Dr. Shiel Gives Perspectives Of Interest On Ankylosing Spondylitis and Psoriatic Arthritis

[Guest guest]

Dr. Shiel Gives Perspectives Of Interest On Ankylosing Spondylitis and

Psoriatic Arthritis From

2004 Annual Scientific Meeting Of The American College Of Rheumatology

http://www.medicinenet.com/script/main/art.asp?articlekey=40222

Ankylosing spondylitis is a form of chronic inflammation of the spine and

the sacroiliac joints. The sacroiliac joints are located in the low back

where the sacrum (the bone directly above the tailbone) meets the iliac

bones (bones on either side of the upper buttocks). Chronic inflammation in

these areas causes pain and stiffness in and around the spine. Over time,

chronic spinal inflammation (spondylitis) can lead to a complete cementing

together (fusion) of the vertebrae, a process called ankylosis. Ankylosis

can lead to total loss of mobility of the spine.

Psoriatic arthritis is a chronic disease that is characterized by

inflammation of the skin (psoriasis) and joints (arthritis ). Psoriasis is a

common skin condition that affects 2% of the Caucasian population in the

United States. It is often characterized by patchy, raised, red areas of

skin inflammation with scaling. Psoriasis often affects the tips of the

elbows and knees, the scalp, the navel, and around the genital areas or

anus. Approximately 10% of patients who have psoriasis also develop an

associated inflammation of their joints. Patients who have arthritis and

psoriasis are diagnosed as having psoriatic arthritis.

Ankylosing spondylitis and psoriatic arthritis are genetically and

clinically related diseases. I will, therefore, report on papers presented

at this meeting related to both of the diseases here.

Medications

Let me start by reporting on a large symposium that was given on ankylosing

spondylitis. During this marvelous talk, three world's experts in the field

of ankylosing spondylitis made several major points. There is an early,

under diagnosed stage of spondylitis that occurs before plain x-ray testing

can detect classic changes. Patients who are treated earlier respond better

to treatments.

Current disease-modifying drugs, such as methotrexate, sulfasalazine, and

Arava, which can be effective for joint inflammation of joints away from the

spine, are NOT effective for spinal inflammation.

If nonsteroidal antiinflammatory drugs (NSAIDs) are not effective in a

patient whose condition is dominated by spinal inflammation (and 50% do

respond), then biologic medications that inhibit tumor necrosis factor (TNF

inhibitors) are indicated.

All TNF inhibitors, including Remicade, Enbrel, and Humira are effective in

treating ankylosing spondylitis. The improvement that results for TNF

inhibition is sustained during years of treatment. If the TNF inhibitors are

discontinued, for whatever reason, relapse of disease occurs in virtually

all patients in a year. If TNF inhibitor is then resumed, it is typically

effective.

Dr. Shiel's Perspective: These are critically important concepts that are

now clear. These speakers went to great length to emphasize key issues in

the treatment of ankylosing spondylitis. The entire treatment methods have

now changed!

Enbrel and Remicade were reported effective in treating ankylosing

spondylitis as manifest by improvements in spinal MRI testing.

Dr. Shiel's Perspective: Enbrel has been approved for ankylosing spondylitis

treatment within the past year. Remicade will be soon.

Remicade (infliximab) was reported as safe and effective in psoriasis,

psoriatic arthritis, and ankylosing spondylitis.

Dr. Shiel's Perspective: Actually, rheumatologists have been using the drug

for these patients for some time because of other preliminary positive

reports in these conditions. It is good to have the support of this further

long-term follow-up research.

Enbrel for ankylosing spondylitis was reported to have sustained benefit and

safety for at least 24 months.

Dr. Shiel's Perspective: Enbrel appears to be a safe and effective treatment

for ankylosing spondylitis. The only reason it is only 2 years is because

that is how long the study has been running at this point.

Remicade's beneficial effect in treating ankylosing spondylitis was shown to

be sustained over a 2 year study period.

Dr. Shiel's Perspective: This is a type of study that demonstrates that not

only does Remicade work for spondylitis patients, but its benefits are

longterm.

Arava (leflunomide) was significantly effective in treating BOTH the skin

inflammation (psoriasis) and the arthritis in patients with psoriatic

arthritis.

Dr. Shiel's Perspective: Another fine addition to the ammunition chest

against psoriatic arthritis.

Affects Quality of Life

Researchers reported clear data that ankylosing spondylitis clearly affects

the quality of life of those who suffer from it.

Dr. Shiel's Perspective: This seems silly doesn't it? Would there be any

question that a disease that causes pain, stiffness, and limitation of

motion of the spine and joints not only could, but would affect the quality

of life of the individual affected? But the importance of the study is to

document the overall impact of this condition on function of those who

suffer from it.

Parameters that these researchers measured included role limitations due to

physical and emotional problems, body pain, social functioning, physical

functioning, general health perceptions, vitality, and mental health. This

study will prove important in justifying appropriate, aggressive management

of ankylosing spondylitis.