis. However, further study results must first be awaited for a sound assessment. More recent studies exist on the effectiveness of thalidomide and pamidronate in the drug treatment of ankylosing spondylitis. However, further study results must be awaited for a well-founded assessment.