Pharmacotherapeutics of Ankylosing Spondylitis

1. ANKYLOSING SPONDYLITIS
Dr. V.S.SWATHI
ASSISTANT PROFESSOR

2. DEFINITION
• It is a form of arthritis which mainly affects spine and also affects other joints and
leads to severe chronic pain and discomfort

3. EPIDEMIOLOGY
• In the world, it affects nearly 10-20% of population of age below 16 years
• In India, it affects nearly 0.1-0.2% of population

4. TYPES
Local Ankylosing Spondylitis
• It affects any one of the joint
• Signs and symptoms occur at specific joint
Generalised Ankylosing Spondylitis
• It affects more than one joint
• Signs and symptoms occur at more than one specific joint

6. RISK FACTORS
• Age- It develops mostly in adolescence age or early adult hood
• Sex- It affects mostly men compared to women
• Persons having family history of Ankylosing Spondylitis
• Infections
• Smoking

7. ETIOLOGY
Abnormal expression of HLA-B 27 who
expose to risk factors

8. PATHOGENESIS

10. CLINICAL PRESENTATION
• Stiffness and pain in lower back, buttocks, hips after period of inactivity
• Back pain relieved by movement
• Difficulty in bending
• Straightening of normal curvature of spine
• Loss of appetite
• Weight loss
• Fatigue
• Sensitivity to light
• Difficulty in taking breath

12. COMPLICATIONS
• Uveitis
• Pulmonary fibrosis
• Cardiac arrhythmias
• Inflammatory Bowel Disease
• Amyloidosis
• Osteoporosis
• Cauda equina syndrome
• Spondylodiscitis

14. DIAGNOSIS
• Medical and family history
• Clinical presentation
• X-ray
• Computed tomography
• Magnetic resonance imaging
• Lab tests- CRP
Diagnostic criteria by assessment of Spondyloarthritis society (ASAS)
• Back pain ≥ to 3 months
• Age < 48 years
• One of the following
• Sacrolitis on imaging and ≥ 1 Spondylitis feature
• HLA-B27 and ≥ 2 Spondylitis features

15. NON PHARMACOLOGICAL TREATMENT
• Exercise
• Thermotherapy
• Electrotherapy
• Massage therapy
• Smoking cessation
• Patient counselling
• Surgery
 Vertebral osteotomy
 Fracture stabilization
 Joint replacement

16. TREATMENT ALGORITHM

17. DRUGS USED IN TREATMENT OF
ANKYLOSING SPONDYLITIS
Drug Category Mode of action Dose Adverse affects
Diclofenac NSAID Inhibit release of
Prostaglandin synthesis
50mg-BD-PO  GI disturbances
 Nephrotoxicity
 Edema
 Hepatitis
 Hypertension
Ibuprofen NSAID Inhibit release of
Prostaglandin synthesis
400mg-800mg-TID-PO  GI disturbances
 Nephrotoxicity
 Rashes
 Tinnitus
 Heart burn
Indomethacin NSAID Inhibit release of
Prostaglandin synthesis
20-40mg-TID-PO  Nephrotoxicity
 Hepatotoxicity
 Head ache
 Dizziness
 GI disturbances

18. Naproxen NSAIDs Inhibit release of
Prostaglandin
synthesis
500-1000mg-TID-
PO
 GI disturbances
 Edema
 Dizziness
 GI bleeding
 Hearing disturbances
Sulfasalazine DMARDs Inhibit leukotriene
synthesis
2-3gTID-PO  GI disturbances
 Rashes
 Fever
 Hepatotoxicity
 Anorexia
Methotrexate DMARDs Inhibit cellular
proliferation
7.5mg-Once in a
week-PO
 Seizures
 Erythema
 Hyperurecemia
 Glossitis
 Gingivitis
Prednisone Corticosteroids Inhibit cell
proliferation
10mg-OD-PO  Diabetes
 Hypertension
 Acne
 Poor wound healing
 Edema

19. Etanercept TNF alpha
inhibitor
Inhibit actions of
Tissue necrotic
factor
50mg-Once weekly-SC  Injection site reactions
 Infections
 Rashes
 Diarrhoea
 Pyrexia
Adalimumab TNF alpha
inhibitor
Inhibit actions of
Tissue necrotic
factor
40mg-Twice weekly-SC  Injection site reactions
 Infections
 Rashes
 Hyperlipidemia
 Hypertension
Secukinumab Interleukin
17 inhibitor
Inhibit actions of
IL-17
150mg-4 times weekly-SC  Infections
 Diarrhoea
 Urticaria
 Nasopharyngitis
 Oral herpes

20. RESOURCES
• https://www.ncbi.nlm.nih.gov/pmc/articles/pmc5741872/
• https://www.ncbi.nlm.nih.gov/pmc/articles/pmc5948268/
• https://www.ncbi.nlm.nih.gov/pmc/articles/pmc5741872/
• https://www.ncbi.nlm.nih.gov/pmc/articles/pmc5062857/
• https://www.ncbi.nlm.nih.gov/pmc/articles/pmc5536700/