Ankylosing spondylitis. Ankylosing spondylitis can impose significant physical limitations on the patient It affect their ability to work and reducing quality of life The onset being early (third decade) which increases the lifetime impact of the disease. Ankylosing spondylitis.
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Plain radiography 19%
J Rheumatol 1996;23-2107-15
-Hip arthritis is the strongest predictive factor being associated with 23-fold increase in the risk of severe arthritis
Arth Rheum 2005;52-1756-65
a breakthrough in treatment
-MRI follow up studies during treatment with etanrcept and infliximab have shown that acute inflammatory lesions in the spine and sacroiliac joints can be effectively suppressed , bony destruction and proliferation can be prevented
-277 AS patients who were enrolled in RCT
(257 continued open labeled Etanrcept.
AS patients continuing Etanrcept Rx had sustained response for almost 2 years
ASAS/EULAR recommendations for
Management of AS
22 expert participants:
Ten Key recommendations for the treatment of AS were developed and assessed using a combination of research based evidence and expert consensus.
- Current Manifestations of the disease
-Level of current symptoms, clinical findings and prognostic indicators
-General clinical status
-Wishes and expectation of the patient
All according to clinical presentations and ASAS core set
Frequency of monitoring should be decided on symptoms, severity, and drug treatment
-Patients associations and self help groups may be useful.
COX2 inhibitors could be used.
i-patients with active disease
ii-Patients with threatening functional disability
iii-patients who may have most benefits from Rx.
( US and EUROPE)
Active disease as indicated by both
on a Likert Scale (1=mild,2=moderate, 3=severe , 4=very severe)
should be present to warrant anti-TNF therapy
Improvement in BASDAI of=or > 2 in BASDIA score and physician global assessment of =or>1